A special hearing in the European Parliament has heard that the global burden of malaria has declined dramatically since the inception of the millennium development goals (MDGs) in 2000. However, a great deal of work remains. The meeting marked the forthcoming launch of the WHO ''World Malaria Report'' for 2015.
UK ECR MEP Nirj Deva, a Vice-Chair of Parliament's development committee, hosted the hearing, which examined progress towards malaria elimination.
Deva pointed out that malaria had been a killer since the dawn of humanity. Although better control had, "prevented the premature deaths of 3.9 million African children between 2001 and 2013," the disease still kills around 400,000 people each year.
He emphasised that some of the most effective solutions need not be sophisticated; used properly, a simple mosquito net costing less than €1.50 was enough to make a substantial difference.
Mosquitos are developing resistance to insecticides, a cause for major concern. "We need to think up new ways of developing effective treatments," he said.
Richard Cibulskis, coordinator for strategy, evidence and economics for the WHO malaria programme, introduced the 2015 World Malaria Report. He highlighted that there had been a number of success stories in the last 15 years, but that challenges remain.
In particular was the fact that "the countries with the highest malaria burden had the weakest health systems." They also "tended to be the poorest, and the least ability to do anything about."
WHO has worked with partners to devise a global strategy for the coming 15 years. This, he said, "aims to reduce malaria case incidence by a further 90 per cent between 2016 and 2030; reduce malaria mortality rates by a further 90 per cent and eliminate the disease from another 35 countries."
This will require an annual investment of about €8bn, some three to four times higher than current levels. The challenge will be, however, to make a difference in those countries where the infrastructure is weakest.
Sylvia Meek, technical director for the Malaria Consortium, examined the key challenges in achieving these new goals. Malaria has less prominence in the new sustainable development goals (SDGs) than it did in the preceding MDGs.
However, she said there were opportunities. She felt that "political will has stayed with malaria" during the transition to the SDGs and that, "funding had increased beyond the dreams of those people who had worked on malaria in previous decades."
She identified four main challenges for the coming 15 years; strengthening delivery systems, maintaining adequate funding, striking an appropriate balance between countries with strong and weak healthcare systems and dealing with the issue of growing insecticide and drug resistance.
She highlighted the concern that, in some countries, the drive toward malaria elimination risked being a victim of its own success. As numbers decreased, it became perceived as less of problem, and ceased to attract the resources or attention required.
Octavian Bivol, senior advisor for relations with the EU institutions for Unicef, reminded the audience of the particular threat that malaria poses for young children, notably the under-fives. They are the most likely to die as a result of the disease. "Over the last 15 years, out of the 6.2 million lives saved from malaria, around 6 million were under five."
He pointed out that, "effective interventions do exist, and when they are delivered, they do work." Yet despite the effectiveness of approaches such as insecticide-treated bed nets, around 25 per cent of children were not benefiting from these. The challenge of maintaining momentum remains.
He urged stakeholders work together with Unicef to find the best ways to deliver these life-saving interventions to those communities that are currently underserved.
Jan Paehler, policy office responsible for global health initiatives in the European Commission's directorate for development cooperation, began with a highly personal perspective. He had contacted malaria twice when living and working in Ghana. He said that this experience gave him perspective on how much progress has been achieved in recent years.
However, the job is not done. Malaria continues to be a priority of EU development is because it is a poverty related-disease. "We don't know whether malaria is a cause or a symptom of poverty, but we do know the two go hand in hand," he explained.
He pointed out that the elimination of malaria in the EU has coincided with great economic progress at the time and subsequently.
The link with poverty and the fact that disease is particularly dangerous for children and pregnant women were strong reasons to pursue current efforts in malaria. However, it is a very difficult disease to control. Diagnostics need to be sophisticated, and we still lack a truly safe and effective vaccine.
He explained the three pillars of the EU's support. It supports research, it supports the global partners and initiatives active in malaria control and we have bilateral cooperation with partner countries.
Michael Johnson, head of technical advice and partnerships at the Global Fund to fight Aids, TB and malaria. He explained that there was a global strategy to eliminate malaria; this requires higher short-term investment to generate a situation of long-term lower investment. The challenge was to create sufficient financial and political momentum to get over this hump, so that progress to date was not lost.
The Global Fund has been very successful to date. Of the 6.2 million premature deaths prevented, its funding had contributed to almost three quarters of those.
The future for the Global Fund were to ensure that countries - especially those with the least ability to pay - continued to purse malaria eradication, and not divert funds away to other initiatives. It would also seek to help build and support sustainable and resilient systems for health.
He highlighted the need to work with its global partners to provide "integrated platforms at the service delivery site, that effectively channel resources," especially in those areas with limited resources.
Following the interventions, Geoffrey Van Orden, also a UK ECR member, raised the issue of the commitment of host governments. He wondered whether there was a concern that the shift in responsibility to external agencies somehow allowed national governments to 'wash their hands' of their duties. He suggested pairing countries; matching donors with aid recipients, so that donors could see the impact of their aid.
The full WHO World Malaria Report report is available for download here: http://www.who.int/malaria/publications/world-malaria-report-2015/en/