Threatened reductions in foreign aid from the European Union and its struggling governments could undermine efforts to combat malaria, a readily preventable disease that nonetheless takes a heavy health toll in poor nations, international health experts say.
With aid spending on the chopping block in the EU’s 2014-2020 budget draft and many European capitals failing to meet their commitments to poor nations, health organisations are bracing for cuts in financing to prevent malaria. The disease kills an estimated 655,000 people every year and sickens millions more.
“Malaria is a disease of poverty which unfortunately keeps people on a downward spiral of poverty, so I am a strong believer that higher-income countries have both a responsibility and moral obligation to countries of lower-income status to break the scourges that are keeping development from occurring,” said Dr. Scott Filler, senior technical advisor on malaria at the Geneva-based Global Fund, an international institution that finances treatment and prevention of AIDS, tuberculosis and malaria.
“The EU’s commitments to the Global Fund are incredibly important, and I think that malaria control is a very significant return on your investment,” Filler said, adding that he hopes that “wealthier countries commit as much money as they can, within their fiscally stressed environments, to these really important endeavours.”
The Global Fund already estimates that money from its biggest contributors – which include the European Commission, EU member states, the United States and Japan – will decline from $3.5 billion in 2012 to $3.3 billion in 2013.
The organisation’s data show that contributions from private foundations and companies are also shifting downwards, from $181.6 million to $164 million, for an overall 6% drop.
WHO concerned about funding
Last month, the World Health Organization (WHO) warned that funding for prevention and control has levelled off after rapid expansion between 2004 and 2009. In a statement accompanying the release of its annual World Malaria Report, the UN health body said “these developments are signs of a slowdown that could threaten to reverse the remarkable recent gains in the fight against one of the world’s leading infectious killers.”
WHO Director-General Margaret Chan called for more than doubling annual donor commitments to malaria prevention from $2.3 billion to $5.1 billion (€1.7bn to €3.9bn).
That seems unlikely given the challenges facing development aid overall. In Europe, billions of euros in spending to support poorer nations is at stake as national leaders weigh cuts to overseas development assistance.
The EU is collectively the world’s largest aid donor, providing $86 billion (€66 billion) from national governments and EU institutions – or 55% of the world total in 2011, according to the Organisation for Economic Co-operation and Development.
But austerity measures could cost the EU’s aid budget nearly €10 billion for the period running from 2014 to 2020 under proposals being discussed by EU leaders.
Similar budget paring in the United States and Japan are already threatening aid programmes.
Overhaul at Global Fund
Spending for malaria and other ailments suffered another setback when the Global Fund temporarily suspended project financing in 2011 amid internal squabbles and allegations of theft in a few recipient countries. The problems led to the appointment of a new director last year and overhaul of how the organisation hands out money.
The fund operates in 77 countries and since its creation in 2002, has provided around half of overall funding for malaria prevention and control, data show.
Health experts echo the WHO in saying that losses in aid could hamper progress measured since the United Nations set out its Millennium Development Goals (MDGs) in 2000 to reduce disease, hunger and poverty. Since then, the mortality rate from malaria has fallen 25% worldwide and 33% in Africa, where 90% of malaria-related deaths occur, WHO data show.
Still, the malaria situation is worsening in some of sub-Saharan Africa’s most populous countries, including the Democratic Republic of Congo and Nigeria, where the full extent of problems is difficult to assess because of spotty monitoring.
‘Breakdown of control’
“The battle against malaria might be successful in some African countries, some Asian countries, but there are still quite some spots on the map where malaria is not decreasing,” Dr. Jorgen Stassijns, malaria advisor and specialist in tropical disease at the Belgian branch of Médecins Sans Frontières.
“Basically what is happening in a place like Congo is the complete breakdown of malaria control – breakdown meaning there is no surveillance for malaria any more, so people don’t know how big the problem is; there is no prevention available and there are no treatments available. And then you see the result is the number of cases starts to increase again.”
The irony in potential loss of international aid is that the cost of battle malaria is relatively cheap. The disease is transmitted by mosquitoes, so eliminating stagnant pools of water where the insects breed is a no-cost start. Sleeping under bed nets treated with insecticides has been heralded as a leading factor in declines of malaria, particularly among children at a price of around €2.
Health experts say that even small cuts can hurt progress, noting that prevention requires public awareness, bed nets need to be replaced over time and treatment requires consistent supplies of medications.
Risk of malaria increase
Stassijns says that cutting treatments and prevention because of lost budgetary support means “you might risk that malaria increases again,” he told EurActiv. “It’s a very simple thing.”
The Global Fund’s Filler says the governments in beneficiary countries also have an important role to play in providing support for preventing malaria.
“In some countries there’s a sense of complacency around malaria,” he said. “It’s something that some of the political figures have lived their lives with malaria, think it’s something that we just become comfortable with and become accepted to it. So in certain places there isn’t the political will or commitment, but where there is political will and commitment, the resources flow and the programmes are successful.”
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Margaret Chan, director-general of the WHO, has argued for bigger commitment from donors in the fight against malaria. In the foreword to the UN organisation’s latest World Malaria Report, she says “the available funding still falls short of the resources required to reach the health-related Millennium Development Goals and other internationally-agreed global malaria targets. An estimated US$ 5.1 billion is needed every year between 2011 and 2020 to achieve universal access to malaria interventions.
"At present, only US$ 2.3 billion is available, less than half of what would be needed. There is an urgent need to identify new funding sources in order to further scale up and sustain malaria control efforts, and to protect the investments made in the last decade. We also need to examine new ways to make existing funds stretch further by increasing the value for money of malaria commodities and the efficiency of service delivery.”
“Malaria is one of the most important communicable diseases but it’s not really an expensive disease to treat or to prevent,” Dr. said Dr. Jorgen Stassijns, malaria advisor and specialist in tropical disease at the Belgian branch of Médecins Sans Frontières.
“Basically the tools we have are not very expense. Why do they not want to put sufficient money malaria control, it’s really a matter of priorities. I think HIV, for example in the ‘90, was well known and people were very active on HIV. For malaria, you don’t have this movement of patients of malaria fighting for the disease like you had for HIV, for example. It’s a disease of small children, it’s not an adult disease. So children, they don’t speak for themselves. It’s maybe less visible but it kills quite a lot people.”