After years of encouraging decline globally, reductions in malaria cases have recently stalled, according to the new World Malaria Report 2018. Launched this week, the World Health Organization (WHO) and partners are now joining a new country-led response to scale up prevention and treatment. However, it is likely to take more than double the current amount of available investment worldwide to combat this deadly disease and meet 2030 targets.

 

After years of unprecedented success, with the number of people contracting malaria globally having fallen steadily (from 239 million in 2010 to 214 million in 2015), 2018 marks the second consecutive year in which the annual report produced by WHO actually reveals a plateauing of the figures. Worryingly, in 2017 there were an estimated 219 million cases of malaria, compared to 217 million the year before.

 

“Nobody should die from malaria. But the world faces a new reality: as progress stagnates, we are at risk of squandering years of toil, investment and success in reducing the number of people suffering from the disease,” said Dr Tedros Adhanom Ghebreyesus, WHO’s Director-General. “We recognise we have to do something different – now.” The organisation’s response this week has been to launch a country-focused and -led plan that will “take comprehensive action against malaria by making [WHO’s] work more effective where it counts most – at local level”, he advised.

 

Where malaria is hitting hardest

 

In 2017, approximately 70 per cent of all malaria cases (151 million) and deaths (274 000) were concentrated in 11 countries: 10 in Africa (Burkina Faso, Cameroon, Democratic Republic of the Congo, Ghana, Mali, Mozambique, Niger, Nigeria, Uganda and Tanzania) and India. There were 3.5 million more malaria cases reported in those 10 African countries in 2017 compared to the previous year, while India actually showed significant progress in reducing its disease burden.

 

Despite marginal increases in recent years in the distribution and use of insecticide-treated bed nets in sub-Saharan Africa – the primary tool for preventing malaria – the new report highlights major coverage gaps. In 2017, an estimated half of at-risk people in Africa did not sleep under a treated net. Also, fewer homes are being protected by indoor residual spraying than before, and access to preventive therapies that protect pregnant women and children from malaria remains too low.

 

High impact response needed

 

In line with WHO’s strategic vision to scale up activities to protect people’s health, the new country-driven ‘High burden to high impact’ response plan has been launched to support nations with the most malaria cases and deaths. The response follows a call made by Dr Tedros at the World Health Assembly in May 2018 for an aggressive new approach to jump-start progress against malaria. This approach is based on four pillars: First, galvanising national and global political attention to reduce malaria deaths; Second, driving impact through the strategic use of information; Third, establishing best global guidance, policies and strategies suitable for all malaria endemic countries; and fourth, implementing a coordinated country response.

 

Catalysed by WHO and the RBM Partnership to End Malaria, ‘High burden to high impact’ builds on the principle that no one should die from a disease that can be easily prevented and diagnosed, and that is entirely curable with available treatments.

 

“There is no standing still with malaria. The latest World malaria report shows that further progress is not inevitable and that business as usual is no longer an option,” said Dr Kesete Admasu, CEO of the RBM Partnership. “The new country-led response will jumpstart aggressive new malaria control efforts in the highest burden countries and will be crucial to get back on track with fighting one of the most pressing health challenges we face.”

 

Targets set by the WHO Global technical strategy for malaria 2016–2030 to reduce malaria case incidence and death rates by at least 40 per cent by 2020 are not on track to being met.

 

Pockets of progress

 

Despite the overall stall in combating malaria, the report does highlight some positive progress. The number of countries nearing elimination continues to grow (46 in 2017 compared to 37 in 2010). Meanwhile in China and El Salvador, where malaria had long been endemic, no local transmission of malaria was reported in 2017 – proof that intensive, country-led control efforts can succeed in reducing the risk that people face from the disease.

  

In 2018, WHO certified Paraguay as malaria-free – the first country in the Americas to receive this status in 45 years. Three other countries – Algeria, Argentina and Uzbekistan – have requested official malaria-free certification from WHO.

 

India – a country that represents four per cent of the global malaria burden – recorded a 24-per-cent reduction in cases in 2017 compared to 2016. Also in Rwanda, 436 000 fewer cases were recorded in 2017 compared to 2016. Ethiopia and Pakistan both reported marked decreases of more than 

240,000 in the same period.

 

“When countries prioritise action on malaria, we see the results in lives saved and cases reduced,” says Dr Matshidiso Moeti, WHO Regional Director for Africa. “WHO and global malaria control partners will continue striving to help governments – especially those with the highest burden – to scale up the response to malaria.”

 

Domestic financing is key

 

As reductions in malaria cases and deaths slow, funding for the global response has also shown a levelling off, with US$3.1bn made available for control and elimination programmes in 2017 including US$900 million (28 per cent) from governments of malaria endemic countries. The US remains the largest single international donor, contributing US$1.2bn (39 per cent) in 2017.

 

To meet the 2030 targets of the global malaria strategy, malaria investments should reach at least US$6.6bn annually by 2020 – more than double the amount available today.