Over the last decade and a half, the world’s fight for malaria eradication has yielded tangible results. According to the 2015 World Malaria Report, there has been a sharp decline in the global malaria incidence since 2000 with the malaria-related targets of the Millennium Development Goals (MDGs) achieved.

In 57 countries malaria cases reduced by 75%. In addition, the European region reported zero indigenous cases of malaria for the first time since the World Health Organization (WHO) began keeping track.

Globally, the number of malaria cases fell from an estimated 262 million in 2000 to 214 million in 2015, a decline of 18%; the number of deaths fell from an estimated 839,000 in 2000 to 438,000 in 2015, a decline of 48%.

Sadly, most cases and deaths in 2015 are estimated to have occurred in the WHO African region, 88 percent, followed by the WHO Southeast Asia region.

The overall numbers are encouraging. In the four decades before this, malaria eradication had almost slipped off the global health agenda despite a much-trumpeted Global Malaria Eradication Program in 1955.

While this campaign succeeded in eliminating malaria from Europe, North America, the Caribbean and parts of Asia and South-Central America it made no headway in sub-Saharan Africa. The program was abandoned in 1969 largely on account of the failure in tackling the technical challenges of executing any reasonable strategy in Africa.

Subsequently, the attention of the world shifted to other scourges like HIV. In small pockets research was being done on advances in drug and vaccine development, vector control and insecticide-treated nets, but little was achieved on the ground.

The latest numbers then, showing the real gains made in the battle against the disease particularly in Africa, are a welcome sign and owe much to initiatives by Civil Society Organizations (CSOs) such as non-governmental organizations (NGOs) and faith-based organizations (FBOs).

They bring much-needed technical as well as cultural expertise along with economies of scale to reach larger sections of populations in afflicted countries. Prominent among these are The Bill & Melinda Gates Foundation, Malaria Eradication Project (MEP) and the President’s Malaria Initiative (PMI).

In the fight against the killer disease, insecticide-treated mosquito nets (ITNs), indoor residual spraying (IRS), chemoprevention in pregnant women and children and treatment with artemisinin-based combination therapies (ACTs), have been the most effective methods.

Despite this tremendous progress, much more needs to be done to further reduce malaria’s burden. The Global Technical Strategy for Malaria 2016–2030 approved by the World Health Assembly in May 2015, set ambitious targets for 2030, including a reduction of at least 90% in global malaria incidence and mortality.

There are major challenges ahead. Decreases in malaria incidence and mortality have been slowest in countries that had the highest number of malaria cases and deaths in 2000.

As expected, malaria is concentrated in countries with weaker health systems and lower national incomes. In sub-Saharan Africa in 2014, some 269 million of the 834 million people at risk of malaria lived in households without nets or access to spraying.

In addition, the effectiveness of insecticide-based vector control is threatened as malaria mosquitoes develop resistance to the insecticides used in ITNs and IRS.

These are going to be the biggest hurdles in the way of eventually eliminating malaria from most parts of the world. However, with continued assistance from the global community, it seems likely that malaria will go the way of polio and smallpox over time.

– Mallika Khanna

Photo: Flickr