World Malaria Report highlights two decades of progress while calling for increased commitment as gains plateau
According to this special edition of the World Malaria Report, the past two decades have seen unprecedented progress towards defeating one of the world’s most persistent diseases. Since 2000, an estimated 1.5 billion cases and 7.6 million deaths have been averted globally1 thanks to country leadership and global solidarity.
Key moments paved the way for progress
The Report highlights moments in time, beginning in the 1990s, that have paved the scientific and political foundation for a period of success in reducing the malaria burden. Notably, these include increased investments in research and innovation leading to the development of insecticide-treated nets (ITNs), rapid diagnostic tests (RDTs), and artemisinin-based combination therapies (ACTs), which remain crucial interventions today.
The scale-up of ACTs represented a breakthrough in the global fight against malaria at the start of the 21st century. These medicines are now the first-line treatment for acute, uncomplicated malaria in approximately 80 countries. MMV and partners have brought forward six high quality ACTs, including the first paediatric formulation approved by a stringent regulatory authority. Four hundred million treatments have been distributed in more than 50 countries since the launch of this child-friendly medicine, saving an estimated 840,000 lives.
The levelling-off of progress
Despite two decades of progress, increased commitment is imperative if we are to meet the WHO’s 2030 goal of reducing malaria by 90%. WHO projects that interim targets set for 2020 for the reduction of case incidence and mortality will be missed by 37% and 22%, respectively.2
In 2018, the WHO warned that the 10 highest burden African countries had reported 3.5 million more malaria cases in 2017 than the previous year. In 2019 this number has stagnated, at one million more than in 2018. Malaria also continues to take a heavy toll on children and pregnant women. In 2019, an estimated 11.6 million pregnant women across Africa had been infected with malaria, resulting in around 822,000 children born with a low birth weight.3
COVID-19 threatens progress further
In addition, the COVID-19 pandemic has increased pressure on health systems in resource-limited settings. According to the Report, disruptions in malaria diagnosis and treatment have been difficult to quantify, ranging from 5% to 50%. What we do know is that the impact has been much less than what we feared it could be, thanks to concerted efforts by countries and partners who have adapted the way they deliver interventions.4 As countries experience disruptions we must continue to ensure that medicines for malaria are delivered to those who need them most, as the WHO’s analysis suggests that even a moderate decrease in access to treatment could lead to substantial loss of life.
Global partnerships and increased funding key to past and future success
To tackle these and other challenges, the international community must approach the fight against malaria with a reinvigorated urgency. Increased funding is needed to develop new tools and scale up access to existing ones.
MMV has worked diligently with partners throughout the COVID-19 pandemic to track this year’s seasonal malaria chemoprevention (SMC) campaign across several countries and to ensure the availability of sulfadoxine-pyrimethamine plus amodiaquine (SP+AQ; the two medicines used for SMC). MMV is also working closely with the WHO and partners to consider the desired attributes of the next generation of medicines for malaria chemoprevention.
In addition, MMV recognizes that the medical needs of young children and pregnant women have not been met and is working to fill the gap. Three child-friendly formulations, including the first potential ACT for neonates and infants weighing under 5kg, are progressing through the pipeline. To protect pregnant women, the WHO recommends intermittent preventive treatment in pregnancy (IPTp) with sulfadoxine-pyrimethamine (SP), starting as early as possible in the second trimester. In 2019, however, just over one third (34%) of pregnant women in 33 African countries received the recommended dosage. MMV is working with partners to expand access to this intervention.
“Partnerships have propelled the unprecedented progress against malaria achieved by the international community thus far,” said Dr David Reddy. “Furthermore, while COVID-19 has been a major set-back, it has also served to highlight that success is possible through urgency, partnership, political commitment and requisite resource allocation. Moving forward there are three things we must achieve to get back on track with malaria control and eradication. First, we must be data-driven to ensure we deploy resources and tailor our approach more contextually, to maximize impact. Second, we must enhance the effectiveness and efficiency with which programmes are implemented. Finally, we must continue to improve the tools that will be used for malaria control and elimination. MMV will continue to work in partnership to address the unmet needs highlighted in the World Malaria Report 2020 and the goal of a malaria-free world.”
1. WHO, World Maria Report 2020.