Scale-up of effective malaria control dramatically reduces deaths

The World Malaria Report 2014 shares the good news, but warns the fight is far from over

The World Malaria Report 2014, released today by the World Health Organization, was launched in the UK Parliament in the presence of the Duke of York. In this annual report the progress being made to control, prevent and eliminate malaria is outlined, and gaps that remain identified. So how is the fight against malaria progressing?

Good progress being made in certain areas

The general outlook is positive, with more people being reached with preventive interventions and treatments, malaria incidence and mortality rates falling and more countries than ever achieving significant reductions in disease burden. The key positive points from the report are:

• Access to insecticide-treated mosquito nets (ITNs) has increased dramatically, from three percent of households in 2004 to 49 percent in 2013
• The availability of diagnostics and artemisinin-based combination therapies (ACT) treatments have both increased, and this year’s report marks the first time ever that the number of diagnostic tests provided to the African public health sector exceeded the number of ACTs distributed. This demonstrates a welcome trend towards more cases of malaria being diagnostically-confirmed rather than being treated presumptively
• In countries where it has been adopted, over half of pregnant women received at least one dose of intermittent preventive treatment in pregnancy (IPTp) for malaria, although this remains below programme targets
• Between 2000 and 2013 estimated mortality rates decreased by 47 percent worldwide and 54 percent in Sub-Saharan Africa
• This translates into 670 million fewer cases and 4.3 million lives saved since 2001, 3.9 million of which are children under the age of five
• A new analysis this year reveals that since 2000 the prevalence of malaria parasite infection has decreased significantly across sub-Saharan Africa. Average infection prevalence in children has seen relative decline of an impressive 48 percent
• 64 countries are on course to meet the Millennium Development Goal target of reversing the incidence of malaria, and of these 55 are on track to meet Roll Back Malaria and World Health Assembly targets of reducing malaria case incidence rates by 75 percent by 2015.

Challenges remain

However, gaps in preventative coverage and access to diagnostics and treatment remain, and least progress has been made in countries with the highest disease burden, particularly in sub-Saharan Africa. Some of the other key gaps are:

• Roughly 278 million people in Africa live in households without a single ITN
• 15 million pregnant women do not have access to IPTp
• Between 56 and 69 million children under the age of five with malaria did not receive an ACT in 2013
• Despite good progress in reducing mortality rates, malaria still caused the death of an estimated  584,000 people in 2013
• While there are logistical reasons for some of these gaps, the biggest factor remains the large shortfall between the £2.7 billion available for malaria control and prevention in 2013 and the $5.1 billion that the WHO estimates is needed each year to meet international targets.

Unless there is a dramatic increase in domestic and international funding, many countries, including those with the highest disease burden, will not meet these targets.

Antimalarial Drug Resistance

One of the biggest challenges we face in our fight against malaria is the growing resistance of the malaria parasite to our most effective drugs. Artemisinin resistance has been detected in five countries of the Greater Mekong subregion, in Cambodia, Thailand, Myanmar, Laos and Vietnam. In many areas along the Cambodia–Thailand border, P. falciparum has become resistant to most available antimalarial medicines.

The issue of drug-resistant malaria poses the gravest threat to international malaria elimination efforts and demands a strong, coordinated international response. If the spread of resistance follows the trajectory of parasite strains that developed resistance to previously effective anti-malarials, the impact could be devastating. In particular the effect in Africa, where the disease burden is highest, could be disastrous.

Despite the challenges, the outlook is positive

New technical and advocacy strategies for malaria elimination are being finalised by the WHO, which will provide a framework for international action for the next 15 years. At the East Asia Summit in November a historic commitment was made by the 18 member states to eliminate malaria in the Asia-Pacific region by 2030.

Within this context of strong international commitments the actions of donor and endemic countries governments alike will be important. The UK must continue its role as one of the leading countries funding malaria control, and we encourage the Government to develop a new framework for doing so when the current Malaria Framework for Results expires in 2015. At the same time, endemic countries must be encouraged to increase domestic funding for health and disease control, and supported in developing their health systems to be resilient enough to tackle diseases such as malaria. 

Keywords: Drug resistance | Maternal, neonatal and child health | Diagnosis | Treatment | Advocacy and policy | Vector control

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