Defining and Defeating the Intolerable Burden of Malaria III. Progress and Perspectives

Luis Gomez SamboAfrican Regional Office, World Health Organization

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The excess of malaria-attributed mortality in the African region is estimated to be well over a million, mainly because of the premature death of children younger than 5 years of age and the adverse consequences during pregnancy. Therefore, children and pregnant women—the most vulnerable segments of society—bear the greatest burden. Malaria is responsible for keeping millions of people in the vicious cycle of ill-health, diminished cognitive capacities among children, and absenteeism from activities of daily living, productivity and income loss, and poverty. Malaria-related mortality, morbidity, and economic loss could be averted if the available effective preventive and treatment interventions were made universally accessible to all those in need.

Malaria is a polymorphous disease, and its burden varies among different regions and populations. As such, particular attention needs to be paid to the range of challenges that have been compromising optimal program implementation and preventing most endemic countries from being on track for achieving the internationally agreed targets. These challenges will need to be tackled in a comprehensive and rational manner to accelerate progress toward malaria control.

The current supplement to the American Journal of Tropical Medicine and Hygiene (AJTMH) is entitled “Defining and Defeating the Intolerable Burden of Malaria III. Progress and Perspectives.” It is the third volume of a series of AJTMH supplements aimed at shedding light on the scientific, technical, programmatic, and developmental issues related to the malaria burden and its decrease. This volume provides updates on the malaria situation, describes challenges facing the malaria control programs, and suggests new approaches and tools, which, if made available and accessible to the populations in need, would avert millions of deaths and save billions of dollars.

This issue of the AJTMH illustrates beautifully the collaborative effort of scientists, public health researchers, and practitioners around the world in tackling the malaria scourge. It is commendable to witness malaria stakeholders and advocates for control coming together in bridging the gaps in knowledge, building consensus, and rallying around the same cause and objective of reducing the considerable morbidity, mortality, and disability attributable to malaria. This oneness of purpose is critical now, because there are unprecedented political and financial commitments to combat malaria coming from the donor community, private sector, non-governmental organizations, and the governments of endemic countries. Never before has malaria enjoyed such attention in public health research and international development agendas. We must sustain the current momentum to ensure that we fulfill the promise made to the children of Africa and those of other malaria-endemic continents of a world free of malaria.

At their last gathering in August 2006, Ministers of Health of the African Region debated the challenges faced in controlling malaria and called for improved monitoring and evaluation systems, effective partners’ coordination, pro-poor population policies, and increased and sustainable funding. The Ministers highlighted the importance of cross-border initiatives, the added value of integrated services at the point of delivery, and the critical role of research in improving program implementation and generating new knowledge and technologies for combating the disease. It was acknowledged that endemic country governments’ leadership in driving this agenda is paramount for sustainability.

Stakeholders should be able to express their scientific goals and be creative in building a consensus and pragmatic pluralism to defeat malaria. The power of a government’s good stewardship and partnerships at all levels is the recipe to strengthen community capacity for effective prevention and control. Success will depend on the universal access to essential technologies and tools; this presupposes a palpable commitment to those who cannot afford costly malaria drugs and vector control interventions.

It has been estimated that direct and indirect costs to prevent and treat malaria can be as high as 25% of household annual incomes. This perennial economic burden has a devastating impact on the ability of people to rise out of poverty. Any meaningful poverty reduction strategy should use “tackling malaria” as an important indicator and milestone. Without question, more research is needed to better understand the tight linkages between malaria and poverty and their wide-ranging social impact. Such research will yield new evidence to develop innovative strategies for emancipating the poor from ill-health, catastrophic health care expenditures, and poverty.

We must keep reminding ourselves that research is not an end in itself but a vital means of bringing more novel and effective strategies to scale for waging concerted war against disease. It is important that research findings are shared widely and promptly. Such scientific evidence is used to inform advocacy, priority-setting, policy development, planning, implementation, and evaluation of national prevention and control programs.

We need to intensify our efforts to strengthen endemic countries’ institutional, human, and community capacities to contribute to their own well being and empower countries to better link research and control activities. This is a major challenge and requires creative thinking and collegial commitment. Strengthening health research in Africa will certainly contribute to building integrated and sustainable mechanisms for all disease control including malaria.

Despite the social, economic, and environmental determinants of malaria and their challenges, it is possible to bring this disease under control if we scale-up effective coverage of the many proven and cost-effective interventions—and if funding is assured that is commensurate to the magnitude of the problem. This will require sustained commitment for decades, particularly from governments, affected communities, and international partners. It will also require putting the target populations at the center of our efforts. To this end, the World Health Organization will continue actively playing its directing and coordinating role. We are fully committed to providing the most skilled, proven, and synergistic technical support to endemic countries for the effective control of malaria.

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Address correspondence to Luis Gomez Sambo, African Regional Office, World Health Organization. E-mail: sambo@nzila.net

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