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Funding crisis could reverse progress on malaria treatment, experts warn
Children rest in western Cambodia, where the WHO's distribution of bednets has helped tackle drug-resistant malaria. Photograph: Paula Bronstein/Getty Images
Hard-won gains in malaria control may be reversed unless more funding is forthcoming, experts warned as the World Health Organisation (WHO) published its annual report on progress against the disease.
Deaths from malaria, which predominantly kills babies and children under five, are down by 26% over the past decade and 33% in the badly-affected African region, but the world is not on target for its declared goal of reducing them to near-zero by 2015.
Last year there were 655,000 deaths, a 5% drop compared with 2009. "While this represents significant progress, the mortality figures are still disconcertingly high for a disease that is entirely preventable and treatable," said the report. It added that estimated malaria deaths in the African region have already been lowered following a general revision of all child mortality rates by the UN.
Major efforts over the past few years have succeeded in getting insecticide-treated bednets and new, effective anti-malarial drugs to large numbers of families. The report noted an increase in the number of bednets delivered to endemic countries in sub-Saharan Africa, from 88.5m in 2009 to 145m in 2010. Half of all households in the region are now believed to have at least one net.
Such progress has raised hopes for an end to malaria deaths, but funding has been insufficient and is now in jeopardy. Donor governments' reluctance to fill the coffers of the Global Fund to fight Aids, TB and Malaria – which has resulted in the cancellation of the organisation's next grant-awarding round – is a serious setback.
WHO director general Margaret Chan said in a foreword to the report: "Worrisome signs suggest that progress might slow, especially in view of projected decreases in the funding needed to finance universal access to life-saving malaria prevention and control measures. International funding for malaria appears to have peaked at $2bn, well short of the $5 to $6bn that are required. While new commitments, such as those from the United Kingdom, have been indispensable for maintaining our current gains, they are not sufficient to achieve the goals that the global malaria community has set."
Domestic spending in endemic countries often seems inadequate, she added.
Malaria control is critical for reaching the health-related millennium development goals. The next few years will be critical. "We know from experience how fragile our gains are," said Chan. Over the past few years, several hundred million long-lasting, insecticide-impregnated nets have been distributed, but will need replacing in the next few years.
"It is our responsibility to ensure that these and other life-saving commodities reach all who need them – before our hard-won progress slips away," said Chan.
There are also major worries over resistance, affecting both artemisinin drugs – which have transformed malaria treatment – and the insecticide sprays used inside houses. Resistance to the drugs has now been reported in Cambodia, Myanmar, Thailand and Vietnam. Insecticide resistance has been reported in 27 countries in Africa, and 41 worldwide. "Unless properly managed, such resistance potentially threatens future progress in malaria control," said Chan.
Even when control measures have brought case numbers down, pressure must be maintained. Malaria numbers rose in Rwanda and in Sao Tome and Principe in 2009 following reductions. Those areas have now brought cases back down, but Zambia, which also experienced a rise in 2009, has not yet reversed the trend.
Important progress has been made in the roll-out of rapid diagnostic testing, which enables healthcare staff to be sure a child's fever is malaria and not caused by some other illness. Using malaria treatment properly prevents resistance and saves money.
But funding looks set to drop in 2012 and 2013, triggered primarily by the crisis at the Global Fund. "This decrease will considerably alter the malaria control landscape and threaten the sustainability of the multipronged approach to fighting the disease, which relies heavily on investments in bednets, indoor residual spraying, diagnostic testing, treatment, research and innovation," says the WHO.
Dr Robert Newman, director of the WHO's global malaria programme, said: "We need a fully-resourced Global Fund, new donors and endemic countries to join forces and address the vast challenges that lie ahead … We need to act with urgency and resolve to ensure that no one dies from malaria for lack of a $5 bed net, $1 anti-malarial drug [or] a 50 cent diagnostic test."