Comprehensive approach to better malaria control

Abstract

Malaria is a complex and deadly disease but is also treatable and preventable. In 2000, an estimated 350 million to 500 million malaria cases led to the death of 1 million people, mostly African children. Since then, the establishment of the Millennium Development Goals for reducing global malaria incidence and mortality, have driven greater awareness and progress towards malaria control, and more than 4 million lives have been saved. With the aim of accelerating progress toward malaria elimination, the Roll Back Malaria (RBM) partnership has coordinated the development of the Global Malaria Action Plan 2 (GMAP2), Towards a Malaria-Free World: A Global Case for Investment and Action 2016–2030—the second generation of an RBM consensus document that provides a practical, multisectoral, action-oriented guide toward better control of malaria transmission. The draft of the English version of the document was under review until March 18, allowing interested partners and individuals to contribute. Representatives from more than 90 countries participated in the development of the consensus document. The approach is extremely collaborative and involves academia, the private sector, research bodies, and governments. The consensus document will be accompanied by a second document, the Global Technical Strategy (GTS) for Malaria 2016–2030, which will be presented to the World Health Assembly in May, 2015. The five chapters of GMAP2 provide a comprehensive overview of how resources should be mobilised. Its strategy sets out how to reduce malaria case incidence globally by 90% in 2030 compared with 2015, and how to eliminate malaria from at least 35 countries by 2030 in which malaria was transmitted in 2015. Crucial to reaching global malaria targets is adequate funding, and GMAP2 estimates that US$8 billion of investment will be needed annually between 2026 and 2030 to reach its goals, as well as an additional annual $673 million to fund malaria research and development. If achieved, this will lead to 12 million lives saved and 2·9 billion cases averted. The report highlights that if the 2030 targets are not met, the costs will be catastrophic. If the coverage of malaria interventions were to revert to the 2007 level, there would be an additional 2 billion malaria cases and 4·9 million deaths, leading to $5·8 billion in direct costs to health systems and households. Returns on investment in malaria control, according to the report, will be higher than expected: $4·6 trillion in economic benefits in 2030. Small investments can bring major returns. The report highlights the case of Neema Gunda, a widow and head of a household in rural Tanzania—thanks to the bednets and instruction on their correct use she and her family get sick less often. Although small investments can make enormous differences to individual lives, substantial investments will have worldwide benefits for billions of people. But to have the greatest effect worldwide, investments will need to be channelled into locally tailored interventions sensitive to the needs of specific nations, regions, and villages. The report also focuses on how environmental, social, cultural, and biological factors are all interconnected elements in the control of the disease. Biological factors, such as the growing problem of resistance to antimalarial drugs and insecticides, represent one of the biggest threats to reaching the 2030 goal. Agriculture, education, housing, water and sanitation, and tourism are also all important, as well as the interfaces between land use, climate change, and environmental policy. Stakeholders in all these areas need to intensify their engagement. Despite progress, as of today, about 3 billion people are at risk in 109 countries. Ongoing advances in the fight against malaria will contribute to the realisation of the Sustainable Development Goals (SDG), and progress towards the SDGs will support the continued reduction and elimination of malaria. Tackling malaria is essential if sustainable changes are to be made for people living in areas where it is endemic. For example, it creates healthier, more productive workforces which can help attract trade and commerce, it makes a substantial contribution to improvements in child health, and protects households from lost earnings and the costs of seeking care. The SDGs provide an unprecedented opportunity to widen the circle of engagement and intensify multisectoral action and cross-country collaboration to defeat malaria. The comprehensive approach of GMAP2 will help ensure this opportunity will be taken and will guide us, we hope, towards a brighter future of malaria control.