Africa, Development & Aid, Headlines, Health

HEALTH-AFRICA: Renewed Fight Against Old Killer

Sarah McGregor

DAR ES SALAAM, Oct 8 2008 (IPS) - The key to a new multi-billion dollar strategy to eliminate malaria deaths worldwide by 2015 is to widen availability of existing diagnostic and preventative treatments.

Explaining proper use of mosquito nets in Kenya -- treated nets are key to malaria prevention. Credit:  Allan Gichigi/IRIN

Explaining proper use of mosquito nets in Kenya -- treated nets are key to malaria prevention. Credit: Allan Gichigi/IRIN

However, that goal, announced by the Roll Back Malaria Partnership at the end of September, may be difficult to achieve because malaria is a major threat in some of the world's poorest nations, where fragile health systems struggle to find money and resources to cope with a slew of other severe and deadly diseases.

There were more than 247 million cases of malaria recorded in 2006; about 880,000 of them fatal, according to the World Health Organization's World Malaria Report released Sep. 18.

Nine out of every ten of those deaths were in Africa, the report said. Malaria, a disease passed to humans through the bite of an infected mosquito, has no vaccine and some strains can be fatal if left untreated.

The Roll Back Malaria Partnership, a collaboration of governments, multilateral institutions, civil society, academics and businesses, aims to save 4.2 million lives by 2015 through its Global Malaria Action Plan.

The plan calls for a massive boost in coverage of simple and effective prevention measures.

They include distributing 730 million insect-repelling bed nets, spraying insecticide in 127 million households, and boosting access to testing and malaria-blocking medicine especially for high-risk pregnant women.

The plan also demands delivery of more treatment – 228 million doses of a new class known as artemisinin-class combination therapy (ACTs), and 19 million doses of the less-effective drugs, chloroquine and primaquine.

Health experts often recommend ACTs, a newer class drug, over older treatments which have built up a resistance to the the malaria infection.

One health expert warned against a one-size-fits all approach in the fight against malaria. For instance, over-stretched national health care ministries in some nations may be unable to coordinate a massive anti-malaria campaign in such a short time frame.

"These methods being proposed would reduce transmission and the number of cases. I believe achieving better control is possible," Robert Black, chair of the Department of International Health at the Johns Hopkins Bloomberg School of Public Health, said in an interview.

"But it has to be individualised to every country to be money well-spent. In addition, primary health and basic services must be strengthened for good outcomes."

Even with these tools provided free-of-charge, ensuring their proper use will be a challenge. Tiny health care budgets in African nations have left hospitals under-funded and prompted an exodus of medical workers abroad in search of higher-paying jobs.

Extra community-based and voluntary health workers will have to be trained to help with implementation.

"We can only do so much with funding, interventions, and technical assistance," Ray Chambers, the UN special envoy for malaria said in a media teleconference from New York City last week.

After that, "it will matter with what happens on the ground with distribution, education, and how to use the nets."


The plan calls for the international community to invest 5.3 billion dollars next year, rising to $6.2 billion in 2010 and then $5.1 billion every year to 2020. That's more than five times the current annual spending on anti-malarial efforts $1.1 billion.

Financing to develop new, more effective drugs and research vaccines is pegged at another $8.9 billion over 10 years, the plan said. However, Africa alone suffered a $1.6 billion funding gap for programs to curb malaria between 2007-2009, it added.

Going forward, donors may be motivated to give generously because case studies show that efforts to curb malaria have brought "return on investment," Chambers, the UN malaria envoy, said.

This approach has seen the African nations of Eritrea and Rwanda succeed in more than halving the number of malaria cases between 2000 and 2006, he said.

The Indian Ocean archipelago of Zanzibar, off the coast of Tanzania, has eliminated malaria as a major public health threat for its 1-million strong population. Tanzania received 334 million dollars for anti-malaria measures this year from the U.S. President’s Emergency Plan for HIV/AIDS Relief and the President’s Malaria Initiative (PMI).

The number of malaria cases on the islands has dropped to a "low level," according to the website of the PMI, a U.S. government funded program. That means Zanzibar is just short of meeting the WHO's criteria for pre-elimination status – less than 1 case of confirmed malaria among 1,000 persons with fever, it said.

The approach in Zanzibar was three-pronged – a combination of ACTs, long-lasting treated bed nets for pregnant women and children under five, and indoor insecticide spraying in 90 percent of homes, Jeffery Salaiz, Public Affairs Officer at the U.S. Embassy in Tanzania, said in an interview.

Two previous efforts to eradicate the disease on the islands in the 1960s and 1980s failed to stick due to inadequate funding, said Salaiz. Zanzibar's current success to combat malaria should stay on track if residents continue to act cautiously such as sleeping under bed nets, he said.

Still, most of the 109 nations endemic for malaria are falling behind a development target for controlling the disease, according to the WHO 2008 World Malaria Report. One of the eight Millennium Development Goals aims to stop and reverse the incidence of malaria by 2015.

Governments and charities in September announced $3 billion in new money to underpin the Global Malaria Action Plan.

The Global Fund to Fight AIDS, Tuberculosis and Malaria pledged $1.62 billion for 100 million bed nets; the World Bank $1.1 billion to expand a malaria booster program and the Bill and Melinda Gates Foundation $168.7 million for the "new generation" PATH Malaria Vaccine Initiative. The UK government, Global Business Coalition, United Nations and Mattell promised the rest.

"If the perfect storm happens… the 2015 timeline for achieving the Millennium Development Goal (on malaria) will be attained. But, even much more important, we are expecting to get near zero deaths from malaria by 2015. I believe it's within our grasp," said Chambers.

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