The Global Fund / Karin Schermbrucker

The fight against malaria is one of the biggest public health successes of the 21st century. Global malaria death rates have dropped by 60% since 2000 – translating to millions of lives saved.

However, after many years of breathtaking progress, malaria is on the rise. We have the tools and treatments to prevent and cure malaria. This is a fight we can win, if we build and maintain unwavering commitment.

Malaria, caused by a parasite spread by certain types of mosquitoes, is among the deadliest diseases in human history. In 2018, there were 228 million cases and 405,000 deaths from malaria, with Africa accounting for 94% of all deaths. Pregnant women and children under age 5 are most at risk, because of their weaker immune systems. In 2018, children under 5 accounted for 67% of all malaria deaths worldwide.

Malaria is present in more than 80 countries, and these increasingly fall into one of two categories: those progressing toward elimination and those with a high burden of malaria that are experiencing setbacks in their responses.

This progress toward elimination underscores the fact that we have effective tools and strategies to halt malaria. The issue is investment. An estimated US$2.7 billion was invested in malaria control and elimination efforts globally in 2018 – a reduction from the US$3.2 billion invested in 2017, and well short of the US$5 billion estimated to be required globally to stay on track toward agreed milestones.

The Global Fund provides 56% of all international financing for malaria, and has invested more than US$13.5 billion in malaria control programs as of August 2020, using a comprehensive approach that combines:

  • Education about symptoms, prevention and treatment
  • Prevention through use of mosquito nets, spraying structures with insecticide and preventive treatment for children and pregnant women
  • Diagnosis, including supplying rapid diagnostic tests to community health workers
  • Treatment
In countries where the Global Fund invests
The Global Fund / Nana Kofi Acquah

Community awareness and action

Global Fund partners work with communities in malaria-endemic areas to provided information about what malaria is, how it is transmitted, what treatments are available, and, most importantly, what actions to take if malaria is suspected. In Ghana, for example, village elders teach their community “not to let the sun set twice” on a child with fever. In many countries, malaria prevention lessons are added to the school curriculum. In Senegal, community health workers are a critical force in the fight to eliminate malaria, particularly in hard-to-reach rural villages.

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Race to elimination

The malaria map is shrinking. The number of countries with fewer than 100 indigenous cases – a strong indicator that elimination is within reach – increased from 17 countries in 2010, to 25 countries in 2017 and 27 countries in 2018. The global malaria strategy and the Sustainable Development Goals call for malaria to be eliminated from at least 35 countries by 2030. An additional milestone has been set for the elimination of malaria in at least 10 countries by 2020.

In places on the cusp of elimination, the Global Fund supports approaches that focus control activities in targeted geographic areas or for specific, high-risk populations. Enhanced case finding is resource intensive – requiring identifying and following up with every case, including family or community members who also might have been exposed. But it is essential to interrupting malaria transmission and achieving elimination. The investment to eliminate malaria will pay dividends beyond one disease, by alleviating a significant burden on resource-constrained health systems.

Despite the progress and promise, we face serious challenges and the COVID-19 pandemic threatens to further derail hard-won gains:

  • With COVID-19 spreading across malaria endemic areas, there is a real and growing risk that malaria deaths will rise. Malaria control programs are postponed, critical prevention programs like distribution of mosquito nets are being delayed and parents refrain from taking sick children to health clinics out of fear of COVID-19 infection.
  • The Greater Mekong region is ground zero for the emergence of drug-resistant malaria.
  • Insecticide resistance is gaining ground across Africa, where the disease burden is highest.
  • Climate change, migration and political instability impact malaria transmission dynamics and service delivery.
  • Sub-standard and counterfeit drugs can still be found in many markets.
  • Attention and focus can dissipate as the malaria burden drops, or progress stalls.

The last point is significant. The history of malaria elimination efforts shows that the disease will exploit any let up in efforts to control it. Even impressive gains can be wiped out by a lapse during a single transmission season, and failure to maintain effective control can result in resurgence of the disease. A “rebound” can make the situation even worse than before control efforts, because people lose the partial immunity acquired through repeated exposure to malaria.

This is why we must step up efforts where progress has stalled and commit to the sustained investment required to achieve the targets of the global malaria strategy.

“Today we are talking about self-driving cars and drones that deliver our groceries and yet this ancient disease, this disease that we know can be conquered because it has been conquered in different parts of the world, is still killing so many people. We have the science and the knowledge to beat malaria. It is doable. May we also have the will to do it.”
Chimamanda Ngozi Adichie, Author

Beating malaria, mile by mile

Access to medicines is essential, and any delay can mean the difference between life and death. This is especially true for malaria. For a child with fever, every minute matters.