It is a disease as old as mankind. One whose lethal impact has helped shape human history and one that continues to leave a scar on each and every generation. Malaria remains the deadliest disease known to man – infecting hundreds of millions and killing hundreds of thousands of people year after year.
Our battle to beat malaria has been a long and difficult one. Ever since Ronald Ross discovered in 1897 that malaria parasites could be transmitted by infected Anopheles mosquitoes, we have been fighting both the disease and its carrier. Nearly half of the world's population currently live in areas at risk of malaria transmission.
The past century has seen the world successfully develop a range of medicines and vector control interventions that can effectively prevent and treat malarial infection. But there is still a long way to go – it is still very difficult to reach at-risk populations in remote regions, while resistance to both antimalarials and insecticides is one the rise.
It is a challenge that requires a huge global effort, but how close are we to defeating our oldest foe?
Based on CDC estimation, 2016
A 21st century success story
Since 2000, there has been unprecedented progress in the fight against malaria – deaths have been cut by 60%, saving almost 7 million lives. Between 2010 and 2015 alone, malaria cases fell by 21% and death rates by 29%.
The 21st century has seen seven countries certified by the World Health Organization to have eliminated malaria, 12 additional countries have attained zero malaria status, and more than 40 countries have fewer than 10,000 cases in a single year.
Nearly 80% of malaria cases averted in this same timeframe have been due to vector control interventions, such as long-lasting insecticide treated bed-nets (LLINs) and indoor residual spraying (IRS) of houses, that help prevent transmission. For example, since 2000, more than 1 billion insecticide-treated bed nets have been distributed in Sub-Saharan Africa.
The problems with progress
Despite these achievements, malaria remains a widespread problem. A child still dies from malaria every two minutes. In 2016, there were 216 million cases of malaria in 91 countries leading to 445,000 deaths. And the burden of this disease falls disproportionately on Sub-Saharan Africa, which accounts for 90% of all malaria cases and 91% of malaria deaths.
Those countries that suffer the most tend to be the poorest, lacking the infrastructure and funding to have effective surveillance systems, meaning they cannot assess the distribution of the disease and quickly respond to outbreaks.
This is further exacerbated by the fact that while global malaria funding grew by almost 1000% since 2000, it has now plateaued. WHO estimates that annual funding would need to increase to US$6.5 billion per year by 2020 to achieve its target of reducing malaria cases and deaths by 40% between 2015 and 2020. The US$2.7 billion invested in malaria in 2016 represents less than half (41%) of that amount.
There is also a growing problem of resistance both in terms of an emerging parasite resistance to antimalarial medicines and of mosquito resistance to insecticides. In 2014, 60 countries reported mosquito resistance to at least one insecticide used in nets and indoor residual spraying. In addition, certain types of transmission are not addressed by LLINs and IRS and will require new types of vector control interventions.
The next generation of tools and tactics
So how do we overcome these hurdles? The good news is that the innovation pipeline is producing results – in prevention, detection and treatment.
In April 2018, the world’s leading crop protection companies joined forces with the Bill & Melinda Gates Foundation and the Innovative Vector Control Consortium (IVCC) to create the Zero by 40 initiative. A commitment from partners to research, develop and supply the next generation of vector control products to save lives and help eradicate malaria by 2040.
By combining such products with increased access to rapid diagnostic tests (RDTs) that can swiftly distinguish between malarial and non-malarial fevers; improved surveillance data from the highest risk countries; and the use of effective anti-malarial drugs, we have the opportunity to make a long-term difference in reducing the malaria burden. And even give us all hope that we might defeat it once and for all.