On 20 November 2018, the World Health Organization said the global fight against malaria had lost momentum, warning that the decline in cases and deaths was no longer moving fast enough to meet international targets.
The warning came with the release of the World malaria report 2018, which showed that malaria cases had levelled off for a second straight year. WHO estimated 219 million cases in 2017, up from 217 million in 2016. That followed a longer period of decline, when global cases fell from 239 million in 2010 to 214 million in 2015.
To respond to the slowdown, WHO and its partners launched a new country-led initiative aimed at scaling up prevention, treatment and investment in the places carrying the heaviest burden. Dr Tedros Adhanom Ghebreyesus, WHO Director-General, said: “Nobody should die from malaria. But the world faces a new reality: as progress stagnates, we are at risk of squandering years of toil, investment and success in reducing the number of people suffering from the disease,” says Dr Tedros Adhanom Ghebreyesus, WHO Director-General. “We recognise we have to do something different – now. So today we are launching a country-focused and -led plan to take comprehensive action against malaria by making our work more effective where it counts most – at local level.”
The report said the burden remained heavily concentrated. In 2017, about 70% of all malaria cases and deaths were recorded in 11 countries: Burkina Faso, Cameroon, Democratic Republic of the Congo, Ghana, Mali, Mozambique, Niger, Nigeria, Uganda, United Republic of Tanzania and India. Those countries accounted for 151 million cases and 274,000 deaths. WHO also said the 10 African countries in that group recorded 3.5 million more cases in 2017 than in the previous year, while India made progress in reducing its disease burden.
Coverage of basic prevention tools remained uneven. WHO said insecticide-treated bed nets had expanded slightly in sub-Saharan Africa, but major gaps persisted. An estimated half of people at risk in Africa did not sleep under a treated net in 2017. Indoor residual spraying also reached fewer homes than before, and access to preventive treatment for pregnant women and children remained too low.
The new response, called High burden to high impact, was built around four pillars: stronger political attention to cut malaria deaths, better use of information, improved global guidance and strategies, and a coordinated country response. WHO said the plan followed Dr Tedros’s call at the World Health Assembly in May 2018 for a more aggressive approach to restart progress.
Dr Kesete Admasu, chief executive of the RBM Partnership to End Malaria, said the latest report showed that “business as usual is no longer an option.” He said the country-led response would help accelerate control efforts in the highest-burden states and was needed to get the fight back on track.
WHO also said the targets in its Global technical strategy for malaria 2016–2030 were off course. The strategy seeks at least a 40% reduction in malaria case incidence and death rates by 2020, but the agency said current trends were not enough to meet that goal.
Even so, the report pointed to some gains. The number of countries approaching elimination rose to 46 in 2017, up from 37 in 2010. China and El Salvador reported no local malaria transmission in 2017, which WHO said showed that sustained national control efforts can work.
In 2018, Paraguay became malaria-free after WHO certification, the first country in the Americas to receive that status in 45 years. Algeria, Argentina and Uzbekistan also sought official malaria-free certification from WHO.
Several countries reported sharp drops in cases. India, which carries about 4% of the global malaria burden, recorded a 24% fall in cases in 2017 compared with 2016. Rwanda reported 436,000 fewer cases over the same period, while Ethiopia and Pakistan each reported declines of more than 240,000.
Dr Matshidiso Moeti, WHO Regional Director for Africa, said countries that make malaria a priority see results. “When countries prioritize action on malaria, we see the results in lives saved and cases reduced,” she said. “WHO and global malaria control partners will continue striving to help governments, especially those with the highest burden, scale up the response to malaria.”
Funding for malaria control also appeared to be flattening. WHO said US$3.1 billion was available for control and elimination programmes in 2017, including US$900 million, or 28%, from governments of malaria-endemic countries. The United States remained the largest single international donor, contributing US$1.2 billion, or 39%, in 2017.
WHO said annual malaria investment would need to rise to at least US$6.6 billion by 2020 to stay on course for the 2030 targets. That would be more than double the amount available at the time of the report.
