against malaria

The fight against malaria has stalled in some countries. A mix of new and existing tools and approaches can help eliminate and eradicate this preventable but deadly disease.

The world must take a more proactive approach to fight malaria, insists Simon Bland CBE, CEO of Global Institute for Disease Elimination (GLIDE), a United Arab Emirates-based organisation focused on eliminating infectious diseases of poverty. After all, malaria is preventable but accounts for 80% of all deaths in children under five in Sub-Saharan Africa.

Global fight against malaria

Climate, natural disasters and conflict displace millions of people into zones where malaria is highly prevalent, creating major challenges for humanitarian response.

Global coordination can offer improved support to displaced populations in malarial regions. Millions, particularly in Sub-Saharan Africa, face an increased threat from malaria after being displaced by changing weather conditions or conflict.

Displaced populations

Humanitarian experts believe a more coordinated, continuous and adaptive approach between countries and emergency agencies is critical in addressing these challenges.

Joseph Lewinski, Multisectoral Malaria Platform Lead with Catholic Relief Services (CRS), says: “The world is living with a large level of displacement, with 110 million people displaced and many of these in malaria-endemic areas.” CRS is an NGO working in the malaria sector in 12 countries.

Lewinski adds: “We have seen an increasing amount of displacement from natural causes through weather-related events and climate as well as through civil strife and conflict, leading towards internal displacement and refugees flowing out of countries.” He cites the recent cyclone in Malawi with local populations displaced by flooding.

Prevention commodities

A challenge lies in aligning systems designed for routine malaria care. Lewinski continues: “We also have challenges with getting the right malaria prevention commodities like bed nets or other prevention tools to distribute to displaced populations.

“Changing weather patterns are creating further challenges when it comes to mosquito breeding and transmission and our ability to effectively control that.”

Malaria tools

With ecological changes creating malarial issues, Lewinski emphasises the importance of improved coordination between humanitarian response partners. He points to their recent work co-hosting roundtable discussions with Red Cross, Alliance for Malaria Prevention and the UN Foundation to examine how cluster system partners can mitigate ongoing challenges.

Coordination between private and public sectors and affected communities is critical to developing strategies that better serve displaced populations. “These include shelters with insecticide on them; changing the dimensions of bed nets; and improved indoor residual spraying,” he says. Another step is around prepositioning commodities to enable better and quicker responses to emergencies.

Blended transition

CRS and its partners are working with the vaccination/immunisation sector to better understand where displaced populations are missing out on routine services. One project with USAID Bureau for Humanitarian Response is piloting delivery of nets through water, sanitation and hygiene (WASH) services they provide.

Multisectoral coordination can ensure a more blended transition from emergency response to the development phase and a collaborative approach in funding, with the flexibility to mitigate effects of the climate crisis on stable communities that become displaced.

Lewinski stresses that countries must learn from one another’s experiences to plan for — and respond to — emergencies in the future.

Written by Mark Nicholls

In recent years, a certain amount of complacency has set in. “Great progress was made just after the turn of the millennium,” notes Bland. “The UN had launched its Millennium Development Goals (MDGs) and more global investment was going into health. As a result, we saw the malaria curve falling.” But progress stalled long before Covid-19 muddied the waters.

This is not to underplay some impressive successes or ignore the 40 countries that have been granted malaria-free certification from the World Health Organization (WHO). These include El Salvador, Algeria, Argentina, Paraguay and Uzbekistan. Additionally, there was the development of the world’s first malaria vaccine — RTS,S — hailed as a game-changer.

Link between climate and infectious disease

However, significant challenges remain. “For instance, we’re going to need different tools and approaches to tackle a species of Anopheles mosquito now appearing in Africa, which is more urban and bites during the day,” says Bland. “Resistance to therapies and insecticides is increasing — so we need new therapies; new insecticides; and new, rapid, accurate diagnostics that can diagnose several diseases at once.”

There is no silver bullet for this, he admits. “We must use the tools we have and keep developing and rolling out new ones to re-energise the global programme towards the elimination and ultimate eradication of malaria.”

Worryingly, the climate crisis and extreme weather events could hamper these efforts because, as the world gets warmer, more countries may prove to be amenable habitats for mosquitoes carrying disease-causing parasites. With COP28 taking place in the UAE in November, GLIDE has been contributing to building the field of knowledge about climate and infectious diseases. This includes launching a second iteration of its Falcon Awards for Disease Elimination, supporting research into the subject. Ultimately, eliminating malaria requires joined-up thinking, says Bland. “No one can do this in isolation. If we work together to eliminate this disease from affected countries, that will be a cause of real celebration. We hope to support, promote and accelerate more celebrations over the next decade.”