With drug and insecticide resistance on the rise and slow progress in reducing cases and deaths, the clock is ticking on malaria. The EU must join other health leaders and scale up its efforts to fight the disease, writes Charles Goerens.
Charles Goerens is a Member of the European Parliament for Luxembourg. He sits with the Alliance of Liberals and Democrats for Europe (ALDE) and also is the Vice-Chair of Friends of the Global Fund Europe.
A mosquito bite is a nuisance to those who live in Europe. But for nearly half of the world’s population, this bite can inflict severe illness, and even result in death for pregnant women and young children. The disease is malaria, which is caused by parasites in the anopheles mosquito. With drug and insecticide resistance on the rise, and millions still not benefitting from vector control, the clock is ticking on malaria.
In the early 2000s, the international community made immense progress in controlling and starting to eliminate malaria. 7 million lives have been saved, and since 2010, 11 countries have eliminated malaria. Several are on track to do so by 2020. The malaria map is shrinking.
But warning signs have appeared. For the first time in a decade, there were more malaria cases than in the previous year. 216 million cases were reported in 2016 compared to 211 million in 2015, according to the World Health Organization (WHO). Furthermore, progress is stalling in reducing mortality: 445,000 deaths in 2016 down from 446,000 in 2015. And one grim statistic still challenges us: a child still dies every 2 minutes from malaria.
Malaria both causes and results in poverty. People afflicted with malaria or who have family members suffering from it, lose work hours, have to pay for treatment or travel to a clinic or hospital, and pay for funeral costs in the event of a death. The WHO African region has the heaviest disease burden with 90% percent of cases worldwide.
Thanks to better science, we know that malaria results in losses of $12 billion per year and 1.3% of lost annual GDP growth in Africa. Yet in malarial regions, 45% of people do not sleep under insecticide treated nets (ITN). Unfortunately, it is also in Africa where the first signs of insecticide resistance are appearing, although experts insist that nets and indoor residual spraying (IRS) still offer great amounts of prevention in most settings.
A resurgence of malaria would take a very grim and tragic toll on the world’s most vulnerable and poorest populations. Scientists have been ringing the alarm bells, and international and health leaders are responding.
In the Greater Mekong area of Southeast Asia, which includes Thailand, Cambodia, Vietnam, Myanmar and Laos, efforts are underway to tackle artemisinin resistance, the standard medicine which is combined with at least one other antimalarial drug to form artemisinin-based combination therapy (ACT). With mortality rates low in the region, the development is puzzling, but there are proposals to inoculate entire village populations with a triple form of ACT.
Kenya, Ghana, and Uganda are taking the first steps in implementing a vaccine pilot, though it is a partial vaccine that needs to be ministered in addition to ACT. It is not a replacement. Nevertheless, children, especially, would benefit from having this extra line of defence.
In reflecting on this World Malaria Day’s theme: Ready to beat malaria, how does Europe figure into this? Together with its member states, the EU is the world’s largest donor of official development assistance (ODA). But in regard to malaria, our efforts are quite small. While the European and Developing Countries Clinical Trials Partnership (EDCTP) is a great tool and has many success stories, it has only resulted in €60 million of investments towards fighting malaria. This figure must grow.
In 2016, the USA contributed $1 billion to fighting malaria. At the recent Malaria Summit in London, the UK reaffirmed that it would invest £500 million annually up to 2020-2021, and also raise its contribution to the Global Fund by £100 million to match investments from the private sector.
European ODA, however, is still channeled back to countries owing to in-donor expenses related to the refugee crisis. At the same time, the rise of peace and security agendas are distorting the true purpose of aid: the elimination of poverty, which includes the elimination of malaria. The WHO estimates that annual funding of $6.5 billion is required by 2020 to reach the first milestone of 40% reduction of malaria case incidence and mortality rates globally from the baseline year 2015. In 2016, only $2.7 billion was spent on fighting malaria. With this kind of gap, it is unsurprising that progress is stalling and problems are mounting.
With the window of opportunity on malaria closing, Europe must do more. The next EU Budget can be made ready by increasing the amount for research and innovation to a minimum of €120 billion, while further incentivising research and enhancing collaboration with partners such as the African Union and the ACP Group of States. This could be done through the second and improved EDCTP under the successor to the Horizon 2020 framework research programme (FP9).
Furthermore, in terms of its development cooperation, the EU wisely invests in the Global Fund to Fight AIDS, Tuberculosis, and Malaria, and given the urgency surrounding malaria, it should boost its contribution. The Global Fund, which channels 57% of international resources for malaria, has invested $8 billion fighting the disease in ACP countries since 2003. In Global Fund-supported countries, 795 million nets have been distributed and there has been a 60% decrease in mortality for children under 5.
If the EU is serious about being a true Global Health leader, it must step up its financial and scientific support in the fight against malaria. This a question of leadership. Are European leaders ready to beat malaria? They can be. In shaping the post-2020 MFF and the EU’s relationship with the ACP Group, there will be several opportunities in 2018 and 2019 to prove it.