A concerted campaign launched in April 2000 in Abuja, Nigeria, led to dramatic reductions in cases and deaths. But about five years ago it stalled. Between 2000 and 2015, global malaria case incidence declined by 27 percent, but between 2015 and 2019 it fell less than 2 percent. In 2019, there were an estimated 229 million malaria cases worldwide, virtually unchanged over four years, and 409,000 deaths, mostly children in sub-Saharan Africa.
Africa bears 90 percent of the malaria burden. The battle against it has fallen far short of the World Health Organization’s targets. The reasons are varied, including that half the children in sub-Saharan Africa are not sleeping under treated nets, a major prevention measure, and mosquitoes’ emerging resistance to insecticide. Overall, experts say, the anti-malaria effort badly needs new tools.
New instruments for the fight include technology such as changing mosquito genes, known as gene drives. Also, one-third or more of children who contract malaria don’t have access to health care for diagnosis and treatment; building stronger and more resilient health-care systems would do wonders. Eleven countries most hard-hit by malaria are engaged in a renewed effort to tailor their responses to local data and intelligence.
Ultimately, effective vaccines will be the best response. A vaccine by GlaxoSmithKline has shown moderate efficacy, about 56 percent, and about 700,000 children have been vaccinated with it, using WHO support, in Malawi, Ghana and Kenya. On April 20, researchers reported positive results with an experimental vaccine in a small clinical trial of 450 toddlers in Burkina Faso. The vaccine, developed at the University of Oxford’s Jenner Institute, showed efficacy of 74 to 77 percent in children. However, a much larger clinical trial is needed, and planned, to verify these preliminary results. The malaria parasite has a complex life cycle, making it a far more difficult target for vaccines than, say, the novel coronavirus. Other quite promising anti-malaria vaccines are also under development, including by the Maryland biotech company Sanaria.
The pandemic has played havoc with the global response to other diseases. A recent survey by the Global Fund to Fight AIDS, Tuberculosis and Malaria showed last month that about half of the countries where malaria is endemic reported moderate or high disruption in their programs. An estimated 1.4 million fewer people received care for tuberculosis in 2020 than the year before. The WHO reports 60 mass immunization campaigns are currently postponed in 50 countries, putting around 228 million people, most of them children, at risk for diseases such as measles, yellow fever and polio.
More than one sickness roils the planet. While putting out the blaze of the coronavirus pandemic, we must not forget the other raging killers.