Perspective

Global report shows again that progress against malaria has slowed

Many low-burden countries are on their way to eliminating malaria, but progress has slowed in recent years and there has been no improvement in the rate of infections in the countries with the highest burden of the disease, according to the annual World Malaria Report.

Experts called for increased action to get back on track, especially to support of the two groups most at-risk: children and pregnant women.

“This year’s report continues, to some degree, the key findings that were reported over the last few years — progress has slowed down,” Pedro Alonso, MD, PhD, director of WHO’s Global Malaria Program, said during a news briefing. “We also recognize that on a global scale, there has been exceptional headway made in the last few years and this must be taken as a clear sign that progress is possible.”

According to the report, 49 malaria-endemic countries reported fewer than 10,000 cases of malaria in 2018 compared with 40 countries in 2010, and 27 countries reported fewer than 100 cases, up from 17 countries in 2010. Additionally, Algeria and Argentina were declared malaria-free, joining the 36 other countries that have achieved the milestone.

However, progress in reducing new infections has slowed, according to the report. There were an estimated 228 million cases in 2018 — and 405,000 deaths — compared with 231 million in 2017. The report showed that the global incidence of malaria fell from 71 cases per 1,000 population in 2010 to 57 cases per 1,000 population in 2014 and remained around that level through 2018.

According to the report, pregnant women and children in Africa carry the brunt of the burden. Overall, an estimated 11 million pregnant women in 38 sub-Saharan African countries were infected with malaria, accounting for 29% of all pregnancies. An estimated 872,000 children in these countries were born with low birth weight due to malaria in pregnancy. Children aged younger than 5 years accounted for 67% of global malaria deaths in 2018.

To help further protect pregnant women and children, WHO recommends that these at-risk populations sleep under insecticide-treated bed nets. According to the report, coverage of this intervention expanded, with an estimated 61% of children and 61% of pregnant women sleeping under a treated net in 2018, up from 26% in both groups in 2010.

The report notes that WHO recommends full courses of antimalarial medicine for children younger than age 5 years living in Africa’s Sahel subregion during the malaria season, and intermittent preventive treatment in pregnancy (IPTp) in pregnant women in malaria-affected areas of sub-Saharan Africa. But just 72% of children were given the preventive therapy and 31% of pregnant women received the recommended three doses of IPTp. The report also found that a high proportion of febrile children (36%) do not receive any medical attention.

According to the report, several new tools and approaches for malaria and vector control have been submitted to WHO for evaluation, including new types of insecticide-treated nets, spatial mosquito repellants, vector traps and sugar baits. If these measures prove effective, WHO will formulate new policy recommendations.

Another key component in the fight against malaria would be a vaccine. In 2019, three African countries introduced the RTS,S (GlaxoSmithKline) malaria vaccine in a WHO-coordinated pilot program that aims to immunize around 360,000 children a year in Ghana, Kenya and Malawi.

The report revealed that in 2018, total funding for malaria control and elimination reached an estimated $2.7 billion, falling short of the $5 billion funding target.

“The report confirms that we already knew — it clearly tells us today that malaria is a disease of poverty and inequity. Despite the availability of effective lifesaving malaria interventions, unfortunately, too many of the world’s most vulnerable continue to face the greatest risk of dying,” Abdourahmane Diallo, MD, MPH, CEO of the RBM Partnership to End Malaria, said during the briefing. “Overall, we need to accelerate and intensify what we’ve been doing up until now.” – by Caitlyn Stulpin

Disclosures: Alonso and Diallo report relevant financial disclosures.

Many low-burden countries are on their way to eliminating malaria, but progress has slowed in recent years and there has been no improvement in the rate of infections in the countries with the highest burden of the disease, according to the annual World Malaria Report.

Experts called for increased action to get back on track, especially to support of the two groups most at-risk: children and pregnant women.

“This year’s report continues, to some degree, the key findings that were reported over the last few years — progress has slowed down,” Pedro Alonso, MD, PhD, director of WHO’s Global Malaria Program, said during a news briefing. “We also recognize that on a global scale, there has been exceptional headway made in the last few years and this must be taken as a clear sign that progress is possible.”

According to the report, 49 malaria-endemic countries reported fewer than 10,000 cases of malaria in 2018 compared with 40 countries in 2010, and 27 countries reported fewer than 100 cases, up from 17 countries in 2010. Additionally, Algeria and Argentina were declared malaria-free, joining the 36 other countries that have achieved the milestone.

However, progress in reducing new infections has slowed, according to the report. There were an estimated 228 million cases in 2018 — and 405,000 deaths — compared with 231 million in 2017. The report showed that the global incidence of malaria fell from 71 cases per 1,000 population in 2010 to 57 cases per 1,000 population in 2014 and remained around that level through 2018.

According to the report, pregnant women and children in Africa carry the brunt of the burden. Overall, an estimated 11 million pregnant women in 38 sub-Saharan African countries were infected with malaria, accounting for 29% of all pregnancies. An estimated 872,000 children in these countries were born with low birth weight due to malaria in pregnancy. Children aged younger than 5 years accounted for 67% of global malaria deaths in 2018.

To help further protect pregnant women and children, WHO recommends that these at-risk populations sleep under insecticide-treated bed nets. According to the report, coverage of this intervention expanded, with an estimated 61% of children and 61% of pregnant women sleeping under a treated net in 2018, up from 26% in both groups in 2010.

The report notes that WHO recommends full courses of antimalarial medicine for children younger than age 5 years living in Africa’s Sahel subregion during the malaria season, and intermittent preventive treatment in pregnancy (IPTp) in pregnant women in malaria-affected areas of sub-Saharan Africa. But just 72% of children were given the preventive therapy and 31% of pregnant women received the recommended three doses of IPTp. The report also found that a high proportion of febrile children (36%) do not receive any medical attention.

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According to the report, several new tools and approaches for malaria and vector control have been submitted to WHO for evaluation, including new types of insecticide-treated nets, spatial mosquito repellants, vector traps and sugar baits. If these measures prove effective, WHO will formulate new policy recommendations.

Another key component in the fight against malaria would be a vaccine. In 2019, three African countries introduced the RTS,S (GlaxoSmithKline) malaria vaccine in a WHO-coordinated pilot program that aims to immunize around 360,000 children a year in Ghana, Kenya and Malawi.

The report revealed that in 2018, total funding for malaria control and elimination reached an estimated $2.7 billion, falling short of the $5 billion funding target.

“The report confirms that we already knew — it clearly tells us today that malaria is a disease of poverty and inequity. Despite the availability of effective lifesaving malaria interventions, unfortunately, too many of the world’s most vulnerable continue to face the greatest risk of dying,” Abdourahmane Diallo, MD, MPH, CEO of the RBM Partnership to End Malaria, said during the briefing. “Overall, we need to accelerate and intensify what we’ve been doing up until now.” – by Caitlyn Stulpin

Disclosures: Alonso and Diallo report relevant financial disclosures.

    Perspective
    Philip J. Rosenthal

    Philip J. Rosenthal

    Those interested in malaria control and elimination eagerly await annual release of the World Malaria Report. The 2019 report has no major surprises but offers insight into recent trends and WHO priorities. It is again noted that impressive strides were made against malaria from about 2000 to 2015, but that, despite continued success in many countries with a relatively low malaria burden, progress has slowed, in particular in the high-burden countries of sub-Saharan Africa, with children and pregnant women in this region at greatest risk. The theme now is getting “back on track,” although last year’s train tracks cover art has been replaced by an African woman who is visibly pregnant and toting two young children. Proven tools for malaria control include prompt treatment with artemisinin-based combination therapies for those suffering from malaria, use of drugs to prevent malaria in high-risk children and pregnant women and vector control with insecticide-impregnated bed nets and indoor residual spraying of insecticides. Of high priority are new tools and strategies, with stepped up financing to allow their use. These new strategies may include introduction of new vector control tools, use of the RTS,S vaccine now being piloted in three African countries and improved use of available tools to treat and prevent infections and to limit transmission. In summary, we can celebrate progress but must admit that this progress has stalled in many countries, and so we must look for new solutions. New tools are available, but adequate funding to enable their use is uncertain. It is hoped that with programs “back on track,” we can return to the impressive gains seen against malaria earlier this century.

    • Philip J. Rosenthal, MD
    • Professor of medicine
      University of California, San Francisco

    Disclosures: Rosenthal reports receiving research support from Gilead Sciences, Abbvie and Merck.