Malaria kills. Sadly, I have lost family and patients I have cared for to this ancient disease. I was born in southern Africa, trained and practiced there as a community doctor and obstetrician, and saw firsthand how malaria ruthlessly targets pregnant women and young children.
In the year 2000, in the South African province of KwaZulu-Natal, the end of malaria looked like an impossible dream. Amid a cross-border refugee crisis and a severe shortage of vital medicines and healthcare infrastructure, malaria deaths spiked, claiming more than 450 lives in the area that year.
But global attention, government investments, and broader public-health actions (including the effort to obtain regulatory approval for a new antimalarial medicine, with which, as chief scientific officer for Novartis in South Africa, I was involved) made transformative progress possible: in KwaZulu-Natal province from 2000 to 2010, we saw a 99% reduction in malaria cases and a 98.5% reduction in malaria deaths.
Today, on World Malaria Day, I’m reminded of this story because it demonstrates a simple fact: progress is possible. Since 25 April 2001 – the day when African leaders signed the Abuja Declaration and launched a global movement to end the disease – we’ve overcome untold hurdles. Between the turn of the century and 2015, malaria deaths plummeted by 60% worldwide.
We’ve made great progress against this epidemic – but we’re not there yet.
One child still dies of malaria every two minutes. This is both tragic and unacceptable.
In addition, recent news indicate that malaria deaths actually increased over the past two years, and funding commitments have flatlined. In the face of so many competing global priorities, it’s easy to lose sight of a reality that demands attention.
Let’s recommit to the fight against malaria. The key to success right now is straightforward: support local experts and healthcare providers on the frontlines.
New research shines light on the specific needs. Novartis recently commissioned a study called Malaria Futures for Africa, which surveys 68 key leaders across 14 African countries – ministers of health, heads of national malaria control programs, academics and community leaders striving to eliminate the disease.
Resistance remains the gravest concern – to both insecticides and artemisinin, which anchors the most effective treatment we currently have for malaria.
The World Health Organization has identified insecticide resistance in 61 countries. And artemisinin resistance has been documented in the Mekong Delta region of south-east Asia. History has shown that, left unchecked, these malaria- resistant parasites could spread to Africa and lead to 100,000 more deaths every year.
There’s clear guidance on next steps. African leaders surveyed in the study called for stronger surveillance measures and better intergovernmental coordination to understand, monitor and rapidly respond to the spread of resistance. Respondents also pressed for priority investments in R&D to produce new malaria-fighting tools and treatments.
Crucially, participants highlighted the importance of operational research to optimize investments in eliminating malaria. Data-driven operations, combined with new technologies, could transform diagnosis, treatment and make eventual elimination possible.
Resources are vital. Respondents expressed a strong desire to mobilize new domestic attention and financing to fight malaria. These countries have necessarily relied on donor funds to support malaria elimination – something survey participants want to see change.
Without a vigorous and sustained commitment of their own national budgetary resources, the fight against malaria will be subject to the vagaries of international politics and donor agendas. As the survey co-chairs, Dr. Richard Kamwi and Professor Bob Snow, put it, “The need for better, more equal partnerships and for more resources jumps off almost every page.”
The private sector has a key role to play. Over the coming years, it must invest heavily to accelerate research and development of next-generation treatments to combat emerging resistance to artemisinin and other currently used antimalarials: Novartis will spend more than $100 million. Other companies have made encouraging new commitments as well.
My experience in KwaZulu-Natal – and the tremendous progress we’ve made against malaria worldwide in the years since – has shown me what’s possible.
When African leaders signed the Abuja Declaration, committing to bold new action to fight malaria, outright elimination of the disease was hard to fathom. Today, it’s thankfully in sight.
Let’s muster the courage to take the final steps. This means heeding calls from the frontlines of the fight, resisting complacency and reaffirming commitments. We’re almost there.