Malaria

The Challenge

For millions of people around the world, a simple mosquito bite can have deadly consequences. Malaria is a tropical disease caused by parasites and transmitted through the bite of infected Anopheles mosquitoes. Every year, malaria kills approximately 655,000 people—mostly children under the age of five. About 91% of all malaria deaths occur in sub-Saharan Africa, where a child dies of malaria every minute of the day. One half of the world's population lives in areas at risk of malaria, and approximately 216 million people become infected each year. While vector control measures, such as indoor residual spraying (IRS) with insecticides and insecticide-treated bed nets (ITNs), have successfully reduced the incidence of malaria by 17% since 2000, mosquitoes developing resistance to some insecticides poses a threat as these control measures continue to be scaled up. The emerging drug resistance to artemisinins (the base of the most effective antimalarial drugs), is also very concerning; the resistance was first identified among malaria cases in four countries in Southeast Asia. Artemisinin-based drugs are highly-effective and are used as the first-line treatment for malaria. However, in places where the parasites are gaining resistance to artemisinin-based drugs, efforts must be made to use other drug regimens in combination.

Not only does malaria cause significant morbidity and mortality globally, it also decreases productivity and increases the risk of poverty for the communities and countries affected. For example, infection rates are highest during the rainy season, often resulting in decreased agricultural production. In total, malaria costs sub-Saharan Africa an estimated $12 billion in economic productivity, foreign investment, tourism and trade every year, which economists believe may slow economic growth by up to 1.3% per year. Malaria also presents a serious strain on public health systems—In sub-Saharan African countries with high-rates of transmission, malaria accounts for as much as 40% of public health expenditure.

The Opportunity

Malaria is an entirely preventable and treatable disease with cost-effective interventions available. For just $10, a bed net specially treated with insecticide can be purchased and distributed, and its recipients— primarily mothers and children—can be educated on how to use it properly. Coupling bed nets with other simple actions, such as spraying homes with insecticides, could prevent millions of people from getting sick. For those who do become infected with malaria, ACTs (artemisinin-based combination therapies) costing roughly $6-10 per treatment, are highly effective and can dramatically reduce the number of deaths from malaria.

In the past few years there has been a dramatic increase in the resources available to fight malaria, and these increases have shown dramatic positive health impacts. Initiatives such as the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM), the President’s Malaria Initiative (PMI) and the World Bank’s Malaria Booster Program have significantly expanded coverage of bed nets and access to treatment. The GFATM alone has distributed 310 million bed nets and 260 million ACT treatments, while PMI has distributed nearly 45 million bed nets and 95 million treatments. This support is producing results; annual malaria deaths have fallen from nearly a million in 2002 to fewer than 700,000 today, and estimates suggest that more than 1.2 million lives were saved in Africa alone thanks to malaria control programs. Eight African countries as well as Zanzibar, and most endemic countries globally, have successfully cut malaria cases or deaths by 75% or more. Overall, malaria mortality rates have fallen by 26% globally and 33% in sub-Saharan Africa since 2000.

Sustained funding for malaria control and treatment programs is still needed to build on the gains achieved in the last few years. To coordinate and catalyse efforts, the Global Action Plan on Malaria (GMAP) was created by the Roll Back Malaria Partnership and announced at the September 2008 United Nations High-Level Event on the Millennium Development Goals. Due to the successes achieved since 2008, the Partnership has established three new primary objectives for the GMAP by 2015:

1. reduce global malaria deaths to near zero
2. reduce global malaria cases by 75% (from 2000 levels)
3. eliminate malaria in 10 new countries (since 2008) and in the WHO European Region

Moving forward, a renewed commitment to malaria control is necessary to preserve gains attained. Incorporating a range of new tools and promising malaria vaccines (currently in development) will be critical to counter threats including growing insecticide resistance and waning external resources for public health. With a coordinated global effort, we can continue to make progress and ensure the virtual elimination of malaria deaths by 2015.