Recently I asked Dr. Robert Newman, MD, MPH, Director of the Global Malaria Programme at the World Health Organisation, a few questions about malaria.
This is what he said:
Me: Drug and insecticide resistance, lack of global funding, and poor testing and treatment facilities in many infected areas are some of the obstacles to eradicating malaria, but which one gives you most cause for concern?
Robert Newman: While all of these issues are concerning, the greatest threat to continued success in the control and elimination of malaria is financial rather than biological. While there has been a massive increase in international funding for malaria, from less than 200 million USD annually to nearly 2 billion USD today, that total still falls far short of the more 5 billion USD annually that are required to scale up life-saving malaria interventions.
That said, parasite resistance to antimalarial medicines, and mosquito resistance to insecticides are also major threats to success. In the past, the spread of resistance to chloroquine in Africa was responsible for major increases in child mortality on the continent. We now have resistance to artemisinins that has emerged in the greater Mekong Subregion. For the time being, this is restricted to four countries (Cambodia, Myanmar, Thailand, and Viet Nam) but given population movements in Asia and the world, the geographic scope of the problem could widen quickly.
Insecticide resistance has been detected in 64 of the 99 countries with ongoing malaria transmission. This affects all classes of insecticides that are used in malaria vector control, and has had the worst impact on the pyrethroids, which are the only class used on insecticide-treated nets. While vector control tools remain effective in most settings, this issue needs to be addressed urgently to prevent a global resurgence of the disease.
WHO has released global plans on the management of these two biological threats (The Global Plan for Artemisinin Resistance Containment and the Global Plan for Insecticide Resistance Management). If adequate funding were available, both challenges could be fully addressed.
Me: I read recently that the UK has pledged £1 billion over the next 3 years for the Global Fund, which is really good news for the fight against malaria. What do you think is the most positive news in the fight against malaria today?
Robert Newman: The most positive news today is the steady decline in malaria cases and deaths that have occurred over the past decade. The unprecedented scale up of life-saving malaria interventions, including long-lasting insecticidal nets, indoor residual spraying, diagnostic testing, and effective antimalarial treatment (especially with artemisinin-based combination therapies or ACTs as they are known) has resulted in an estimated 26% decline in malaria mortality rates globally, and a 33% decline in the WHO African region.
Malaria interventions saved an estimated 1.1 million lives over the past decade; this is a tremendous achievement. But the gains are fragile, and history shows us just how quickly malaria can resurge if funding is decreased or stopped. A decade of progress can be undone in one or two malaria transmission seasons.
Me: Do you think you will see a world without malaria in your lifetime?
Robert Newman: I do believe that I will see a world without malaria in my lifetime, but this requires a few assumptions to be met:
a) that I have a long life (as I think global malaria eradication is probably 40 years away)
b) that political and financial commitment to control, eliminate, and ultimately eradicate malaria continues
c) that innovative tools continue to be developed that allow us to stay ahead of the mosquito and the parasite, and
d) that overall development continues, especially in Africa.
I am optimistic that these assumptions will be met, and I believe that human beings are capable of amazing things when we dedicate ourselves to solving a challenge and then work together to get there.
I’d like to thank Dr Newman for his generous time in answering these questions for me. I first met Dr. Newman when I went to the APPMG at Westminster to give a presentation about malaria for World Malaria Day in April. This is what he said afterwards: ‘I very much enjoyed meeting you… during the All-Party Parliamentary Malaria Group meeting earlier this year, and I was so impressed with what you said, and the way you delivered it.’