Malaria has been a stubborn public health enemy. In 2021 it killed 619 000 people, of whom approximately 96% lived in Africa. It is 6-20 times more likely to spread in mosquito-prone environments than the Omicron variant of sars-cov-2. The disease was once endemic across most of the world, sweeping through the Americas in the 1600s and reaching as far north as the Arctic coast and east as Japan. But we can now save millions of lives each year from sickness and death caused by malaria following novel progress toward the disease’s elimination.
Today marks the 16th World Malaria Day and an appropriate time for us to take stock of malaria’s devastating impact on people’s lives and economic development in this Region. Concerted efforts yield positive results. In 2021, because of the joint actions by malaria-affected countries and partners, malaria deaths decreased compared to 2020 despite the consequences of the COVID-19 pandemic. That effort is echoed in this year’s theme: “Time to deliver zero malaria: invest, innovate, implement.”
In terms of progress, a solid national-level commitment was demonstrated despite the pandemic and led to many successes: About 75% of the planned 171 million insecticide-treated bed nets (ITNs) were distributed. The seasonal malaria preventive treatment was further expanded, reaching nearly 45 million children in 15 African countries, a significant increase from 33.4 million in 2020, while malaria testing and treatment services were maintained. More than 1.6 billion malaria cases and 11 million malaria deaths were averted in the WHO African Region from 2000-2021.
In addition, the first malaria vaccine recommended by the WHO to prevent malaria in children (also known as RTS,S) is saving lives. In Ghana, Kenya and Malawi, where nearly 1.5 million children have received the vaccine through a WHO-coordinated pilot programme, there is a substantial decrease in hospitalizations for severe malaria and a drop in child deaths. At least 28 countries in Africa have expressed interest in introducing the vaccine, with some additional countries to start in early 2024. The unprecedented demand for the first malaria vaccine is considered an opportunity to bring children back to clinics to catch up on missed vaccines and child health interventions – including reinforcing the need for children to sleep under ITNs every night. It is critically important to deliver this vaccine to children at risk: WHO, Gavi, UNICEF, and other partners are working to increase supply as rapidly as possible to protect more vulnerable children and save more lives.
Overall, in terms of reduction in malaria incidence, eight countries are on track to meet the 2025 Global Technical Strategy target (Cabo Verde, Ethiopia, the Gambia, Ghana, Mauritania, Rwanda, South Africa and Zimbabwe). But 15 countries achieved insufficient reduction while 20 have witnessed stagnation or increase in cases. Ten countries saw increases in malaria deaths. The pace of progress must be accelerated if we want to achieve the set targets for 2025 and 2030.
While congratulating our Member States and development partners for achievements over the last year, we are greatly concerned that malaria deaths remain unacceptably high, and cases have continued to increase since 2015. The WHO African Region alone accounted, in 2021, for an estimated 234 million malaria cases and 593 000 deaths, thus bearing the heaviest burden of over 95% of cases and 96% of deaths globally. Our Region, therefore, continues to be hardest hit by this deadly disease partly because too many people do not have access to preventive and curative interventions. Nearly 30% of the population in most African countries cannot access essential health services, and most people face unacceptably high expenditures on health care. Significant inequities affect the most vulnerable, young children and women, whereas about 80% of malaria cases and deaths occur in children under five.
To reverse these trends and accelerate progress, we must rethink and revitalize our strategies by investing, innovating and implementing smartly:
On investments, we are responsible for increasing funding for malaria interventions through primary health care approaches so that malaria services are accessed by the most vulnerable populations wherever they are. In 2021, endemic countries and partners mobilized only 50% of the estimated US$ 7.3 billion required globally to stay on track to defeat malaria. We, therefore, call on our Member States to keep malaria high on their agendas as they allocate resources to health.
On innovation, there is a great need to increase the number and efficacy of control tools and strategies so that interventions can have a greater impact. In this light, WHO recently prequalified new dual active ingredient insecticide-treated nets and several insecticides for indoor residual spraying. The new RTS,S vaccine deployment has been extended beyond the three initial countries, and several other innovative products are in the pipeline. New tools and strategies are needed to address the threats of drug resistance, insecticide resistance, and new invasive vectors that compromise gains in vector control. In this regard, we recently launched two strategies to support countries in the African continent as they work to build a more resilient response to malaria: (1) A strategy to curb antimalarial drug resistance and (2) an initiative to stop the spread of the new invasive Anopheles stephensi malaria vector – a dangerous vector that breeds in urban areas and has the potential of increasing transmission. Fighting against malaria vectors will require multisectoral actions and the involvement of decentralized administrative units and communities to sustain behavioral change and uptake of these tools. A new global framework to respond to malaria in urban areas, developed jointly by WHO and UN-Habitat guides city leaders and stakeholders. Meanwhile, a robust research and development pipeline is set to bring a new generation of malaria control tools that could help accelerate progress towards global targets.
Finally, on implementation. We’ll prioritise this segment as part of the 2023 campaign, and the critical importance of reaching marginalized populations with the available tools and strategies to reduce transmission for present and future gains. Malaria programmes should be decentralized to the district and community levels where health systems are closest to the affected populations. We must empower frontline health workers and communities to participate fully in identifying key barriers in accessing services, ensure effective implementation of malaria control strategies and hold their leaders accountable for health outcomes.
World Malaria Day gives us an opportunity to renew political commitments and bolster investments in malaria prevention and control. Therefore, I call on each Member State to redouble its commitment to implement an ambitious and innovative acceleration plan to rapidly reduce the burden of malaria and save the lives of its populations. This can be done by ensuring that everyone, everywhere, has access to the quality and affordable malaria services they need. This will require a more granular understanding of who is missing out, why they are vulnerable, and what are their barriers to accessing malaria preventive and treatment services. To achieve this, Governments need to mobilize more resources and technical capacities at domestic and international levels and build effective partnerships and multisectoral mechanisms to help strengthen preventive measures and improve coverage of malaria case management Services.
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