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The Global Fund and President’s Malaria Initiative: Fighting Malaria Worldwide

Malaria is an infectious disease caused by blood- borne parasites called Plasmodium, which affect humans.[1] P. falciparum is the most deadly form of this parasite and is primarily found in Africa; P. vivax is less dangerous but more widespread. Malaria parasites are transmitted through the bite of infected female mosquitoes. Early diagnosis and treatment of malaria reduces disease and prevents deaths. It also contributes to reducing malaria transmission. Insecticide-treated bed nets and indoor residual spraying are also forms of prevention of transmission.[1]

Global investments to fight malaria have helped avert 1.2 billion malaria cases and over 6.2 million malaria deaths from 2000-2015.[2,3] As of 2015, 98 malaria-burdened countries have reversed their incidence rates, meeting the Millennium Development Goal target and moving toward elimination. Although the map for malaria is shrinking, it is still a global health threat. In 2014, there were an estimated 214 million cases worldwide and 438,000 deaths from the disease, with 80 percent of global malaria deaths occurring in just fifteen countries, mostly in Africa.[3] In 2015, malaria was the fourth highest cause of death among children, taking the life of a child every two minutes.[3]

Global Investments in Malaria

The Global Fund is the world’s largest global health financier and provides resources to in-country partners for large-scale programs to prevent and treat malaria. International financing for malaria control has increased sharply from less than $100 million in 2000 to an estimated $2.7 billion in 2013.[3] The Global Fund provides about 40 percent of this funding.[5] Partnerships have been integral to the Global Fund’s model. For the fight against malaria, the Global Fund partners with the U.S. President’s Malaria Initiative (PMI), which works only in countries where the Global Fund has a presence and assesses what resources are currently available and unmet gaps in need. Together, the Global Fund and PMI account for around 66 percent of global malaria assistance (26 percent of which is provided by PMI).[5]

Successes in the Fight against Malaria

  • International efforts to fight malaria have led to a total decline of global malaria mortality rates by 60 percent among all age groups since 2000 and by 65 percent among children under five.[3]
  • More than 50 percent of the population is now sleeping under insecticide-treated mosquito nets in sub-Saharan Africa, compared to 2 percent in 2000.[3]
  • Also in sub-Saharan Africa, the percentage of households with access to insecticide-treated mosquito nets and/or indoor residual spraying rose from 2 percent in 2000 to 59 percent in 2014.[3]
  • As of the end of 2015, the Global Fund had distributed 600 million insecticide-treated nets, treated 659 million cases of malaria, and protected 61 million structures with indoor residual spraying.[6]

Strategically Fighting Malaria

Progress in malaria reduction is fragile and can be quickly reversed. More than 90 percent of resurgences over the past 80 years were due, at least in part, to weakened malaria control programs in which resource constraints were the most commonly identified factor.[4] The country of Sri Lanka, for example, nearly eliminated malaria in the 1960s with a mere 17 cases recorded. Once the country relaxed its efforts, however, the disease rebounded dramatically; more than 260,000 malaria cases were diagnosed there in 1999. Thankfully, due to renewed investment and careful surveillance— including blood testing, treatment, widespread prevention efforts and community education — no indigenous cases have been identified in Sri Lanka since October 2012. But the country’s epidemic illustrates how quickly resurgence can occur.

Over the last few years, malaria-carrying mosquitoes have grown resistant to insecticides commonly used in insecticide treated nets; this problem has been reported in 64 countries. Additionally, drug resistance to artemisinin, a core malarial drug, has been reported in four countries in Southeast Asia (Burma, Cambodia, Thailand and Vietnam) and in new areas of the greater Mekong sub-region, increasing concerns about losing the drug as an effective first-line treatment.[4]

New Tools and Strategies Needed for Malaria Treatment and Prevention

The need for new tools and strategies is growing as more countries document insecticide and drug resistance. Development of new insecticides is ongoing, with two new products for indoor residual spray presently going through the World Health Organization’s approval process. In addition, 46 drug candidates are currently in early development, many of which are unlikely to reach preliminary (Phase I) trials.[7] Accelerating this pipeline and more efficiently identifying potential drug compounds are key to the fight against malaria.

While new tools are being developed, and given the long lead time in medical research and development, it is critical that existing tools are used as effectively and resourcefully as possible. For example, in February 2014 the Global Fund launched a $100 million Regional Artemisinin Resistance Initiative in Southeast Asia.[8] Through the use of high- impact, proven interventions, the program aims to catalyze a coordinated response among partners to protect investments made over the last decade in the fight against the disease.

Continuing the Fight against Malaria

Despite significant gains that the Global Fund, PMI and other partners have made against malaria, the disease remains a serious global public health problem. Experts estimate that $5.1 billion would be necessary each year to eliminate malaria as a serious public health threat.[9] Looking forward, the goal is to build on previous efforts and ensure that successes to date are not rolled back, even as the threat of artemisinin drug resistance and the need to replace insecticide-treated nets loom large. Strong, steady funding for the Global Fund, PMI and partners is critical to continue shrinking the map on malaria.

[1] WHO Malaria Key Facts 2015
[2] United Nation’s Millennium Development Goals Report 2015
[3] WHO World Malaria Report 2015
[4] WHO World Malaria Report 2014
[5] Kaiser Family Foundation: Mapping the Donor Landscape in Global Health: Malaria
[6] The Global Fund Results
[7] From Pipeline to Product Malaria R&D Funding Needs Into the Next Decade 2013
[8] WHO Regional Artemisinin Intiative (RAI) January 2014
9] The Global Fund