World Malaria Report: Are We in Danger of Replicating History?

World Malaria Report: Are We in Danger of Replicating History?

When I worked in Smallpox eradication in the mid-1970s, I traveled all over northern India and Bangladesh. I never took malaria prophylaxis, because malaria had been cleared from those areas. Likewise, I did not take malaria prophylaxis when I worked in the Brazilian Amazon in the late-1970s. At that time, malaria was found only in gold miners in isolated tributaries of the Amazon. Now, due to our financial inability to continue high levels of malaria eradication activities worldwide in that time period, emergence of both anti-malarial and insecticide resistance, and spread of the mosquito vectors, all of these are heavily malaria endemic areas with a high mortality rate for pregnant women and children.

The World Health Organization (WHO) recently released the World Malaria Report 2012, summarizing 2011 data from 104 malaria-endemic countries and citing progress and challenges toward the eradication of malaria.

Malaria control, much like HIV, has progressed tremendously in the last decade: Mortality rates are declining for all age groups, more people are receiving both preventive and treatment services, and governments are better coordinating their own resources and donor funds into effective programs that save lives.

Despite the advances of the past decade, malaria is still one of the five leading causes of child under-five mortality worldwide, and deserves continuing attention. The WHO estimates that, in 2010, there were approximately 219 million malaria cases, and 660,000 malaria-related deaths, with 90% of all malaria deaths occurring on the African continent.

One challenge in malaria control is the cost of maintaining services at a high-enough level to continue the rate of improvement—the “health mortgage” effect of investing in programs that cannot be decreased without major declines in program effectiveness that lead to losses of life, especially among women and young children.

The United States leads the way in funding for AIDS, malaria and tuberculosis (TB), but competing spending priorities could threaten that. A number of other donor countries are also facing their own government cutbacks due to the worldwide recession and its aftereffects. The net result is difficulty maintaining malaria programs at their current level, let alone advancing the pace of service expansion.

The human cost of not investing in maintaining the impressive gains of the past decade in malaria control will be very high. We are in danger of re-creating history.

A. Frederick (Fred) Hartman, MD, MPH, is the global technical lead for communicable diseases and epidemic preparedness, and regional portfolio director, East Africa, Center for Health Services at MSH.