Gains against malaria large but fragile, says new report

Major increases in international funding for malaria are responsible for the scale-up of highly successful interventions over the past several years, especially insecticide-treated bed nets, says a new report published last week by the World Health Organization. Still, as of 2008, half of the world’s population was at risk of infection, and an estimated 243 million cases led to an estimated 863,000 deaths.

Painting an overall upbeat picture of global progress against the world’s third biggest infectious killer, the World Malaria Report 2009 describes the global distribution of malaria cases and deaths, and details the dramatic declines in the global malaria burden, including reductions in the number of malaria cases of over 50% (from 2000 figures) in more than a third of affected countries.

According to WHO Director General Dr Margaret Chan, the report’s findings are cause for “cautious optimism”. However, she adds, there are serious threats to those gains, notably the emergence of artemisinin resistance in South-East Asia. Chan adds that WHO and partner organizations are currently working to contain resistance by addressing three priority areas: 1) halting the manufacture, marketing and use of monotherapies; 2) providing universal access to diagnostic testing for malaria; and 3) strengthening of routine surveillance for malaria and regular monitoring of antimalarial drug efficacy. “We need to act quickly to mitigate the threat,” she says.

Though the US$1.7 billion invested in 2009 is more than double that of 2006, funding for malaria remains well short of the $5bn that WHO estimates is needed annually to ensure high coverage and maximum impact worldwide. Moreover, some experts worry that international funding may have already peaked.

Dr Matthew Lynch, director of the Global Program on Malaria at Johns Hopkins Bloomberg School of Public Health, told the New York Times that funding for malaria is at an all-time high. “Which is good news. But it’s far below what we need.” More worrying, he says, is that, “the window of donor largesse for malaria may be beginning to close”.

Others, like Richard Tren, director of the non-profit advocacy group Africa Fighting Malaria, argue that in spite of major gains in some areas, the report does not reflect the reality on the ground and, in fact, may overstate the progress made to date. This, he says, is due to the fact that “the data are based on a few countries” and largely on modelling. Quoted in the Canadian Medical Association Journal, Tren cautions that declaring success too early could result in malaria coming back. “This is a long tough road and we are by no means beating malaria,” he says. “There are an awful lot of policy problems that need to be dealt with.”

Still, encouraging trends are clearly afoot, among them the substantial indirect benefits attributed to recent malaria control efforts. According to the report, the impacts of interventions observed in health facilities are being mirrored by population level declines in all-cause child mortality.

Indeed, as Dr Robert Newman, director of the WHO’s Global Malaria Program and one of the co-authors of the report, told attendees at the Multilateral Initiative on Malaria (MIM) meeting last November, “despite targeting a single disease, malaria control is not vertical.” More than reducing malaria burden, it can build health systems, he said. “And there is no better intervention for maternal and child health.”

from Paul Chinnock, TropIKA.net