The World Malaria Day is marked on 24 April each year, and the theme for this year’s World Malaria Day is “Ready to beat Malaria”. WHO joins partner organizations to call for collective efforts and commitment of the global malaria community to unite for a world free of malaria.
The 2017 World Malaria Report highlighted the remarkable progress achieved in malaria control, but also noted the worrying trend that progress has stalled. The current pace is insufficient to achieve the 2020 milestones of the WHO Global Technical Strategy for Malaria 2016–2030 – specifically, targets calling for a 40% reduction in malaria case incidence and death rates.
WHO's global technical strategy for malaria, 2016-2030
In May 2015, the World Health Assembly approved WHO’s Global Technical Strategy for Malaria 2016–2030, a 15-year blueprint for all countries working to control and eliminates malaria. The strategy set ambitious targets for 2030, including reducing malaria case incidence and death rates by at least 90%, eliminating malaria in at least 35 countries, and preventing the resurgence of malaria in all countries that are malaria-free.
This global technical strategy is based on 3 key pillars: ensuring universal access to malaria prevention, diagnosis and treatment; accelerating efforts towards elimination and attainment of malaria-free status; and transforming malaria surveillance into a core intervention.
Interim 2020 targets call for 40% reductions in malaria case incidence and death rates and for the elimination of malaria in at least 10 countries. Less than half of the world’s 91 countries with malaria transmission are on track to achieve these interim targets for case incidence and mortality reductions. However, prospects for achieving the 2020 elimination target are bright: WHO’s “Eliminating Malaria” report, published in 2016, and identified 21 countries with the potential to achieve at least one year of zero indigenous cases of malaria by 2020.
Global progress and disease burden
Countries with ongoing transmission are increasingly falling into one of two categories: those moving towards elimination and those with a high burden of the disease that have reported significant increases in malaria cases.
Lessons from sub-Saharan Africa, which accounts for 90% of the global malaria burden and 91% of malaria deaths, showed that insecticide-treated nets have had the greatest impact, accounting for an estimated 69% of cases prevented through control tools.
Together with diagnosis and treatment, WHO recommends a package of proven prevention approaches, including insecticide treated nets, spraying indoor walls with insecticides, and preventive medicines for the most vulnerable groups: pregnant women, under-fives and infants, patients with HIV/AIDS, as well as non-immune migrants, mobile populations and travellers.
According to the World Malaria Report 2017, released in November 2017, there were 216 million cases of malaria in 2016, up from 211 million cases in 2015. The estimated number of malaria deaths stood at 445 000 in 2016, a similar number to the previous year (446 000).
Reductions in malaria case incidence and deaths (2010-2015)
| WHO Region | Case incidence rate reduction | Mortality rate reduction |
|---|---|---|
| Europe | 100% | 100% |
| South-East Asia | 54% | 46% |
| Americas | 31% | 37% |
| Western Pacific | 30% | 58% |
| Africa | 21% | 31% |
| Eastern Mediterranean | 11% | 6% |
| Global | 21% | 29% |
Lao PDR progress and disease burden
In terms of reducing the malaria burden in Lao PDR, the number of national cases fell by 92% since 2002, and the goals of the current national malaria strategic plan to eliminate the more deadly P. falciparum parasite strain from all northern and central provinces by 2020, and to eliminate all malaria from the entire country by 2030, is well on track (Figure 1). Malaria related deaths have also decreased dramatically, from 24 in 2000, to now be consistently below 5 deaths per year. There have also been significant successes in the national malaria program outcomes as well, with the percentage of confirmed cases receiving a treatment being above 95% since 2015 and the proportion of targeted high risk populations being protected by long lasting insecticide impregnated bednets at 98%.
Figure 1: National malaria goals (API = number of cases per 1,000 population)
Antimalarial drug resistance
Resistance to antimalarial medicines is a recurring problem. Resistance of P. falciparum to previous generations of medicines, such as chloroquine and sulfadoxine-pyrimethamine (SP), became widespread in the 1950s and 1960s, undermining malaria control efforts and reversing gains in child survival.
WHO recommends the routine monitoring of antimalarial drug resistance, and supports countries to strengthen their efforts in this important area of work.
An ACT contains both the drug artemisinin and a partner drug. In recent years, parasite resistance to artemisinin has been detected in 5 countries of the Greater Mekong subregion: Cambodia, Lao People’s Democratic Republic, Myanmar, Thailand and Viet Nam. Studies have confirmed that artemisinin resistance has emerged independently in many areas of this subregion.
In 2013, WHO launched the Emergency response to artemisinin resistance (ERAR) in the Greater Mekong Subregion, a high-level plan of attack to contain the spread of drug-resistant parasites and to provide life-saving tools for all populations at risk of malaria. But even as this work was under way, additional pockets of resistance emerged independently in new geographic areas of the subregion. In parallel, there were reports of increased resistance to ACT partner drugs in some settings. A new approach was needed to keep pace with the changing malaria landscape.
Consequently, WHO’s Malaria Policy Advisory Committee in September 2014 recommended adopting the goal of eliminating P. falciparum malaria in this subregion by 2030. WHO launched the Strategy for Malaria Elimination in the Greater Mekong Subregion (2015–2030) at the World Health Assembly in May 2015, which was endorsed by all the countries in the subregion. With technical guidance from WHO, all GMS countries have developed national malaria elimination plans. Together with partners, WHO will provide ongoing support for country elimination efforts through the Mekong Malaria Elimination programme, a new initiative that evolved from the ERAR.
A high-level meeting to ‘Accelerate the Elimination of Malaria in the Greater Mekong Subregion by 2030’ was convened by the Ministry of Health and Sports, Myanmar, on 8th December 2017 at Naypyidaw, in close collaboration with the World Health Organization (WHO) and the Asia Pacific Leaders Malaria Alliance (APLMA). Representatives from the six GMS countries, including Lao PDR, stressed that eliminating malaria in the GMS required urgent and coordinated action, with support from implementing agencies, funders and other partners. A ‘Ministerial Call for Action to Eliminate Malaria in the Greater Mekong Subregion by 2030’ was endorsed by the country representatives and supported by partners. The agreement marks an important milestone for combating resistance to malaria as a greater public good for the whole world.