The Cost of Malaria

London, 11 May: Malaria is among the five most deadly diseases and is the world’s most serious parasitic infection, transmitted by certain types of mosquito from person to person.

The parasite, once in the bloodstream, infects and destroys red blood cells and obstructs the capillaries that carry blood around the body. Symptoms include fever, headache, vomiting and other flu-like symptoms. If suitable drugs are not administered quickly or the parasites are resistant to them, the infection can result in coma, life-threatening anaemia and death.

Half the world’s population, some 3.3 billion people in 108 countries, are at risk of contracting malaria. Every year there are nearly 250 million reported cases around the world and an estimated 850,000 deaths, 85% of them children under the age of five. It is particularly prevalent in sub-Saharan Africa, where on average a child dies every 45 seconds from the disease. There are five countries that make up 53% of the world’s deaths from malaria: Sudan, Nigeria, Uganda, Democratic Republic of the Congo and Tanzania.

Young children and pregnant women are particularly at risk because their immune systems are either under-developed or suppressed and unable to cope with the parasite. Malaria during pregnancy is also a major cause of maternal anaemia, infant mortality and low birth weight. Children older than five and adults also remain at risk, however, especially if they are already weakened by other underlying health conditions or if they are unable to find medical help quickly to manage a severe malaria infection.

Malaria is a disease of the poor, mostly affecting the poorest people in the countries where it is endemic, but it also exacerbates poverty. On a macro level, it has a serious adverse impact on economies, reinforcing poverty by diminishing productivity. The disease is estimated to cost Africa US$12 billion a year, and economists believe that it is responsible for reducing GDP in endemic countries by as much as 1.3%.

At the micro level, malaria obviously has a devastating impact on individuals and communities both emotionally and economically. It is not uncommon for people in high risk areas to suffer from malaria attacks up to five times a year and families have to spend a significant amount of their income on medical care. Artemisinin-based combination therapies (ACTs), currently the most effective drugs for treating malaria and the only way to beat severe malaria, are up to 30 times more expensive than vastly less effective single-drug therapies such as chloroquine, which are usually more readily available.

In Asia, Malaria Consortium, the world's leading non-profit organisation dedicated to the comprehensive control of malaria, is conducting critical work with the World Health Organization to monitor and contain growing resistance to anti-malaria drugs in Thailand and Cambodia. Resistance to single-drug therapies has become widespread over the last 50 years, but in pockets of Southeast Asia, there is now clear evidence of growing resistance to artemisinin derivatives which are used in ACTs as well. Malaria Consortium is working with both national and international partners to help contain and monitor this resistance. If resistance to ACTs reaches Africa, where the incidence of severe malaria is so much greater, it would be disastrous, as currently there is no alternative anti-malarial medicine waiting in the wings.

A number of malaria vaccines have been under research and development and the most successful of these has reached Phase three trials. However, even assuming everything goes well with the trials, this vaccine will not be available for widespread use before 2025 according to the developers GlaxoSmithKline.

All this suffering and loss for a disease that can be prevented, diagnosed and treated with a combination of already available interventions. Adequate funding and supportive policy environments are the prerequisites for getting these capabilities to those that need them most. Much is already being done, with some donors and national governments way ahead of the game in their efforts to tackle malaria. But the needs hugely exceed the response to the disease so far.

According to the latest figures from the Roll Back Malaria Partnership, an international partnership of organisations, governments and agencies involved in the fight against malaria, an estimated $6 billion is needed in 2010 to meet the pledges of global implementation of malaria control interventions made by the African heads of State in the Abuja Declaration of 2000 and backed up by the UN Secretary General by the end of this year. Current funding levels will only deliver about one third of that amount.

At the moment, mosquito nets, indoor residual insecticide spraying and ACTs form the front line defence against malaria in most countries and much of the current funding from the Global Fund to Fight AIDS, Tuberculosis and Malaria and other key international donors has been to deliver insecticide-treated mosquito nets and drugs to as many vulnerable people and families as possible. But for malaria to be tackled sustainably over the long term, it has been recognised that investment needs to move beyond nets and drugs to recognise the importance of diagnosis and surveillance. We cannot control malaria unless there is a clear knowledge of what interventions have been successful and why.

The UK Department for International Development under the Labour government has been providing significant funding for malaria interventions, including net distributions, health system strengthening and research and development into vaccines. But there are concerns that with the near achievement of 2010 targets of universal coverage targets of proven effective interventions, global financing commitments to malaria may decrease in response to a job well done. But unless the outstanding needs and issues continue to be addressed, there is a very real risk that some of the excellent gains made so far will begin to fade. 

This article was first published on EGovMonitor on 10th May 2010.

For more information, contact Diana Thomas [email protected]