World Malaria Report 2018 – Progress, Opportunity and Action

Nov 19, 2018 | PMI

For more than a dozen years, the U.S. President’s Malaria Initiative (PMI) has been investing in the fight against malaria, in some of the most malaria-endemic countries in the world, where progress is hard-fought. As a way to measure of progress, we welcome the 2018 World Health Organization World Malaria Report in-depth analysis of global and national trends in malaria. While we continue to see many reasons to celebrate, we also recognize that following a decade of unprecedented progress, the rate of change has slowed. For a variety of reasons, some of the highest burden countries in the world continue to see tremendous progress, others slowed, but continued progress, and some countries remain behind in the fight against malaria.

Following the initial decade of dramatic and unprecedented progress, progress has slowed. There is evidence, though, that the efforts of countries and the global community to date has reset the global distribution of malaria, with malaria now heavily concentrated in a shrinking number of countries.

We are at a juncture where our wider community must understand the challenge ahead. Urgent action is being taken by countries, and supporting their efforts is critical to protecting hard-earned gains and reigniting the pace of progress toward our goal of ending malaria.

This year (2018) there have been a number of positive developments in malaria funding and an emphasis on data that can serve as a foundation for future efforts:
  • Malaria-affected countries invested more in their own health systems, adopted innovations and launched new sub-regional efforts to put aside borders that mosquitoes don’t respect anyway.
    • Eight countries across the Sahel launched the Sahel Malaria Elimination Initiative committing to share best practices and resources to accelerate the end of malaria.
    • The leaders of 16 countries belonging to the South African Development Community pledged to do more to advance cross-border collaboration to end malaria.
    • Leaders of the African Union endorsed the pan-African launch of the Zero Malaria Starts with Me campaign, co-launched by the RBM Partnership to End Malaria and the African Union Commission, to engage Africans at all levels of society to take greater ownership of malaria prevention and care, and to mobilize additional resources for the effort.
  • At the London Malaria Summit, global leaders pledged $4.1 billion to advance the malaria fight, including new funding for research and development and renewed commitments to meet co-financing requirements for the Global Fund.
    • 53 leaders of the Commonwealth pledged to do what it takes to halve malaria in the Commonwealth by 2023.
  • Three of the major organizations in the fight against malaria have introduced new leadership (The Global Fund, the Bill and Melinda Gates Foundation, and at the U.S. President’s Malaria Initiative) which has injected new energy into the fight.
    • Over the past months, these organizations have embarked on a joint efforts to improve work even more closely with endemic countries to optimize implementation and are focused on bringing greater precision based on programmatic and epidemiological surveillance data, within countries and at a global level
Progress against malaria is evident on a number of fronts:
  • Across the globe, the trend in fewer child deaths due to malaria continues steadily downward.
  • The progress toward elimination continues in a growing number of countries:
    • Paraguay was certified by WHO as malaria free in 2018 — the first eliminating country in the Americas since 1974;
    • China and El Salvador both reported zero cases in 2017;
    • There is a steady and growing progression of countries that demonstrate case numbers <10,000, <1,000, <100 and <10 in the past year
    • Generally these countries that have done well, continue to show progress.

  • Overall, malaria intervention coverage continues to increase — long-lasting insecticide treated mosquito nets, intermittent preventive treatment during pregnancy, seasonal malaria chemoprevention;
    • Half of people at risk of malaria in Africa are sleeping under an ITN. In PMI focus countries, ITN access has tripled since baseline surveys.
    • Among 33 African countries that reported on IPTp coverage levels in 2017, an estimated 22% of eligible pregnant women received the recommended three or more doses of IPTp, compared with 17% in 2015 and 0% in 2010.
    • In 2017, 15.7 million children in 12 countries in Africa’s Sahel subregion were protected through seasonal malaria chemoprevention programs. However, many children who could have benefited from this intervention were not covered and PMI is working closely with 9 partner countries in the region help fill this gap.
  • Malaria surveillance is greatly improving in many places;
    • In 2017, among 52 moderate to high-burden countries, reporting rates of malaria were 60% or more. In the WHO African Region, 36 out of 46 countries indicated that at least 80% of public health facilities had reported data on malaria through their national health information system.
    • As of 2017, all 19 PMI focus countries in Africa have either fully transitioned, or are planning to transition, their health management information systems to the District Health Information System-2 (DHIS2), an open-source electronic platform that enables real-time access to data at national and subnational levels.
  • India, now the most populous malaria-endemic nation, shows substantial reductions in malaria. And Ethiopia and Rwanda (where PMI has had long-standing support) are back on track, both showing a decrease in cases over the past year thanks to a renewed focus on malaria, better use of data, and increased coverage of core malaria interventions.
  • Global funding for malaria has been maintained and modest growth was evident this past year. As in previous years, the United States of America (USA) was the largest international source of malaria financing, providing US$ 1.2 billion (39%) in 2017 through its support to the Global Fund and by direct assistance provided by PMI.
The malaria fight is not without its challenges — but these challenges highlight the next opportunities for action.
  • Following the initial decade of dramatic and unprecedented progress, progress has slowed. There is evidence, though, that the efforts of countries and the global community to date has reset the global distribution of malaria, with malaria now heavily concentrated in a shrinking number of countries. As a result, several of the critical targets of the WHO Global Technical Strategy for Malaria 2016-2030 (GTS): reducing malaria deaths and disease by at least 40% by 2020 are not likely to be met with the current efforts, although many countries will meet or exceed these targets.
  • The report shows that falciparum malaria cases and deaths remain heavily concentrated in sub-Saharan Africa (92% of cases and 90% of deaths) and most of these are in a group of 10 countries that account for 3/4ths of the falciparum malaria globally.

       Of note, US-PMI began its work in the most malarious countries in Africa with the understanding that it was critical to go to hard places early in the fight. PMI now works in 24 malaria-endemic African nations — including all of the 10 countries with the highest burden.

  • Funding for the malaria fight has stabilized over the past 7 years and this is generally true for the domestic and international investments.
  • In 2017, while the 10 African highest burden countries, all had evidence of increasing malaria cases over the previous year, 7 of the countries also had evidence of increased per-capita spending against malaria which may hopefully bear fruit in subsequent years.
  • Efforts to sustain and grow the replenishment of the Global Fund to Fight AIDS, TB and Malaria remain central to the stability and growth of progress — noting that the next Global Fund replenishment is in 2019.

       Of note, US-PMI began working in 5 new countries in Africa in 2017 — all of these have high per-capita burden. We hope the addition of PMI support will spur accelerated progress in reducing malaria cases and deaths.

Nonetheless, there are still significant barriers to further progress on malaria control and elimination:
  • Despite rapid scale-up in the early years of the RBM Partnership and PMI, intervention coverage remains inadequate in many countries, particularly for some key interventions;
  • Drug resistance and insecticide resistance pose an increasing threat to our progress — but recent years have demonstrated our ability to better track these threats and major investments in diagnostics, drugs and insecticides have provided new tools that can help us mitigate these risks in the near term;
  • Data collection, assembly, analysis and use for decision-making has improved in many but not all countries. Substantial investments and improvements in coming years may bear fruit in the effort to establish information and surveillance as a key tool in the fight against malaria;
  • Community engagement efforts have expanded (e.g., with mobilization via efforts like “Zero Malaria Starts with Me”) and the opportunity to dramatically expand this engagement exists in nearly all countries, but civil society groups are few and have less impact then they could
  • Efforts to raise endemic-country direct investments in the malaria fight will be critical in the coming years; because although countries have increased funding in some cases, there are many countries that Should increase funding.
There is no standing still with malaria. We must move quickly to step up efforts and continue progress for all countries toward ending malaria for good. Fortunately, there has never been a better time to invest in malaria.

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