Malaria, Poverty and Underdevelopment

The countries affected by malaria are often unable to assume the economic burden it imposes, and the poorest families may spend up to one third of their annual income on fighting this diseaseAs we look forward to 2015, the deadline for the Millennium Goals and the year formal agreement is expected on the post-2015 agenda, it is worthwhile taking a look at the role of the fight against malaria in promoting development and combating extreme poverty, the two principal goals of these mega agendas that will guide the action of the world’s countries and of the United Nations itself over the coming years.

Malaria is not just a disease that gives rise to over 200 million cases and kills more than 600,000 people annually, primarily in Africa, where it is the leading cause of morbidity and mortality among children under five years of age. Apart from its direct impact on the health of individuals, malaria is also responsible for millions of lost workdays as well as absences from school that have serious repercussions on children’s academic performance. The countries affected by malaria are often unable to assume the economic burden it imposes, and the poorest families may spend up to one third of their annual income on fighting this disease.

Despite this bleak scenario, it is also true that immense progress has been made in the last ten years. The launch of the Millennium Development Goals in conjunction with a significant increase in resources and the introduction of new tools—the products of years of research—achieved a 30% reduction in malaria mortality rates between 2000 and 2012. During that period, it is estimated that in the African continent alone interventions averted the deaths of three million children.

A 30% reduction in malaria mortality rates was achieved between 2000 and 2012While this is good news indeed, it is nevertheless overshadowed by concern that it will be difficult to maintain the current level of effort indefinitely. Several projections indicate that, even if we manage to sustain the current cover of the main malaria interventions, the number of cases will rise due to the loss of the partial immunity normally acquired by those living in endemic areas after repeated bouts of the disease.

In this context, the question that arises is how the issue of malaria will be positioned in the post-2015 Sustainable Development Goals.

The debate has been heated, and undoubtedly not an easy one. What must be defined is how much emphasis will be placed on health issues relative to the other key components in the development strategy. Within the health agenda, we need to establish—among other things—the weight of infectious diseases, such as malaria, compared to chronic diseases, which now account for a growing burden of disease even in the least developed countries.

Several projections indicate that, even if we manage to sustain the current cover of the main malaria interventions, the number of cases will riseIn the case of malaria, some experts are saying that now that we have started on this road we cannot stop and that, with everything that has been achieved, the only way to go forward is to follow the process through to its logical end: to eliminate malaria completely from certain regions in order to prevent the much feared resurgences of the disease, and in the longer term to launch a worldwide campaign to eradicate malaria from the planet, emulating the success already achieved with smallpox.

There are many challenges, ranging from the need to strengthen health systems and train human resources in endemic countries to preventing the emergence of drug resistance—a problem already observed in both the malaria parasites and the mosquito vectors that transmit them. Other issues that need to be addressed include funding, governance, and defining the best strategies from the strictly technical standpoint.

In the case of malaria, some experts are saying that now that we have started on this road we cannot stop and that, with everything that has been achieved, the only way to go forward For the moment, the World Health Organisation will launch a new Global Technical Strategy for Malaria in May 2015 and this plan will define the road map and goals for the next 15 years, including the financial implications of its implementation.

Meanwhile, whether or not the Sustainable Development Goals deal explicitly with malaria, continuing the fight against this disease is unavoidable. Because it is impossible to conceive of development in a population that is constantly sick, and because malaria is one of the diseases that throughout history has contributed most to the persistence of poverty and inequality.