An unprecedented mobilisation of the international community to fight malaria, as well as massive investments since the beginning of the century have allowed cutting by half the mortality rate of the disease globally.
Since 2000, 11 countries have been declared malaria free and several countries are on the road to eliminate malaria. Yet, the parasitic disease transmitted by the Anopheles mosquito keeps being a threat for the health of 50% of the world population living in malaria-prone regions.
In 2018, 228 million cases and 405,000 deaths were recorded. Ninety-three per cent of malaria cases were in Africa, mainly among children under 5 and pregnant women, who are the most vulnerable to the disease. 67% of malaria deaths were in children under 5.
Gender inequalities hinder access to prevention and care. Reaching out to the most vulnerable, particularly to displaced people, is a major factor of success against malaria, as is against all other epidemics. Fifty per cent of all malaria cases occur in just 6 countries: Nigeria, the Democratic Republic of Congo. Uganda, Ivory Coast, Mozambique and Niger.
Progress against the disease were achieved thanks to massive vector control efforts, either through indoor residual spraying (IRS) or the distribution of long-lasting mosquito nets impregnated with insecticide (ITNs), diagnosis tests, and Artemisinin-based combination therapies (ACT). While research for the development of an antimalarial vaccine is encouraging and would add a new tool to the existing arsenal to fight the disease, its development and provision to all populations in need is not yet at a wide use stage.
Today, progress seems to stall, and stagnation could well be a step backwards in the fight against malaria. The number of declared cases has increased from 214 million in 2015 to 228 million in 2018. However, in 2018, 49 countries reported fewer than 10,000 cases of indigenous malaria, compared to 40 in 2010. The number of countries with fewer than 100 cases of indigenous malaria increased from 28 in 2010 to 51 in 2018, with 24 countries reporting fewer than 10 cases.
Since 2010, USD 9,4 billion have been directed to malaria high burden countries. 82% came from international sources. However global financing is stalling. US$ 5 billion annually would be necessary to progress towards malaria elimination by 2030. Yet, available funding reaches only US$ 2.7 billion / year, i.e. just over 50% of the financing needed.
In addition, resistance of the parasite to artemisinin, the only available drug against malaria, develops. The Anopheles mosquito also shows resistance to insecticides used to impregnate nets:
- Partial resistance to ACTs was observed in the Greater Mekong region. Nevertheless, ACTs are still effective in endemic regions. Monitoring the efficiency of antimalarial drugs is necessary to adapt treatments and prevent the expansion of resistances.
- Vector control is the first tool to prevent and reduce the risk of transmission of the disease. Its effectiveness depends on the coverage rate in a given geographical area. In 2016, resistance to at least one insecticide was detected in all malaria-prone areas.
- Pyrethroids are the only insecticides used to treat mosquito nets, but resistance to this category of product is growing: 81% of endemic countries declared a resistance, against 70% in 2010. If they lose effectiveness, over 55% of gains achieved through vector control will vanish.
Reducing efforts in the fight against malaria, either through decreased funding, lesser political mobilisation or fewer programmes, could rapidly hamper progress of the last 20 years. Gains in the fight against malaria, though spectacular, remain fragile.