Past successes should not hide what remains to be done towards complete eradication of malaria, write Maurice Ponga and Cristian Dan Preda.
MEP Maurice Ponga is Vice-President of the European Parliament’s Committee on Development.
MEP Cristian Dan Preda is Vice-President of the European Parliament’s Committee on Development.
As the 2000 Millennium Development Goals (MDGs) were set to be achieved by 2015, the European Year for Development reminds us that Europe can play a key role in fighting against inequalities and poverty, and fostering sustainable socio-economic development at global level. As April focuses on public health challenges in developing countries, it is the right time to take stock of the health targets of the MDGs, and reflect on the priorities for the post-2015 global health agenda.
The Sixth Millennium Development Goals (MDG), which aimed at fighting against malaria, has proven successful, thus showing that tangible results can be achieved thanks to the MDGs. As target 6c of MDGs was to “control malaria and other major diseases and begin to reverse the trend” by 2015, the World Health Organization (WHO) reports that the wide distribution of mosquito nets, malaria treatments and rapid diagnostic tools have contributed to reduce malaria-related mortality by 47% between 2000 and 2013.
However, past successes should not hide what remains to be done towards complete eradication of malaria. To date, malaria remains a major health challenge: it is by far the most important tropical parasitic diseases in the world, making more victims than any other transmissible disease, except for tuberculosis. Although malaria can be prevented and treated, half a million people still die from it each year, mostly in Africa and South-West Asia. Among those, children under five are particularly affected (7% keep lasting neurological sequels).
Furthermore, it has been observed in Southeast Asia (Cambodia, Laos or Malaysia) that the parasite responsible for the major strand of malaria P. falciparum, which is transmitted by the bite of Anopheles mosquitoes, is becoming increasingly resistant to artemisinin-based combination therapies, the first-line treatment recommended by WHO since 2001. In the 1970s and the 1980s, the parasite had developed a resistance to former generations of antimalarial treatments such as chloroquine and sulfadoxine-pyrimethamine, thus undermining the progress of eradication policies. Today, only a new generation of malaria treatments can address this challenge and ensure the elimination of the disease on the long term.
These mixed results show how important it is to continue our efforts towards prevention and control of malaria, not only on the ground but also in the context of the post-2015 framework. Reducing the current efforts at local or international level could hinder advanced eradication processes, as it happened in India in the 1970s and in Panama in the 2000s. Indeed, most of the 75 outbreaks of malaria since 1930 have been attributed to a decline in funding for control programs.
Whilst the support of the international community is crucial and sends a strong political signal, the involvement of all stakeholders remains a critical success factor. In particular, local authorities from endemic countries must adopt a more sustainable approach focusing on the consolidation of health systems rather than ad-hoc responses to emergency situations. Examples in Morocco and Turkey show that the quality of local health infrastructure, the continuous supply of antimalarial drugs and health workers’ skills are critical factors to ensure good health outcomes for affected populations – or populations at risk.
Moreover, the private sector can also be a key partner, as outlined in the European Commission Communication on “A Stronger Role of the Private Sector in Achieving Inclusive and Sustainable Growth in Developing Countries” published in May 2014. Pharmaceuticals companies have provided malaria treatments on a large scale, but they can make a significant difference by developing innovative treatments that can address the growing resistance of P. falciparum. Furthermore, single-dose treatments are a promising research area; whilst existing treatments are currently administered over a couple of days, single-dose treatments would optimize treatment’s uptake, thus improving its effectiveness.
In order to support the progress of international community towards the eradication of malaria, we call on the public and private stakeholders to work together to develop innovative solutions ranging from awareness-raising to prevention, drug supply, access to care and research and development. In this respect, the European and Developing Countries Clinical Trials Partnership, for which Maurice Ponga – co-author of this editorial, was rapporteur in the Development Committee during the previous parliamentary term, demonstrates how multilateral cooperation in clinical trials can contribute to the development of treatments against poverty-linked diseases. Many research projects on malaria and improvement of health policies in endemic countries can help overcome the obstacles previously mentioned and build capacity on the ground.
In line with the work of EDCTP2 and the 2010 Communication on “The EU Role in Global Health”, we believe that the European Union must play a leading role in the post-2015 agenda to address global health issues, and in particular drive the fight against malaria.