The past decade has demonstrated what can be accomplished when the pieces come together in public health. Malaria presents a striking example of the progress that is possible.
Since 2000, the world has made huge progress against this disease, cutting deaths by 60%, while certifying malaria elimination in many countries. Whereas malaria was nearly universal a century ago, today it has been eliminated from more than half of the member states of the United Nations – truly an amazing achievement.
What worries us, though, is that the rate of progress against malaria is slowing globally, and it is moving in the wrong direction in some regions of the world. The latest annual progress report from the World Health Organization showed an overall increase in cases of malaria for the first time in more than a decade. Deaths due to the disease remain near record lows, and 2017 marked the largest number of bed nets distributed in a year. So while there are reasons to be optimistic, this is also sobering news.
We’re at a crossroads. Progress is still possible, but it’s not inevitable, and the decisions the world makes today will determine whether we eliminate malaria or see a resurgence of this deadly disease. This is the message of our Goalkeepers report, launched last September.
Any decisions we make must account for the more than $3 billion funding gap facing malaria control and elimination efforts. Since 2010, global funding for malaria has barely increased, despite the fact that it needs to more than double by 2025 to put us back on track to reach global elimination goals.
We need innovative financing to help affected countries take increasing ownership of the fight against malaria. We also need full funding for the development of next-generation drugs, transmission-blocking tools and state-of-the-art data and analytics if we are to regain momentum against one of humanity’s oldest and deadliest foes.
Traditional donors currently provide most of the funding for the fight against malaria – and their generous funding remains essential – but domestic financing is growing, and we believe that it will be the key factor in funding ambitious elimination efforts over the next two decades. We need affected countries to increase funding for malaria and donors to sustain investments in proven and effective global and bilateral programs, like the Global Fund to Fight AIDS, Tuberculosis and Malaria.
There’s also an important transformational role for the private sector, alongside the development of innovative financing models to unlock and sustain additional resources. Philanthropies, multilateral and bilateral programs, and global and regional development banks have a critical role to play. We can forge the partnerships needed to build novel funding models that incentivise affected countries to increase domestic funding for malaria programmes.
At the Bill & Melinda Gates Foundation, we are committed to supporting these efforts to help energise the malaria fight. That’s why, at the World Economic Forum in Davos this week, we announced a new partnership with the Inter-American Development Bank (IDB) and the Carlos Slim Foundation to establish the Regional Malaria Elimination Initiative (RMEI), which will make new funding available to enable the nations of Central America and the Dominican Republic to take the final steps toward ending malaria for good.
Under the initiative, the IDB will provide up to $37.1 million in loans to countries in the region while the Gates Foundation will provide up to $31.5 million for associated interest and administrative costs. This joint effort has the potential to unlock more than $100 million in domestic funding and complement the nearly $40 million in existing donor resources – from sources including the Global Fund – to provide the technical and financial resources needed to achieve elimination goals. The partnership can yield enormous health and economic benefits while also addressing other vector-borne disease threats.
The RMEI is an example of the type of leadership, collaboration and innovative financing needed to regain global momentum and accelerate toward zero cases of malaria. We hope it offers a blueprint for using innovative financing to create regional solutions to stop malaria – laying the essential building blocks for one day ending it around the world.
Next generation R&D
We also need to double down on the development of next generation tools and strategies that can transform the fight against malaria in sub-Saharan Africa and South Asia. These regions together account for more than 90% of the global malaria burden, and parasite transmission in Africa and Asia is facilitated by a complex set of variables, including well-adapted mosquito species, warm and wet environments, extreme poverty, and weak health systems. We will need more effective drugs, new transmission blocking tools, and smart data and analytics.
The funding required to produce these innovations is estimated at $700 million per year, but public and private sector partners are only providing 80% of the necessary resources. While $700 million may sound like a lot of money – and it is – it is just 1% of the estimated $70 billion that the world’s 10 largest pharmaceutical companies invested in R&D in 2016.
And it shrinks in comparison to the tens of billions of dollars that are drained away from African and Asian economies each year by the crippling economic costs that malaria extracts from families, communities and nations. That’s why leading economists have identified the fight against malaria as one of the “best buys” in global development, calculating that a 50% reduction in global malaria incidence could produce $36 in economic benefits for every $1 invested.
So what advances do we need to reignite progress against malaria?
⦁ Drugs to overcome resistance
As with bacteria, malaria parasites evolve over time, and they ultimately develop resistance to the drugs we use to treat and cure the disease. One of the toughest challenges we face is the potential spread of multi-drug resistant strains of Plasmodium falciparum from Asia to Africa. We can address this immediate problem by accelerating efforts to eliminate P. falciparum malaria from Southeast Asia, stopping the problem at its source. And we also need to invest in the development of new combination therapies of three or four drugs that can slow the emergence of superbugs over time.
⦁ Drugs to accelerate elimination
We ultimately need novel treatments for P. falciparum and P. vivax malaria that can completely clear all parasites from the human body through the administration of just one or two drug tablets. Effective short-course curative therapies will help break cycles of infection and reinfection in sub-Saharan Africa by reducing the reservoir of infected individuals.
⦁ New transmission-blocking methods
We can also enhance malaria control and ultimately pave the way for elimination by developing an array of new methods to block the transmission of parasites between mosquitoes and people. Because mosquitoes, like parasites, evolve to defeat the tools we deploy against them, we need multi-pronged prevention strategies, especially in high-transmission areas of Africa.
There are many promising options to pursue. These could include use of new bed nets that combine active ingredients, the application of indoor residual spraying, treating local water sources with larvicides, installing mosquito traps in and around homes, the deployment of gene drive technologies to target three or four of the most dangerous mosquito species and the development of a next generation malaria vaccine.
⦁ A revolution in data and analytics
For more than 100 years – stretching back to the foundational research of Ronald Ross – data and analytics have played a critical role in shedding light on how malaria spreads across populations and the role that insecticides, drugs and other interventions play in reducing infection rates. But recent advances in data collection, computational capacity and machine learning have created new opportunities to use data and modeling in new and incredibly powerful ways.
We can now use a variety of surveillance tools to measure the impact of various interventions and generate tailor-made control and elimination strategies that are adapted to the needs of specific populations in specific environmental settings.
We can also analyse data streams in real time, using the insights they generate to make course corrections and maximise the life-saving impact of every dollar invested. This is especially important as low and middle income countries take on an increasingly central role in funding the fight against malaria.
While traditional donors currently provide most of the funding for the fight against malaria, domestic financing is growing, and it will ultimately be the key factor in funding ambitious elimination efforts over the next two decades.
Continued progress will be largely built on a series of successful national and sub-regional elimination programs, driving global eradication from the bottom up. The success of these efforts will be determined largely by the willingness of global partners to invest in innovation and stay committed to the goal of ending malaria for good.