The WHO’s 2017 malaria reports says progress in fighting disease has slowed, and more money is needed to reach elimination target
Progress in driving down infections and deaths from malaria has stalled and even reversed in some countries, according to the World Health Organization.
The WHO director general, Tedros Adhanom Ghebreyesus, warned of a “troubling shift” in the downward trajectory of malaria, one of the biggest killers in poorer countries, and until recently, one of the greatest public health success stories.
There is a real chance malaria could be eliminated, this year’s world malaria report suggests, but only if funding increases.
Inadequate investment in controlling the disease in high-burden countries, which have been reducing funding for at-risk populations, represents the “greatest threat” to gains the world has made, said the report.
Since 2014, investments in malaria control have, on average, declined in many high-burden countries. The WHO estimates that a minimum of $6.5bn will be needed annually by 2020. Last year, just $2.7bn was invested.
Sub-Saharan Africa still accounts for 90% of malaria cases and deaths worldwide, but inefficient implementation of interventions, conflict and other crises – as well as climate change – have shifted attention away from the disease.
Following an unprecedented fall in global malaria cases since 2010, conservative estimates suggest cases have increased by 5m between 2015 and 2016. The global toll of malaria deaths reached 445,000 in 2016, a similar number to that reported in 2015.
Fifteen countries account for 80% all malaria cases globally. Nigeria accounts for the highest proportion of cases, at 27%, followed by the Democratic Republic of the Congo, at 10%.
In a foreword for the report, Tedros, the former Ethiopia health minister, said the malaria response was “at a crossroads”. He urged countries and the global health community to boost funding to save lives.
“The choice before us is clear,” he said. “If we continue with a business-as-usual approach – employing the same level of resources and the same interventions – we will face near-certain increases in malaria cases and deaths.
“As I have said before, countries must be in the driver’s seat; they alone are ultimately responsible for the health of their citizens. Universal health coverage is indeed a political choice – one that takes courage, compassion and long-term vision.”
The data showed a “precipitous drop” in spraying the inside walls of houses with insecticide since 2010 in all regions, while access to public health system was an ongoing problem. Although the threat of drug resistance remains “serious”, the immediate threat was low.
Eleven of the 21 countries identified by the WHO as having the potential to reach zero indigenous cases in 2020 reported increases in malaria since 2015. Five of them, Botswana, Ecuador, Saudi Arabia, South Africa and Swaziland have reported increases of more than 100 cases in 2016 compared with the previous year.
Dr Abdisalan Noor, of the WHO’s surveillance global malaria programme, described the findings as a “wake-up call” to action. “Globally, we can safely say that after an unprecedented period of success, we are no longer making progress, which is supported by the data in this year’s report.”
If the trend continued, the WHO said, it would miss its target of a 40% reduction in case incidence and mortality by 2020.
There were some gains, it said. Globally, the number of countries that were malaria endemic in 2000 and reported fewer than 10,000 cases increased from 37 in 2010 to 44 in 2016.
For the second consecutive year, the WHO European region continued to be malaria free, and coverage rates of access to insecticide treated bednets increased across most regions in 2016 when compared with 2010.
Kyrgyzstan and Sri Lanka were certified malaria-free by the WHO in 2016, and Algeria, which remained malaria free in 2016, is now eligible. Argentina and Paraguay have begin the certification process, while Uruguay is set to request certification of elimination by the end of 2017, the report said.
In warring countries, or those with other major crises, such as Yemen, Nigeria, South Sudan, Venezuela, interruption of services have all resulted in an increasing malaria burden.
New data from national surveillance systems suggests the WHO has been underestimating the global malaria burden and it would review estimation methods in 2018.