Rotarians Against Malaria display one of the insecticide treated mosquito nets being used throughout Papua New Guinea. Credit: Catherine Wilson/IPS

By Jim Lobe
WASHINGTON, Dec 11 2013 (IPS)

Enhanced efforts to fight malaria have saved an estimated 3.3 million lives and nearly halved the disease’s global mortality rate since 2000, according to the latest edition of the World Health Organisation’s (WHO) annual “World Malaria Report”, released Wednesday.

But much more needs to be done to eliminate the disease, which last year killed an estimated 627,000 people worldwide, about 483,000 of whom were children under the age of five. That pace averages one malaria-caused child death almost every minute, according to the 253-page report.

Prevention and control measures by multilateral organisations, national governments, private foundations, business and civil society organisations over the past dozen years have been particularly effective in sub-Saharan Africa, which, along with South Asia, has suffered most from the mosquito-borne illness, the report said.

While malaria mortality rates fell by 45 percent worldwide since 2000, the percentage in Africa was 49 percent and 54 percent among African children under five. Similarly, while malaria infections fell by 29 percent globally, infections in Africa, where about 80 percent of malaria cases are found, were reduced by 31 percent, according to the report.

“The remarkable gains against malaria are still fragile,” Robert Newman, who directs WHO’s Global Malaria Programme, told reporters at the report’s release. Several countries over the past 75 years have come close to eliminating the disease only to see it resurge due to complacency and reductions in funding. “A 50 percent reduction is great, but we can’t get to the endgame with that.”"The greatest threat to continued success in malaria efforts is financial."
-- Robert Newman

“In the next 10-15 years, the world will need innovative tools and technologies, as well as new strategic approaches to sustain and accelerate progress,” he emphasised. “The greatest threat to continued success in malaria efforts is financial: we have less than half of the 5.1 billion dollars needed annually to ensure universal access to life-saving interventions.”

Last year’s toll of malaria deaths might have been fallen even more if funds had been available to procure insecticide-treated bed nets, a major prevention measure, in malaria-endemic countries. But, for the second year in a row, bottlenecks caused by insufficient funding resulted in the delivery of only 70 million new bed nets, far below the 150 million annual target.

In 2013, however, that problem appears to have been overcome, as 136 million nets were delivered, and WHO officials are predicting that some 200 million more will be delivered in 2014.

“We are going to see a much more rapid procurement process,” said Joy Phumaphi, executive secretary of the African Leaders Malaria Alliance, a group that includes 39 African heads of state and a former vice president of the World Bank’s Human Development Network.

Due to a recent restructuring of the Global Fund to Fight AIDS, Tuberculosis and Malaria, she said, the time between fund allocation and actual delivery of nets has fallen from 18-24 months to three months. “This is an example of the new efficiencies that have come with the restructuring” of the Fund, she said.

The Fund, a multilateral agency that is by far the most important single source of funds for anti-malaria projects, received a boost earlier this month when donor countries pledged a record 12 billion dollars to its fourth replenishment, which will take it through 2016.

While that total fell short of the 15-billion-dollar goal that the Fund set for itself, it marked a three-billion-dollar increase from its third replenishment in 2009.

That amount should help the global anti-malaria effort come close to the goal of reducing malaria mortality rates for children under five by 75 percent from 2000 levels. The WHO report estimated that if the annual rate of decrease that has occurred over the past 12 years is maintained through 2014, then mortality rates should decrease by 56 percent in all ages and 63 percent for children under five.

Currently 59 countries are on track to meet the 75 percent goal, but they account for only four percent of total estimated malaria cases. That goal will be much harder to reach in the 18 most-affected countries, which include 17 African nations and India. Two African countries – Nigeria and the Democratic Republic of the Congo, whose sheer size makes it difficult to track malaria cases – account for fully 40 percent of all malaria deaths worldwide.

“We can reach 75 percent, but it’s going to take efforts by all of us,” said Newman.

International spending for malaria control rose from 100 million dollars in 2000 to just shy of two billion dollars in 2013, while national governments of affected countries have also increased their funding since 2004. In 2012, they contributed an estimated 522 million dollars.

“The vote of confidence shown by donors last week at the replenishment conference for the Global Fund is testimony to the success of the global partnership,” said Fatoumata Nafo-Traore, executive director of the Roll Back campaign. “But we must fill the annual gap of 2.6 billion dollars to achieve universal coverage and prevent malaria deaths. This is our historic opportunity to defeat malaria.”

In addition to the distribution of bed nets, the most effective interventions now in use include indoor residual spraying (IRS), diagnostic testing, and artemisinin-based combinations therapies (ACTS), which are recommended as the first-line treatment for the most deadly form of malaria.

The proportion of the at-risk population in sub-Saharan Africa sleeping under a bed net in 2013 was 36 percent in 2013, according to the report, which cited studies showing that 86 percent of the population with access to a net actually used it.

IRSs were much less prevalent, accounting for only eight percent of the at-risk population. Mosquito resistance to at least one insecticide used for malaria control has been identified in 64 countries worldwide and represents a major challenge in the anti-malaria fight.

Meanwhile, diagnostic testing to determine whether a patient who shows symptoms of malaria actually has the disease and is treated accordingly and ACTS have been increasing rapidly. In 2012, 331 million ACT courses were procured by public and private facilities in endemic countries – up from only 11 million in 2005.

In addition to ensuring increasing access to these tools, Newman stressed the need for improving surveillance and monitoring systems in most-affected countries. Much more funding is also needed for research and development (R&D) of new insecticides and drugs to overcome resistance to existing products by mosquitoes and the parasite itself.

He also noted the importance of R&D into malaria vaccines, one of which – RTS,S – was shown to almost halve the number of malaria cases in young children (aged 5-17 months at first vaccination) and to reduce the number of cases by about a quarter in infants in late-stage trials in Africa announced in October.

In Swaziland, which has been hard-hit by the AIDS pandemic, an HIV-positive mother sits next to her 18-month-old baby girl. Credit: Mantoe Phakathi/IPS

By Jim Lobe
WASHINGTON, Dec 3 2013 (IPS)

The gap in health standards between the world’s poorest countries and the more advanced middle-income nations could close by the year 2035, according to a major new report published Tuesday by Britain’s The Lancet medical journal.

Written by a group of 25 of the world’s top global-health experts and international economists, Global Health 2035: A World Converging Within a Generation makes the case for the international community, governments and key donors, such as the Bill and Melinda Gates Foundation, to increase investments in health to meet the target.

“Now, for the first time in human history, we are on the verge of being able to achieve a milestone for humanity: eliminating major health inequalities, particularly inequalities in maternal and child health, so that every person on earth has an equal chance at a healthy and productive life,” according to Harvard University professor and former U.S. Treasury Secretary, Lawrence Summers.

“The powerful drugs and vaccines now available make reaching this milestone affordable. It is our generation’s unique opportunity to invest in making this vision real,” said Summers, who 20 years oversaw the preparation of the only ‘World Development Report’ (WDR) devoted to global health when he served as the World Bank’s chief economist.

The 58-page report, which calls for government policymakers to adopt a new approach to measuring the importance of health to their national economies, is being published as the Global Fund to Fight AIDS, Tuberculosis and Malaria – a unique multilateral agency that has approved 29 billion dollars in grants since its founding in 2002 – is meeting here this week to gain new donor commitments for its fourth three-year replenishment.

The three diseases are among the biggest health challenges faced by the world’s poorest countries and poorest people in middle-income nations.

The Fund’s leadership got a big lift here Monday when, at a World AIDS Day ceremony, President Barack Obama pledged continued U.S. support for the Fund, promising to provide one dollar for every two dollars committed by other donors over the next three years, up to a total of five billion dollars.

Bill Gates also announced that his foundation – the single biggest private funder of global health initiatives – will provide up to 500 million dollars through 2016, including 300 million dollars that was previously committed and up to 200 million dollars in new matching grants.

“Don’t leave our money on the table,” Obama said, speaking to many of the delegates who have gathered here for the pledging conference. “Now is the time to replenish the Global Fund.”

The Fund’s new executive director, Mark Dybul, said he was confident that this week’s pledging would significantly exceed the 9.2 billion dollars that was committed at the last replenishment in 2010.

The Lancet report offers what it calls a “roadmap to achieving dramatic gains in global health through a grand convergence around infectious, child and maternal mortality; major reductions in the incidence and consequences of non-communicable diseases (NCDs), and injuries; and the promise of ‘pro-poor’ universal health coverage.”

If followed, the roadmap could result in averting some 10 million deaths across the target countries in 2035 alone, according to the report.

It points to the experience of the “4C countries” – Chile, China, Costa Rica, and Cuba — as models for poor and lower-middle-income countries. All four started off at similar levels of income and mortality as today’s poor countries but, by 2011, had become among the best-performing middle-income nations.

Among the specific goals, according to the report, are reducing under-five mortality to 16 per 1,000 livebirths, and reducing annual AIDS-caused and TB-caused deaths to eight and four per 100,000, respectively.

To achieve these and other aims, the report calls for “aggressively scaling up” efforts to fight HIV/AIDS, TB, and malaria as well as improve maternal- and child-health conditions which were a major focus of the Millennium Development Goals (MDGs); strengthening health systems to focus on the most problematic sectors, including poor rural sub-populations of middle-income countries that are disproportionately affected by infectious diseases; and devoting more and earlier investment to family planning.

In addition, government should be encouraged to pursue fiscal policies – notably by heavily taxing tobacco and other harmful substances, such as alcohol, that can sharply reduce NCDs and injuries, as well as leverage significant new revenue for low- and middle-income countries that can, in turn be used to reduce subsidies on items, such as fossil fuels that produce air pollution which in turn cause NCDs.

Such savings will provide most countries with enough funds to finance many of the steps urged in the report. It thus urges that, while donor countries, which hopefully will include emerging economies, should increase their investment into research and development to produce new drugs, vaccines, and other health technologies.

The report calls for at least a doubling in health R&D from current annual spending of around three billion dollars to six billion dollars by 2020, with half of the increment coming from middle-income countries.

The report argues that the economic returns from investments in health are “much greater” than policy-makers have previously assumed.

The 1993 WDR found considerable evidence that improvements in health increased gross domestic product (GDP) per capita by enhancing childhood educational advances and adult worker productivity, as well as increasing access to natural resources and foreign investment that are encouraged by controlling diseases like malaria.

But the GDP analysis, the Lancet report asserts, measures only the impact of health improvements on economic productivity. It fails to capture the intrinsic value people place on their own improved health, including their greater life expectancy.

A full-income approach combines growth in national income with the value of additional life years (VLY). The report estimates that, on average, across low- and middle-income countries, one VLY – a one-year increase in life-expectancy – is about 2.3 times greater than per capita income.

Using that approach, the report found that, between 2000 and 2011, 24 percent of the growth in full income in those countries resulted from health improvements; that is, in VLYs gained. By the same token, setbacks to life expectancy, such as in countries hit hard by the HIV/AIDS pandemic, resulted in a far greater adverse impact than the impact on GDP per capita would suggest.

“We believe that if nations worldwide adopt a full-income approach to economic planning, the human returns to investing in health can be brought into resource allocation decisions,” said Dean Jamison, a University of Washington professor who co-chaired the Commission with Summers.

“People value a longer and healthier life, and the notion of full income simply places that value in monetary terms. While it does not put a monetary value on an individual’s life, it does place a value on changing mortality risk, which traditional notions of GDP neglect,” he added.