Global Action for Children

“I ask you to think about orphan children not as a burden but as a great opportunity.

Their education and wellbeing is an investment in our future.”

– Angelina Jolie, Honorary Chairperson of GAC

about

MALARIA

After we started using mosquito nets, my children, who are ages 10, 4 and 2, have not had to go to the doctor for malaria. Before, they had malaria often and bad. Today, they use the nets every night for sleeping... Malaria is terrible; it is not a joke. The difference makes me very happy. [USAID]

What is malaria?
What is the challenge?
What is the opportunity?

 

What is malaria?

 

Malaria is the single biggest killer of children under five years old in Africa. Every 30 seconds, malaria claims the life of another African child.[1] Each year, nearly one million people succumb to the disease worldwide; more than 90 percent of the deaths occur in sub-Saharan Africa.[2]

Malaria is a blood-borne disease caused by a parasite that is carried from person to person through mosquito bites. Severe flu-like symptoms are exhibited nine to 14 days after a bite from an infected mosquito. If the infected person does not receive adequate treatment, the infection can lead to comas, life-threatening anemia, and death by infecting red blood cells that then clog capillaries that carry blood to the brain and other vital organs.

Malaria preys on the most vulnerable - pregnant women and their unborn children, those infected with HIV/AIDS and children under the age of five years of age. Even when children survive the ravages of the disease, they may suffer long-term brain damage and learning disabilities as a result. When pregnant women contract malaria, both they and their unborn children are at risk as the disease causes mortality, low-birth weight and maternal anemia. Under and malnourished children are at an elevated risk for contracting the disease, and the disease is a contributing factor to severe anemia in young children.[3]

The ravages of malaria help to perpetuate the cycle of poverty in the world's poorest countries. The disease disproportionally burdens the rural poor, those who lack the resources for bed nets that prevent infection and those who cannot access treatment once they have contracted the disease. It forces children to miss school and fall behind in their education and causes great economic loss on a countrywide scale. Fifty-eight percent of malaria cases occur in the poorest 20 percent of the world's population.[4] In Africa, malaria amounts to an estimated $12 billion in economic loss annually which translates to a 1.3 percent loss in annual GDP in endemic countries. This, in turn, hinders development. Malaria consumes health budgets; the United States Agency for International Development (USAID) notes that malaria accounts for an estimated 40 percent of public health expenditures in Africa.[5] Malaria is costly, both economically and in terms of human lives.

 

What is the challenge?

 

Although malaria was eradicated from the United States over fifty years ago, nearly half of the world's population is still at risk for the disease. Almost all malaria deaths occur in sub-Saharan Africa. Due to limited access to both prevention and treatment, malaria disproportionately affects the poor and those living in rural areas. The vicious cycle of poverty perpetuates as malaria in turn reduces productivity and social stability. For instance, families affected by malaria clear 60 percent less crops than those free of the disease.[6]

Malaria is a preventable and treatable disease. Effective tools for malaria prevention range from insecticide-treated bed nets that cost only $10 to spraying insecticides indoors to kill mosquitoes to treating vulnerable pregnant women with preventative antimalarial drugs for just pennies per treatment. As of 2006, there were approximately 82 million bed nets in use worldwide, with millions more distributed since then. UNICEF estimates that an average of 12% of households in sub-Saharan African countries have at least on insecticide-treated net. [7]Artemisinin-based combination therapies, when provided within 24 hours of the onset of illness, are currently the most effective drugs for treating malaria. Despite moderately high treatment coverage, many children are still being treated with less effective medicines.[8]

The main challenge in combating malaria is lack of funding. This is not a question of the availability of money, but rather one of political will. Although the international community has dramatically increased funding for malaria prevention and treatment over the past five years, to $1.1 billion in 2008, a huge gap remains between need and demand. The Roll Back Malaria Partnership estimates the funding need for 2009 at $5.335 billion to combat malaria worldwide.[9] Controlling malaria would save Africa alone an estimated $12 billion in lost productivity and priceless human lives.

Despite this global gap in funding, the United States is helping to lead the international community the fight against malaria. Current initiatives include:

  • The President's Malaria Initiative (PMI): Announced in 2005 under President George W. Bush, PMI pledged to provide an additional $1.2 billion over a five year period with the goal of cutting the number of malaria-related deaths by 50 percent in 15 target countries. Working as a partnership with national governments, multilateral institutions, other bilateral donors, private donors, and NGOs and faith-based organizations, PMI is led by USAID and implements proven intervention strategies jointly with the Centers for Disease Control and Prevention. PMI has already reached an estimated 32 million people and contributed to a one-third drop in the overall number of child deaths in Zambia and Rwanda.[10]

 

  • The Global Fund to Fight AIDS, Tuberculosis and Malaria: Founded in 2002, the Global Fund is an international financing institution that coordinates donations from developing and donor nations, foundations, the private sector and other donors[11] to help fight HIV/AIDS, tuberculosis and malaria in the world's poorest nations. To date, The Global Fund has committed $15.6 billion in 140 countries worldwide.[12] It provides three quarters of all international financing for malaria, including helping enable host countries strengthen health systems through training and infrastructure improvements. The Global Fund is financing the distribution of 88 million bed nets and the delivery of 74 million malaria drug treatments free of charge.[13] The United States has typically donated approximately one-third of total contributions to the Global Fund, most recently appropriating $1 billion in 2009.[14] With each one dollar contributed by the United States leveraging two dollars from other donors, increased and stable U.S. contributions are especially critical to move forward the fight for global health.

What is the opportunity?

 

Immediate goals

In September 2000, world leaders came together at the United Nations to create a blueprint for global development, producing eight Millennium Development Goals to be achieved by 2015. These goals range from halving extreme poverty to providing universal access to education. Millennium Development Goal 6 specifically calls for halting and reversing the incidence of malaria by 2015. On World Malaria Day 2008, UN Secretary-General Ban Ki-moon called for "a stop to malaria deaths by ensuring universal coverage by the end of 2010."[15] UNICEF has underscored the fact that "business as usual will be grossly insufficient to meet the health-related Millennium Development Goals for Children."[16]

A comprehensive, multi-faceted approach is necessary to combat malaria effectively. While the commitments of the President's Malaria Initiative and the Global Fund have been impressive, increased funding is needed to provide wide coverage of the following proven interventions:

  • Insecticide-treated bed nets (ITNs) - Bed nets are essential for nighttime prevention, as African malaria mosquitoes usually bite between the hours of 10pm and 4am, and insecticide treated nets provide twice the protection of those that are untreated. A net is large enough to protect a few people at a time and can last for three to five years. Use of ITNs has been proven to reduce mortality in children under five by 20 percent and malarial infection of pregnant women and children under five by up to 50 percent.[17] ITNs cost only $10, including the net, distribution, teaching usage, and monitoring usage.[18] The Roll Back Malaria Partnership estimates that 730 additional bed nets are needed globally to reach their targets for 2010.[19]
  • Indoor Residual Spraying (IRS) - Spraying the inside walls of homes with insecticide helps to reduce malaria transmission to others by killing malaria-transmitting mosquitoes. Each spraying lasts four to ten months. According to USAID, for IRS to be effective, at least 80 percent of the homes in the targeted area must be sprayed.[20]
  • Artemisinin-based combination therapies (ACTs) - ACTs are currently the most effective drugs for treating malaria, as the combination therapy reduces the risk of drug resistance. Cheaper ACTs and a better distribution and access mechanism are needed so that the drugs reach the communities where they are needed most. One course of adult ACTs costs only $6.[21]
  • Intermittent preventative treatment for pregnant women (IPTp) - Two monthly doses of SP (sulfadoxine-pyrimethamine) during the second and third trimesters of pregnancy help to protect pregnant women from anemia and death and help to protect the baby by preventing malaria-induced low birth weight.[22] This costs only 10 to 12 cents and could prevent between 75,000 to 200,000 infant deaths yearly in Africa.[23] The Roll Back Malaria Partnership aims to provide 100 percent of pregnant women in high transmission areas with ITPp by 2010.[24]
  • Better coverage and access to quality antimalarial drugs - It is essential that effective treatment is started within 24 hours of the onset of symptoms to prevent serious illness or death, especially for children under the age of five.[25] However, barriers exist for those who need treatment, including prohibitive cost barriers for the drugs  or physical barriers such as long distances between village and clinic. The distribution of home-based care packages containing antimalarial drugs saves children's lives by acting as the first line of defense with the first onset of symptoms.
  • Quality standards for antimalarial drugs - There has been a rising incidence of substandard or counterfeit drugs. PLoS ONE noted that substandard antimalarial drugs cause an estimated 200,000 preventable deaths per year. Quality testing and inspection by regulatory agencies is necessary and programs, such as PMI, should only buy approved drugs for distribution. According to Africa Fighting Malaria, more than a third of antimalarial drugs sold in Africa have failed quality tests. [26]

 

Future goals

The Roll Back Malaria Partnership has outlined a plan for combating, eliminating, and eradicating malaria. The strategy in the Global Malaria Action Plan (GMAP) is supported by the World Health Organization, UNICEF, and the Bill & Melinda Gates Foundation. To achieve its goals, the GMAP outlines three parts of a global strategy:

  • Control - The control of malaria includes both scaling up commodity access and strengthening health systems. Core malaria control interventions include the distribution of 730 million long-lasting insecticidal nets by the end of 2010, 172 million households sprayed annually with insecticides, and 25 million treatment courses of IPTp for pregnant women in Africa. In addition to increasing commodity access, local health systems must be improved in order to effectively combat malaria and sustain control. Strengthening local capacity is imperative in order to provide sustainable, quality care that can reach the largest possible amount of people.
  • Elimination - Elimination means "the interruption of local mosquito-borne malaria transmission in a defined geographical area, creating a zero incidence of locally contracted cases. Imported cases will continue to occur and continued intervention measures are required."[27] Eliminating malaria over time country by country is the first step to eradication, when the incidence of malaria infection reaches zero worldwide. Elimination programs are broad and integrated, including cross-border initiatives, surveillance and case detection, country commitment in national steering committees, advocacy to prevent elimination fatigue, and strengthened health systems.
  • Research - Research to support malaria control and elimination falls into three categories - research and development for new tools, research to inform policy, and operational and implementation research. Research and development for new tools consists of improving and developing new anti-malaria interventions, including drugs, vector control tools, diagnostics, and vaccines. Several vaccines are in or nearing the clinical field trials stage.[28] These vaccines should target the most vulnerable residents of malaria-endemic areas, children and pregnant women. Research funded by large international partners and bilateral organizations would provide evidence to inform policy decisions on Essential Drug Lists, WHO policy, international guidelines, and country-level policies. Operational and implementation research examines the effectiveness of programs at the country and district levels. Both policy and operational and implementation research need significantly more financial resources and human capacity.

Learn how you can act, now!

While commitments such as the President's Malaria Initiative and the Global Fund to Fight AIDS, Tuberculosis and Malaria have funded life-saving prevention and treatment programming, greater progress and strong political will is needed in order to put an end to needless malaria infections and deaths. In order to achieve the Roll Back Malaria targets for 2010 and 2015 and the Millennium Development Goals for 2015, there must be a significant increase in the amount of funding from both international sources and endemic countries. The current funding for malaria, $1.5 billion, is equivalent to less than 50 cents per person at risk.[29]

Both the President's Malaria Initiative and the Global Fund have reached millions of those affected by malaria. Since 2004, the number of insecticide-treated nets produced worldwide has more than tripled, leading to an increase in the number of children under five years old sleeping under nets. These incredible successes, however, cannot continue without financial support.

The Global Fund to Fight AIDS, Tuberculosis, and Malaria estimates $2.7 billion is needed in 2010 from the United States to renew existing successful grants and continue fighting these three diseases around the world. However, the fiscal year 2010 Senate Appropriations bills, which are currently awaiting action on the Senate floor, only include $1 billion, a shortfall of $1.7 billion. In order for the U.S. to contribute our fair share, Congress must increase funding for the Global Fund to $2.7 billion in the fiscal year 2010 State and Foreign Operations Appropriations and Health and Human Services Appropriations bills.

The State and Foreign Operations Appropriations bill also includes bilateral funding for malaria programs. Currently, the Senate has proposed $585 million, which is $215 million short of the U.S. fair share.[30] By fully funding malaria programs and the Global Fund, the United States would set an example for the rest of the world, continue to save millions of lives, and continue on the path to eradication. You can help! Find your senators and call their offices urging them to fully fund these important programs.

Now is the time to end malaria. As President Barack Obama said on World Malaria Day 2009, "The United States stands with our global partners and people around the world to reaffirm our commitment to make the U.S. a leader in ending deaths from malaria by 2015...It is time to redouble our efforts to rid the world of a disease that does not have to take lives."

 

[1] World Health Organization, [2] Roll Back Malaria, [3] Malaria No More, [4] Roll Back Malaria Partnership, Global Strategic Plan: 2005-2015, [5] President's Malaria Initiative, [6] The Global Fund to Fight AIDS, Tuberculosis, and Malaria, [7] Roll Back Malaria Partnership, Global Malaria Action Plan, [8] UNICEF, Malaria & Children: Progress in Intervention Coverage, Summary Update 2009, [9] Roll Back Malaria, Global Malaria Action Plan: Key Facts, Figures and Strategies, [10] President's Malaria Initiative, [11] Global Fund, [12] Global Fund, [13] Global Fund, [14] Friends of the Global Fight, [15] United Nations, [16] UNICEF, State of the World's Children Report 2008, [17] Malaria Policy Center, [18] Malaria No More, [19] Roll Back Malaria Partnership, Global Malaria Action Plan, [20] President's Malaria Initiative, Annual Report 2009, [21] Roll Back Malaria, [22] Malaria No More, [23] Johns Hopkins Center for Global Health, [24] Roll Back Malaria, Global Malaria Action Plan, [25] UNICEF, Malaria & Children: Progress in Intervention Coverage, Summary Update 2009, [26] Africa Fighting Malaria research in PLoS ONE: "Antimalarial Drug Quality in the Most Severely Malarious Parts of Africa - A Six Country Study", [27] The Global Health Group, Shrinking the Malaria Map: A Guide on Malaria Elimination for Policy Makers, [28] Global Health Council, Reducing Malaria's Burden: Evidence of Effectiveness for Decision Makers, [29] Roll Back Malaria, [30] Global Action for Children

 

Last updated 1 September 2009