A year after the World Health Assembly resolved to eliminate malaria from at least 35 countries by 2030, the World Health Organisation (WHO) is releasing a World Malaria Day report that shows this goal, although ambitious, is achievable. In 2015, all countries in the WHO European Region reported, for the first time, zero indigenous cases of malaria, down from 90,000 cases in 1995. Outside this region, 8 countries reported zero cases of the disease in 2014: Argentina, Costa Rica, Iraq, Morocco, Oman, Paraguay, Sri Lanka and United Arab Emirates.
Another 8 countries each tallied fewer than 100 indigenous malaria cases in 2014. And a further 12 countries reported between 100 and 1000 indigenous malaria cases in 2014.
The “Global Technical Strategy for Malaria 2016-2030“, approved by the World Health Assembly in 2015, calls for the elimination of local transmission of malaria in at least 10 countries by 2020. WHO estimates that 21 countries are in a position to achieve this goal, including 6 countries in the WHO African Region, where the burden of the disease is heaviest.
“Our report shines a spotlight on countries that are well on their way to eliminating malaria,” said Dr Pedro Alonso, director of the WHO Global Malaria Programme. “WHO commends these countries while also highlighting the urgent need for greater investment in settings with high rates of malaria transmission, particularly in Africa. Saving lives must be our first priority.”
Since the year 2000, malaria mortality rates have declined by 60% globally. In the WHO African Region, malaria mortality rates fell by 66% among all age groups and by 71% among children under 5 years. The advances came through the use of core malaria control tools that have been widely deployed over the last decade: insecticide-treated bed-nets, indoor residual spraying, rapid diagnostic testing and artemisinin-based combination therapies.
But reaching the next level – elimination – will not be easy. Nearly half of the world’s population, 3.2bn people, remain at risk of malaria. Last year alone, 214m new cases of the disease were reported in 95 countries and more than 400,000 people died of malaria.
The efficacy of the tools that secured the gains against malaria in the early years of this century is now threatened. Mosquito resistance to insecticides used in nets and indoor residual spraying is growing. So too is parasite resistance to a component of one of the most powerful anti-malarial medicines. Further progress against malaria will likely require new tools that do not exist today, and the further refining of new technologies.
Last year, for the first time, the European Medicines Agency issued a positive scientific opinion on a malaria vaccine. In January 2016, WHO recommended large-scale pilot projects of the vaccine in several African countries, which could pave the way for wider deployment in the years ahead. “New technologies must go hand in hand with strong political and financial commitment,” Alonso added.
Vigorous leadership by the governments of affected countries is key – governments must strengthen surveillance of cases to identify gaps in coverage and be prepared to take action based on the information received. As countries approach elimination, the ability to detect every infection becomes increasingly important.
Reaching the goals of the WHO strategy will require a steep increase in global and domestic funding – from $2.5bn today to an estimated $8.7bn annually by 2030. Through robust financing and political will, affected countries can speed progress towards malaria elimination and contribute to the broader development agenda as laid out in the statement.