World Malaria Day: Can We “End Malaria for Good”?

Kaushik Bharati, PhD

World Malaria Day is celebrated every year across the globe on 25^th April. This day provides a forum for all malaria-endemic countries to discuss their achievements, shortcomings and future goals with regard to malaria control. Ironically, for over half of the world’s population, every day is “Malaria Day”, which underscores the ongoing daily struggle to cope with this dreaded disease. This year’s theme is “End malaria for good”, which envisions a malaria-free world, as set out in the “Global Technical Strategy for Malaria 2016-2030”, and adopted by the World Health Assembly in 2015. So, can we end malaria for good? Maybe we can. But when, and how soon?

What is Malaria?

The word “malaria” is derived from “mal aria” or “bad air”, which originated during Roman times. The early Romans believed that malaria arose from foul-smelling air emitted from marshy or swampy surroundings. However, science had to wait for many centuries before arriving at the actual truth. It was Charles Laveran, the distinguished French physician, who in 1880 discovered that malaria is caused by a protozoan parasite, namely Plasmodium. He was awarded the Nobel Prize in Physiology or Medicine in 1907 for his discovery. In 1897 Sir Ronald Ross, the noted British physician, established that the malarial parasite is spread by the bite of a female Anopheles mosquito, for which he received the Nobel Prize in Physiology or Medicine for the year 1902. It is currently known that at least four major species of Plasmodium are responsible for human malaria in tropical climes.

Malaria: An ‘Historical’ Problem

The history of malaria stretches from its prehistoric (~30 million years ago) origins as a zoonotic disease of primates in Africa through to the present day. Around ten millennia ago, malaria jumped from primates to humans and started to cause human disease, which coincided with the advent of agricultural practices and domestication of animals. The unique periodic nature of malarial fever has been recorded in history as far back as 2700 BC in China. Malaria was highly prevalent in Egyptian times also (circa 2700 – 1700 BC). The disease has also determined the outcomes of many battles and wars throughout history and thereby influenced the destiny of vast populations. A widespread and devastating infectious disease; at its peak, malaria occupied all continents except Antarctica, where the climate is so inhospitable that the vectors (female Anopheles mosquitoes) cannot flourish.

Malaria: The Magnitude of the Problem

The magnitude of the malaria problem is indeed huge! Here are some facts and figures^* that highlight this issue:

• 3.2 billion people (~half the world’s population) are at risk of malaria.
• 80% cases occur in 15 most affected countries.
• 90% deaths occur in sub-Saharan Africa, with 78% occurring in under-five children.
• 35% deaths occur in Nigeria and the Democratic Republic of Congo.
• In 2015, 214 million cases and 438,000 deaths were reported from across the globe.
• In 2015, 97 countries had ongoing malaria transmission.

*Source: www.worldmalariaday.org/about/key-facts

What Has Been the Progress Made So Far?

There has been phenomenal progress in malaria control, particularly over the past decade or so. It has been a collective human effort, involving active community participation, involvement of all stakeholders and government facilitation. Some of the progress that has been made is highlighted below:

• Reduction in Malaria Cases: Between 2000 and 2015, 57 countries reduced the number of new cases by 75%.
• Reduction in Malaria Deaths: It is heartening to know that malaria in no longer the leading cause of death in African children. Malaria deaths have reduced by 60% and saved over 6 million lives in the past 15 years.
• Improvement of Malaria Control: Over the past decades, major progress has been made in the areas of malaria diagnosis, treatment and prevention.
• Development of Malaria Vaccine: A malaria vaccine is finally on the horizon! The final clinical trial results for a partially effective malaria vaccine are out, which is a milestone in the ongoing fight against malaria. The clinical trials were carried out in Burkina Faso, Ghana, Gabon, Kenya, Malawi, Mozambique and Tanzania, across 11 sites. The vaccine has the potential to immunize millions of children and reduce malaria attacks by 30%. With over 1300 children dying daily (1 every minute!) across sub-Saharan Africa, the vaccine spells hope for young children who bear the brunt of the burden.

Malaria Control: What are the Major Hurdles?

Despite the tremendous progress made so far, there is still more to be done. Some of the hurdles that are present in front of us are briefly discussed below:

• Need for Sustainable Funding: There is a severe funding crunch, particularly in the African countries, where the burden of malaria is highest. Importantly, over USD 5 billion will be required per annum, which is double the current funding that is available. If a global solution for sustainable funding is not found soon, resurgence of malaria in these countries will claim many more lives in the long-run.
• Need for a Robust M&E System: For a successful anti-malaria response, there is an urgent need for rigorous monitoring and evaluation (M&E). This will ensure that the programs are progressing according to the initial plans (monitoring) and determine if these are having the desired result (evaluation). A robust M&E system will help to identify and weed-out misplaced allocations of scarce resources and divert them to where they’re needed the most.
• Need for Sustained Political Will: A steadfast political commitment from leaders of various countries where malaria is a problem will be required for the successful eradication of the disease.

What is the Way Forward?

Eradication of malaria is very important for alleviating poverty and improving maternal and child health. Since malaria takes a major toll on human life, eradicating it will mean healthier societies, more productive communities, increased school attendance, and less lost work-days, which will translate into robust and dynamic economies in the future.

Development of next generation drugs, diagnostics and vaccines, as well as new innovations in other control measures against malaria will require major sustained investment in R&D. Therefore, there is a need for ongoing investment by major global donors in this area. Moreover, stronger international partnerships and greater political will by leaders in Africa, Asia and Latin America will strongly impact on how the malaria eradication program takes shape in the coming years.

Following the major progress made under the “Millennium Development Goals”, it is important to build upon this success and maintain the momentum under the “Sustainable Development Goals” until the ultimate goal of malaria eradication is reached – hopefully by 2030!