The best intentions are meaningless without decisive action. In the case of disease control, we have seen across the globe a terrible living experiment in how different approaches have different outcomes. Covid-19 policy comparisons have become a global obsession. From herd immunity to “track and trace,” we can see in real-time how different hypotheses play out.
Eventually, we will find a solution, and life will return to some form of normality - hard though that is to imagine now. But lives will be lost; not just directly to COVID-19 infection, but to diseases that we know how to prevent, treat and cure right now. And one in particular.
A report published by the Lancet in 2019 laid out a plan for “Malaria Eradication Within A Generation.” Authored by leading epidemiologists and public health experts, including Dr Winnie Mpanju-Shumbusho, the former World Health Organization (WHO) Assistant Director General for HIV/AIDS, Tuberculosis, Malaria and Neglected Tropical Diseases, the report stated: “malaria eradication is possible, worthwhile, and affordable, and that the alternatives to eradication are untenable.”
This appears to be a straightforward green light for industry and governments to get moving, but of course, the timing could not have been worse. The months following the Lancet’s report saw the emergence of COVID-19, and from that point on, there has only really been one health story that anyone is thinking about.
The diversion of our attention to COVID-19 is understandable - but it could yet be disastrous. Deaths from malaria have already been on the rise in recent years, as resistance to pyrethroids - the dominant insecticide in use in malaria prevention - manifests itself.
Now, the WHO has warned that that malaria fatalities may double in 2020 as resources are diverted to tackling the pandemic. That’s an increase from 405,000 to 810,000. In normal circumstances, the prospect of almost 400,000 extra fatalities in one year would be seen as a global crisis in itself, but now it could be relegated to a mere side effect.
That is not to say that we should take COVID-19 less seriously. My organisation and many others in the sector have been working flat out to provide vital protective gear (PPE) and other equipment to healthcare professionals. Rather,we must be careful that this doesn’t become an either/or situation where one condition is addressed at the expense of another.
It’s sadly easy to see how this could happen. COVID-19 has (so far) hit hardest in the most prosperous parts of the world; malaria is almost entirely confined to the poorest populations in the poorest countries.
Already a perception exists, that, to put it bluntly, there is no money in malaria. Bill Gates, who has been genuinely heroic in the amount of time and money he has dedicated to the malaria problem, once pointed out in a Ted Talk that more money is spent on researching treatments for male pattern baldness than treatments for malaria.
A small investment in malaria prevention and treatment could reap huge rewards. The prevalence of the disease actively holds back many countries - particularly in west Africa - whose young populations could and should be driving dynamic economies.
It’s not just fatalities that should concern us; 219 million people are infected with malaria each year, causing a massive drain on economies. Workers - in particular, casual workers - miss days of work and hence miss out on income. Studies suggest that even with cases that are not severe enough for people to miss work, the quality of labour in regions afflicted with malaria is significantly reduced, as people suffering from symptoms are quite simply incapable of working to their full capacity and potential. Meanwhile, children, who are disproportionately affected by malaria, miss out on up to 12 school days a year due to the disease. All this adds up; malaria endemic countries have per capita income levels that are 70% lower than those of non-endemic countries.
Discussing malaria with people not directly involved in attempting to solve the problem, one sometimes encounters the notion that the disease will always be with us in some form. But eradication of malaria is possible. After concerted effort over decades, Europe was officially declared entirely malaria free in 2016. In the United States, malaria was effectively eradicated in just four years between 1947 and 1951 after a spraying campaign in the southern states led by the Office of Malaria Control in War Areas, the agency which subsequently became the Centers for Disease Control and Prevention (the very agency now charged with the fight against COVID-19).
Eradication by 2030 could have an astonishing effect on the fortunes of many countries, particularly in sub-Saharan Africa. WHO estimates suggest that over $4 trillion (€3.6 trillion) of economic output could be generated, all this for relatively small investments in new technologies and medicines, such as the bed nets and sprays that use non-pyrethroid chemicals. But, in spite of the stated WHO intention of malaria eradication by 2030, there is still a shortfall of $2.3 billion (€2.1 billion) in funding for that goal. Make no mistake, funding is the primary issue.
According to the Global Technical Strategy for Malaria, which was launched in 2016, “The fight against malaria is being prolonged, and in some places slowed down, by several interconnected challenges. The greatest of these is the lack of robust, predictable and sustained international and domestic financing.” As funding has plateaued, cases are steadily increasing, and the longer we allow this situation to continue, the harder it will be to bridge the gap.
We know why malaria prevention is falling backwards, and we know what is needed to tackle the problem. And we have seen in the last few months that when governments are proactive and ambitious in their approach to disease, they can get results. The question now is whether the will exists to free millions of people around the world from the cycle of illness and poverty perpetuated by malaria.
Arun Prabhu is the Co-Founder & Vice President of Landcent, a research and development lab developing products to reduce disease burdens on the world’s poorest populations.
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