Amid stalled global progress on reducing malaria cases and deaths since 2015, the World Health Organization has called for renewed and accelerated research and development (R&D) of new tools for malaria prevention and treatment, improved use of data, and strengthened international, regional, and sub-national cooperation.

WHO’s Strategic Advisory Group on Malaria Eradication (SAGme) said in the executive summary of their 23 August report that while much progress was made between 2000 and 2015, “the world is not on track to meet the 2020 milestones,” which could undermine the goal of reducing malaria cases and deaths by 90 percent by 2030.

“To achieve a malaria-free world we must reinvigorate the drive to find the transformative strategies and tools that can be tailored to the local situation. Business as usual is not only slowing progress, but it is sending us backwards,” said Dr Marcel Tanner, Chair of SAGme, according to a WHO press release.

“Freeing the world of malaria would be one of the greatest achievements in public health,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General, in the release. “With new tools and approaches we can make this vision a reality.”

Research and development of new tools for prevention and treatment are among the top priorities outlined by the SAGme report. Current insecticide-treated mosquito nets and indoor residual spraying are referred to as “old and imperfect,” protecting populations at home but leaving them vulnerable outdoors. Expanded vaccine research and development will also be critical, it says.

Today, however, “less than 1% of funding for health R&D investment goes to developing tools to tackle malaria,” the release states.

“We need the commitment of political leaders to provide adequate funding from international and domestic sources to ensure access to affordable health care,” said Dr. Pedro Alonso, Director of the Global Malaria Programme at WHO, in a 22 August press briefing.

“The economic and societal benefits of malaria eradication would be massive,” he said.

WHO estimates the cost of scaling up malaria interventions through 2030 at US $34 billion, which would be comprised of a combination of international and domestic funding from affected countries. Such a scale-up, it says, would prevent an additional 2 billion malaria cases and 4 million deaths by 2030.

Through this investment of US $34 billion, the Strategic Advisory Group forecasts the economic gain for the highest burden countries to be estimated at US$ 283 billion in total GDP through 2030.

Challenges to Eradication

Outlined by the WHO in its 2018 World Malaria Report and reiterated by Friday’s SAGme report, the fight against malaria has stalled after fifteen years of progress between 2000 and 2015. With progress towards meeting the 2020 Global Technical Strategy for Malaria 2016–2030 (GTS) milestones “off track,” the WHO and the Strategic Advisory Group on Malaria Eradication call for action to remove barriers that may pose a risk to achieving a 90 percent malaria case and mortality reduction by 2030.

Availability of affordable, quality health services is recognised as a major challenge to malaria eradication. “To eliminate malaria and prevent the re-establishment of transmission, a country will require strong political commitment and investment in universal health coverage, with a well-functioning primary health care system at its base,” stated the executive summary.

“Health system quality is strongly correlated with malaria progress across the spectrum of malaria endemicity,” it said, and a strong governance framework will be needed “to bring together health systems infrastructure, service delivery, civil society and communities.”

A second key challenge is regarding data analysis and surveillance and response. “We need to further improve the quality and the use of data to detect changes in malaria transmission and adequately respond,” said Dr Alonso during Thursday’s press briefing.

Improved data will serve as “an active tool that helps the decision makers [on] how to proceed” SAGme Chair Dr Marcel Tanner said in the briefing. In addition to addressing current needs, improving data and surveillance will allow for rapid and effective action in the event of changes in malaria transmission resulting from global trends such as urbanization, climate change and population growth.

“Today, we can say it is feasible to reach eradication but we cannot lay an exact date [for it],” Dr Tanner said in the briefing. However, the report notes that there still remains the possibility of reaching a 90 percent malaria reduction rate by 2030, provided new tools and approaches are implemented.

Image Credits: WHO/Griff Tapper.