Staying the Course against Malaria

 The recently released World Malaria Report 2019 shows a relatively stable global scene: while extraordinary progress in reducing the malaria burden was made between 2000 and 2015, progress stalled over the past few years. Between 2017 and 2018 the number of cases was reduced by only 3 million (from 231 to 228) and the global incidence rate of malaria remained unchanged throughout 2018, while the situation continued to get worse in areas where the malaria burden is highest. In this context, the World Health Organization considers that 2030 global targets for malaria are likely to be missed, and makes a call to intensify efforts, particularly in the highest burden countries.

While action is needed in a variety of fronts to get the situation back on track, the global malaria situation leads to some critical reflections:

• Innovative tools and approaches against malaria are urgently needed. Recent reviews on the prospects for malaria eradication highlight that this goal will not be achieved if novel tools and strategies are not developed, while currently available tools can still be used in innovative and more effective ways. This all implies supporting R&D and developing true game changers such as a second generation malaria vaccine or new radical cure drugs with a long lasting prophylactic effect. Field implementation and operational research that increases the impact of tools that already exist by will be also needed.
• There is a continuum that goes from controlling malaria (reducing deaths and preventing cases) to eliminating it (clearing the parasite in a determined geographical area) and finally eradicating the parasite (eliminating it worldwide). Efforts need to be made in parallel throughout the entire spectrum of this continuum, addressing differences not only between countries, but within countries that have a variety of epidemiological settings that need completely different approaches.
• Funding is still the most critical challenge faced by the malaria community. In 2018, there were an estimated 2,7 billion USD devoted to malaria control and elimination, far from the estimated 5 billion USD needed annually to achieve targets set by the Global Technical Strategy for Malaria 2016-2030. Endemic countries contributed 30% of all available funds. Finding new funding mechanisms and synergies with national health systems, and increasing local commitment against the disease will be critical. The good news is that funds for malaria R&D have steadily increased over the past 3 years.

The WMR highlights other critical components of the malaria strategy, including putting special attention to most vulnerable populations (pregnant women and children in Africa), reaching universal health coverage and increasing access to preventive strategies. The bottom line is that we need to stay the course: eliminate malaria where it is feasible (at least 10 countries are considered to be on track to reach this milestone by 2020), advance control where urgently needed, enhance focus on countries with increasing burden of disease, and demand solutions from the R&D community.