Progress seen in world malaria report
Dr Margaret Chan
Director-General of the World Health Organization
Members of the press, ladies and gentlemen,
I commissioned these annual world malaria reports in 2008. At that time, endemic countries and their development partners were making unprecedented efforts to expand population coverage with effective preventive and treatment interventions.
To maintain momentum, results must be measured. To guide corrective strategies, problems must be identified. Good baseline data and regular monitoring of changes are needed to support both of these objectives.
The 2010 report provides country-specific data, from official government reports, health facility data, household surveys, estimates and models, for each of the world’s 106 countries where malaria remains endemic.
Forty-three of these countries are in sub-Saharan Africa, which is the heartland of malaria in terms of the number of cases and deaths and the severity of illness. Progress in this part of the world gives us our toughest measure of success.
The report sets out data in the main areas important for malaria control, from financial resources to the impact of specific interventions and the extent to which WHO recommendations are being followed.
The 2010 report has two main messages.
First, investment in malaria control brings results. After so many years of deterioration and stagnation in the malaria situation, countries and their development partners are now on the offensive.
Current strategies work. The results set out in this report are the best seen in decades.
In Africa, the distribution of insecticide-treated mosquito nets has increased dramatically. In less than three years, the number of nets distributed has come tantalizingly close to the target of 350 million set in 2008.
Many considered that target as impossibly ambitious. We are nearly there through the largest scale-up of a malaria intervention in Africa’s history. Household surveys indicate that a very high proportion of these nets are actually being used.
Also in Africa, the number of people protected by indoor residual spraying of insecticides rose 6-fold, from less than 13 million in 2005 to 75 million in 2009.
Artemisinin-based combination therapies, or ACTs, are our most effective antimalarial drugs. Worldwide, the number of ACT treatment courses procured increased from just over 11 million in 2005 to 158 million in 2009.
Such massive increases in the delivery of interventions have brought results. Worldwide, the estimated annual number of malaria deaths dropped from nearly 1 million in 2000 to 781,000 in 2009.
Eleven of Africa’s 43 endemic countries are now reporting reductions of greater than 50% in either confirmed malaria cases or deaths over the past decade.
Outside Africa, the malaria map is shrinking, as more and more countries eliminate malaria from their territory. Each country that eliminates malaria benefits all others, but most especially its immediate neighbours.
Ladies and gentlemen,
The second main message is this. Progress, on every front, at every level, is fragile.
Malaria is an extremely complex disease that has been causing deaths and social disruption since the beginning of recorded human history. This is a disease that can take full advantage of any lapse in investment, vigilance, or control.
Beginning in 2000, funding for malaria control rose sharply year after year, but this upward trend appears to have levelled off in 2010.
Current methods of malaria control are highly dependent on a single class of insecticides, the pyrethroids, and on a single class of effective drugs, ACTs. Based on historical patterns, mosquito resistance to insecticides and parasite resistance to drugs must be anticipated.
Resistance to artemisinins was confirmed in 2009 in the Greater Mekong subregion, the traditional epicentre for drug-resistant malaria. Since that time, WHO has been working with affected countries and partners to contain the spread of resistant parasites.
A threat of this magnitude requires a broad global response. Next month, WHO, together with the Roll Back Malaria Partnership, will be launching a global plan for the containment of artemisinin resistance.
Two things need to be done right now.
First, this past year, WHO recommended that all suspected cases of malaria be confirmed by a diagnostic test before antimalarial drugs are administered.
Massive scale up of prevention has produced real changes in malaria transmission. It is no longer appropriate to assume that every African child with a fever has malaria and needs antimalarial treatment.
Inexpensive, quality-assured rapid diagnostic tests are now available that can be used right down to the community level. Using these tests cuts down the over-prescribing of ACTs and guards against resistance.
Second, the use of oral artemisinin-based monotherapies, which contain only a single drug, fosters the spread of resistance to artemisinin and directly threatens the therapeutic life of ACTs.
As of November 2010, 25 countries, mostly in Africa, were still allowing the marketing of artemisinin-based monotherapies, and 39 pharmaceutical companies, mostly in India, were manufacturing these products.
My message is clear: get these products off the market.
To continue to produce and market monotherapies is irresponsible. If we lose the ACTs, we are back to square one. There are no replacement drugs on the immediate horizon.
The estimated yearly number of malaria cases, though declining, is still 223 million. That would be a huge and totally unacceptable number of people to be left with no effective treatment.