Global Policy Forum

By Gustavo Capdevila

Despite the promising advances made in the prevention and treatment of malaria around the world, the disease continues to represent a major challenge in Africa, where the overwhelming majority of deaths now take place. The 2005 World Malaria Report, released Tuesday by the World Health Organisation (WHO) and United Nations Children's Fund (UNICEF), notes that the efforts made in recent years have begun to bear fruit.

Asia and Africa have experienced a 20 percent decrease in the incidence of the disease in the last five years, noted Allan Schapira, coordinator of the policy and strategy team of the Roll Back Malaria (RBM) initiative. Yet Africa continues to bear the brunt of the malaria burden worldwide. According to statistics compiled by Médicins Sans Frontií¨res, of the roughly two million people who die of malaria every year, 90 percent are African children under the age of five. The disease claims some 3,000 lives every day in sub-Saharan Africa alone.

The incidence of malaria rose in Africa during the 1980s and 1990s as a result of increased resistance to the most commonly used medicines to treat it and to the insecticides used to kill the mosquitoes that spread it. These decades also witnessed a deterioration in the provision of health care services in the region. Between 350 and 500 million people around the world contract malaria every year. Over 41 percent of the world's population -- some 3.2 billion people living in 107 countries -- face the risk of infection.

The Roll Back Malaria Global Partnership was launched in 1998 by WHO, UNICEF, the United Nations Development Programme (UNDP) and the World Bank. Its goal is to halve the burden of the disease by 2010. The fight against malaria requires ongoing and significant sources of funding. An estimated 3.2 billion dollars annually are needed to confront the disease in the 82 countries where the majority of malaria deaths take place.

Jon Liden, head of communications at the Global Fund to Fight AIDS, Tuberculosis and Malaria, told IPS that his agency will contribute one billion dollars to anti-malaria efforts over the next two years. The Fund allocates 55 percent of the total available financial resources to the fight against HIV/AIDS, 13 percent to tuberculosis, and over one-third to efforts to combat malaria. The disease costs Africa an estimated 12 billion dollars in gross domestic product (GDP) annually, and increases poverty by reducing productivity and social stability, said Liden. Nevertheless, he said he was hopeful about the possibility of defeating the disease thanks to the emergence of new prevention and treatment methods.

Chloroquine, formerly the most widely used and economical antimalarial drug, is no longer effective in most of the world because of the resistance to it that has developed. In its place, new artemisinin-based combination therapies have proven effective in saving lives, although they are considerably more costly. Another successful initiative has been the distribution of insecticide-treated mosquito nets, a highly effective means of preventing the disease. The agencies that make up the RBM partnership maintain that the price of artemisinin-based combination therapy (ACT), which ranges between 75 cents and 2.75 dollars per treatment, is prohibitive for many of the neediest families. But for its part, Médicins Sans Frontií¨res (MSF) states that treatment with ACT takes just three days and costs "as little as" 60 cents for a child and two dollars for an adult.

The effectiveness of these new treatments was demonstrated in a high transmission area in Angola, where hospital admissions for severe malaria were reduced by 25 percent in the year following the introduction of ACT. Over the same period, mortality decreased by 75 percent in comparison with the previous year, the group noted. In the face of this evidence, most countries in sub-Saharan Africa have changed their national treatment policies and switched from older, inadequate treatments to ACT-based therapy. But the problem is still far from being solved, according to MSF, because effective diagnosis and treatment are still available to only a tiny proportion of those in need.

For MSF, the major problems in tackling malaria are not technical, medical or scientific, because it is completely feasible to produce and distribute enough ACTs for the treatment to reach all of the people in need. However, this will only happen if there is urgent and sufficient political action, the group maintains. For their part, the U.N. agencies involved in the RBM initiative acknowledge that a lack of funds and national capacity to effectively carry out anti-malaria programmes are two major obstacles to the global implementation of prevention and treatment measures.

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