It's that time of the year when we all get to see how well the battle against malaria is progressing: The World Malaria Report 2009 came out today. And, overall, there is much, much progress. Regretfully, and well-documented this time, there are also worries...
The report collates and summarizes statistics received from 108 countries and mirrors this against the previous year and long-term goals (set by the World Health Assembly, the Millenium Development Goals, etc.).
Of the many points that are positive a number stand out and are worth mentioning here:
1) Funding for malaria control has seen a dramatic increase from 0.3 billion USD in 2003 to 1.7 billion USD in 2009;
2) Overall, 31% of African households owned at least one insecticide-treated bednet in 2008, up from 17% in 2006. In 13 high-burden countries in Africa the figure is now up to 50%.
3) Although the use of ACTs has gone up since 2006 it is still very low indeed, with less than 15% of cases in children being treated with these drugs;
4) Many countries (a third of those that provided data) have seen dramatic reductions in cases, though the majority of this success was attained in countries outside Africa;
Nobody would argue that these results aren't impressive and they indeed offer hope and strengthen the belief that more can be accomplished.
Other parts of the report provide worrying information. There is a real issue with insecticide resistance, and absence of new compounds in the limited arsenal may seriously affect future successes. Drug resistance, notably the worrying news from Cambodia this year where resistance against artemisinin surfaced, is another major threat and potential drawback.
The chapter on malaria elimination is highly interesting, and provides clear and unambiguous information and WHO's view on malaria elimination. In it, I noticed Box 5.2 which provides a historical perspective for several countries. It reads that four of the eight 'pre-elimination' countries had already approached success in elimination in the second half of the twentieth century. Sri Lanka, DPR Korea, Paraguay and Argentina ended with only a hand-full of cases and then lost the battle. That is worrying information indeed.
Continued global efforts and increased funding will very likely bring a large number of countries to that same point, when malaria is almost gone, but not completely. It is beyond doubt that the global community will be challenged tremendously at that very time in future. In ensuring that full elimination will be achieved and sustained without resources being diverted to other pressing global issues. Money, large sums of money will be required, at the time when malaria is hardly noticable.
Funding currently falls short of the 5 billion $ needed annually to ensure maximum coverage with interventions and global impact. It will be interesting to see how financial support for malaria control will develop over the next few years.