Turning the rising malaria tide

November 19, 2018 by Dr. Laurence Slutsker

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The 2018 World Malaria Report confirms that malaria cases are up, particularly in high-burden countries. The Zero Malaria Starts with Me campaign is part of a renewed effort to eliminate malaria. Photo: Zero Malaria Starts with Me

Malaria is on the rise. This should concern us all.

Since the turn of the century, a dedicated global effort to fight malaria led to a 60 percent decrease in cases between 2000 and 2015. However, the 2018 World Malaria Report confirms that following more than a decade of progress against the deadly parasite, this dramatic decline in malaria cases has plateaued and in some areas reversed.

A bright spot in the report is that more countries than ever are positioned to eliminate malaria—in fact, 11 countries are on track to eliminate by the end of 2020—but cases are on the rise in the highest-burden countries. Seventy percent of the world’s malaria burden is concentrated in the 11 highest-burden countries, where we’re seeing 151 million cases and more than a quarter of a million deaths.

With malaria, you cannot back off and focus elsewhere. We must continue malaria control activities on all fronts. We have the opportunity to make gains with our current tools and resources, through more tailored and focused delivery and by doing a deep dive into these high-burden areas. We will also continue to need commitment to invest in developing new tools and finding the resources to take us to that next level.

Shifting focus to high-burden countries

In 2016, the global malaria community set targets in the WHO Global Technical Strategy for Malaria 2016-2030 (WHO GTS). The way it stands, we’re off track to achieve two key targets: reducing malaria deaths and disease by at least 40 percent by 2020.

We must challenge the status quo. The “High burden to high impact” response, launched alongside the 2018 World Malaria Report aims to turn the tide by building on landmark commitments from the global community in 2018. PATH, alongside the more than 500 members of the RBM Partnership to End Malaria, stands with partner countries and the World Health Organization (WHO) to support this country-led plan to drive down cases and move us toward a world free from malaria.

“ With malaria, you cannot back off and focus elsewhere. We must continue malaria control activities on all fronts. ”

Visualizing data is vital to reaching zero cases

To continue progress, we must move quickly. The ability of national programs to understand the malaria situation in real time is critical to finding, tracking, and treating new cases as they arise. In Zambia, PATH is supporting the National Malaria Elimination Programme in bringing together quality data to make decisions in a timely way to help decide what to do, where to do it, and how to do it; in other words, information for action. The project is called Visualize No Malaria and it represents a strong partnership between the Zambian Government, its Ministry of Health, PATH, and private-sector partners who work in the data management, collection, and visualization space.

The key point with Visualize No Malaria is that the data visualization tools are designed by the front-line workers who are using the tools. This approach is one of the most exciting near term opportunities for malaria because it is something that we can do now, with the possibility of rapid improvement.

“ More countries than ever are positioned to eliminate malaria—in fact, 11 countries are on track to eliminate by the end of 2020. ”

New tools opening new possibilities

New tools are expanding exciting new horizons in the malaria elimination effort. We are in a very different world from when I first joined the malaria field more than 30 years ago, when we had basically no prevention tools and one failing malaria drug, chloroquine. Now we have a suite of tools, including new products in diagnosis, treatment, and vector control at our disposal.

One tool in particular, the RTS,S vaccine, provides a potentially promising option. Since the turn of the century, PATH has partnered with pharmaceutical company GSK, countries, and others to develop this vaccine. Now we are moving into an important phase with the pilot introduction, coordinated by WHO and in partnership with country programs, GSK, PATH, and many others institutions. PATH is providing technical support, as well as evaluating how vaccine introduction might affect health utilization issues such as uptake or use of other malaria interventions in the pilot communities. We used to say we were waiting for the vaccine, and we actually now have a first generation one to evaluate.

Zero malaria starts with us

In the absence of fresh ideas and renewed commitment to expanding and scaling up available resources, we face a reversal of the gains we’ve made against malaria over the last decade. But despite global resurgence, several model countries have demonstrated a decline in cases, including Ethiopia, India, and Rwanda.

In Ethiopia, we’re celebrating the launch of Zero Malaria Starts with Me, a malaria advocacy campaign co-founded by PATH in Senegal and launched by the RBM Partnership to End Malaria and the African Union Commission. The campaign, endorsed by the leaders of the African Union, aims to spread awareness to and engage citizens at all levels of society and equips countries with a toolkit that supports the many facets of malaria campaign planning. Low- and high-burden countries alike must continue to focus on moving toward elimination, particularly those on track to eliminate in the next few years.

“ What we do in the coming months and years will determine whether or not the malaria parasite lives to see the second half of the century. ”

For half the world’s population, a mosquito bite could mean death—this inequality is unacceptable. Roadblocks to health are everywhere, but access to the right tools and resources to fight a preventable, treatable disease shouldn’t be one of them. With more than 400,000 people projected to die from malaria in the next year, what we do in the coming months and years will determine whether or not the malaria parasite lives to see the second half of the century.

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