Malaria: (still) a global health priority

Abstract

Malaria remains one of the deadliest infectious diseases worldwide. According to the World Malaria report 2020 released by WHO in November last year, 229 million cases and 409 000 deaths occurred frommalaria in 2019. Most cases were reported in children under the age of 5 years (67%) and in pregnant women, mainly in sub-Saharan Africa (94%) and Southeast Asia (3%). Weak health systems, lack of an effective vaccine, and the emergence of drug-resistant and insecticide resistant parasites continue to complicate control efforts in hard-hit areas. Data published in April this year by Aline Uwimana and colleagues from the Rwanda Biomedical Centre in The Lancet Infectious Diseases showed that Plasmodium falciparum parasite mutations associated with artemisinin resistance are worryingly gaining ground in Africa. In most countries where malaria is endemic, the disease affects disproportionally disadvantaged people who have limited access to health-care facilities, acting as a consequence and a cause of inequality. 6 years ago, WHO announced its Global technical strategy for malaria 2016 2030 designed to guide countries affected by malaria. The strategy set four global targets for 2030, including reducing global malaria incidence and mortality rates by 90%. The World Malaria report 2020 highlighted mixed progress towards interim milestones. The goals of eliminating malaria in at least ten countries (Algeria, Argentina, Azerbaijan, China, El Salvador, Kyrgyzstan, Paraguay, Sri Lanka, Tajikistan, and Uzbekistan) and preventing reestablishment have been reached, whereas the goal of reducing global case incidence and mortality rates by 40% was not met, reaching a plateau in progress. In a News report on Feb 1, 2021, WHO announced an update on its global strategy to change the trajectory of the disease. The reformed strategy reflects the current context of uneven progress and acknowledges the impact of COVID-19 and lessons learned from the pandemic. It puts great emphasis on country ownership and community’s’ involvement, and it highlights the importance of building resilient health systems for a successful response to malaria. Other guiding principles focus on the need for stronger surveillance systems and the use of accurate geo-localised data to inform decision-making and to tailor interventions to local conditions, targeting people who need them the most. This approach would also ensure equity in accessing health-care services, tackling the broader determinants of the disease. For example, in Sub-Saharan Africa the number of children younger than 5 years sleeping under insecticide-treated bed nets (ITN) has been overall increasing from