A new study in Malaria Journal surveys the literature to determine why and where resurgences in malaria occur. CDDEP’s David Smith, Senior Fellow and Associate Director for Research, participated in the study, which is timed with the annual World Malaria Day on April 25th. The article is available online (open access) and the press release is copied below. You can also read coverage of the work in BMJ (subscription required).
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Malaria resurgence is linked to weakening of malaria control programs
Since the 1930s, there have been 75 documented episodes of malaria resurgence worldwide, most of which were linked to the weakening of malaria control programs, finds a new study published in BioMed Central s open access Malaria Journal. The study, which is closely related to this year s World Malaria Day (25th April 2012) theme of “Sustain Gains, Save Lives: Invest in Malaria”, found that the most common reason for the weakening of malaria control programs was funding disruptions.
Researchers from the Clinton Health Access Initiative, the Johns Hopkins Malaria Research Institute, the Center for Disease Dynamics, Economics and Policy, and the Global Health Group at the University of California, San Francisco conducted a systematic review of the literature to identify all documented malaria resurgence events. Malaria resurgence refers to the situation in which malaria returns to a region after having previously been suppressed through malaria control activities such as distribution of bed-nets or spraying with insecticide. All causes of these resurgence events suggested in the literature were categorized according to whether they were related to weakened malaria control programs, increased potential for malaria transmission, or technical obstacles like resistance of the malaria parasite to drugs. Sixty-eight of the 75 resurgence events (91%) were blamed on the weakening of malaria control programmes.
Lead author Justin Cohen, PhD, MPH of the Clinton Health Access Initiative explains, Malaria control programmes have been shown to be extremely successful in reducing the number of cases of malaria to very low levels, but history demonstrates that gains can be lost rapidly if financial and political support is not sustained. Finding ways to ensure continued funding for malaria control today will be crucial to building on the gains of the past decade.
Investments in malaria control have created unprecedented momentum and yielded remarkable returns in the past years. In Africa, malaria deaths have been cut by one third within the last decade; outside of Africa, 35 out of the 53 countries affected by malaria have reduced cases by 50% in the same time period. However the future of anti-malaria programmes is uncertain as current funding is projected to decline over the next few years.
Sir Richard Feachem, KBE, FREng, DSc(Med), PhD, who was the founding Executive Director of the Global Fund to Fight AIDS, Tuberculosis and Malaria, and is current Director of the UCSF Global Health Group, calls on the malaria community and donors to heed these results to ensure continued achievements against the disease. This work provides historical evidence that there is great risk in turning our attention away from malaria once it seems like the disease burden has been reduced. This paradox of success needs greater attention to protect and extend our investments in malaria control and elimination.
According to the World Health Organisation, there were an estimated 216 million cases of malaria and 655,000 deaths in 2010, with 86% of all cases occurring in children under five years old. Ninety-one percent of malaria deaths occurred in Africa.
Access to effective treatment and prevention, including insecticide-treated mosquito nets and indoor residual spraying, has increased dramatically in recent years, and reported malaria cases were reduced by more than 50% in 43 of the 99 countries with ongoing transmission between 2000 and 2010.
These gains in have been made possible by an increase in international funding for malaria control from only $300 million in 2003 to almost $2 billion in 2009. However, uncertain economic times have led to expected declines in malaria funding, including the cancelation of the latest funding round from the Global Fund. Despite these cutbacks, ensuring sufficient and sustained funding for malaria control and continued implementation of key interventions even once the disease is absent or low must be the utmost priority if resurgence of malaria is to be prevented.
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