by Sarah Kline

Malaria is hitting the headlines again, with positive stories of a drop in malaria deaths and the promise of a potential first vaccine appearing alongside warnings of drug and insecticide resistance growing internationally.

There has been dramatic progress in the fight against malaria over the past decade, thanks to an extraordinary partnership between governments, the private sector, scientists, researchers and civil society. Now we face the challenge of sustaining and building on this progress. It is hardly surprising that we remain fascinated by malaria: it is one of the oldest recorded afflictions of humankind. Across history, from ancient Rome to India, there are stories of mythical malaria goddesses and daemons; the disease features prominently in accounts from the first colonists of America and explorers in Africa; and, in both World Wars, malaria was a factor in the success and failure of campaigns in parts of Europe and the Far East.

We have seen major successes at various points in history in tackling malaria, most notably after World War II, when concerted campaigns succeeded in eliminating it from North America and western Europe. Malaria is preventable and treatable, yet around half the world's population still lives at risk. Each year there are more than 250 million cases and over three quarters of a million deaths, with over ninety percent of these deaths occurring in Africa. Those most vulnerable are children under five and pregnant women; a child dies from malaria every 45 seconds.

In the United Kingdom, we have seen cases of malaria rise by thirty percent amongst people returning from abroad. Nigeria, Ghana and India are the most common places for British travellers to come into contact with the disease. Whether you live in a malarial area, or travel for business or pleasure, malaria is a disease we are coming into contact with more and more frequently.

In malaria endemic countries, the disease not only devastates families, but also exacts a heavy toll on businesses and economies. Overall it is estimated that malaria costs Africa over 12.5 billion dollars each year, and in some countries reduces economic growth by up to 1.3. Conversely, investing in malaria control yields positive results for African businesses, reducing workplace absenteeism by over ninety percent in cases featured by the Roll Back Malaria (RBM) Partnership's report, Business Investing in Malaria Control: Economic Returns and a Healthy Workforce for Africa.



Malaria control offers some of the most cost-effective health interventions in the world and success is possible, with the World Health Organisation (WHO) reporting an estimated drop of over twenty percent in annual malaria mortality over the last decade. In September, the global umbrella body for those working in malaria published Roll Back Malaria Partnership: A Decade of Partnership and Results. The report describes the extraordinary partnership between governments, the private sector, scientists, researchers and civil society in tackling malaria, as well as its incredible results: over the past decade, 43 countries, including eleven in Sub- Saharan Africa, have cut malaria cases or deaths by fifty percent or more; three countries have been declared malaria-free (United Arab Emirates, Morocco and Turkmenistan) and over 25 more are considered on their way towards malaria elimination.

Commenting on the report's launch, United Nations Secretary General Ban Ki-Moon said: "Only rarely have we seen a public health initiative provide so much return on investment. Thanks to the efforts of the Roll Back Malaria Partners over the past decade, we have a foundation that allows affected countries and communities to reach even greater results in the years to come."

There are several key reasons this success has been possible, and numerous lessons that can be learnt for the wider global effort to help achieve the UN international health goals. A ten-fold increase in the amount of funding for malaria control in the past decade has widened access to new and improved malaria prevention, diagnosis and treatment worldwide. What we are doing today to tackle malaria is almost unrecognisable from ten years ago.

In malaria prevention, we have expanded the use of indoor residual spraying, thanks to donors including the government of the United States. By regularly spraying the walls where mosquitoes carrying malaria rest, we can drastically reduce mosquito survival and thus prevent the spread of the disease. We have also vastly improved quality and access to mosquito nets to protect individuals and families whilst they sleep. Long-lasting insecticidal nets impregnated with insecticide do not need to be re-treated to remain effective and can last up to three years before needing to be replaced. These simple tools have had dramatic effects, with mosquito nets alone shown to reduce deaths amongst young children by over twenty percent.

For those sick with malaria, improvements in diagnosis and treatment have been a lifesaver. The development and increased use of simple and reliable rapid diagnostic tests for malaria enables correct diagnosis in even the most rural areas. This is essential: we need to know if a fever is malaria or something else in order to ensure correct treatment and prevent anti-malarial drug resistance by overuse. We have expanded access and reduced the price of the most effective malaria medicines - Artemisinin Combination Therapies. Making sure people are using these highly effective anti-malarial drugs correctly is a key factor to our success.

The RBM partnership also published a report on funding for malaria research and development. It outlined the need to invest not only in the current interventions that are effectively tackling malaria, but also in those we need for the future. Of particular concern is the current underfunding for the development of diagnostic tools and vector (mosquito) control, including new insecticides.

We not only need to keep developing the best possible tools to combat malaria, but must also ensure that we have the right education and training to enable people to use them effectively. There is a widespread concern at the lack of sufficient numbers of health workers at local levels across the developing world, and this was a feature of discussions at the recent UN General Assembly. The role of the communities who suffer from malaria is essential to our collective success here. I recently travelled to Ghana to discuss the progress of a national campaign to ensure everyone has access to a bed net by the end of 2012. Malaria No More UK is helping fund this campaign alongside the British, American and Ghanaian governments. One of the most important aspects of the campaign in Ghana and others like it across Africa is the use of local leaders and volunteers to help ensure that families understand how and why to protect themselves by sleeping under a net.

Malaria endemic countries have seen a growth in political commitment and leadership, from village elders and faith groups to local and national governments. Forty African heads of state have now come together to form the African Leaders Malaria Alliance and, in September 2011, they launched a score card to track each country's progress on tackling the disease. The score card includes the financing and delivery of tools such as mosquito nets, as well as progress on key policy issues such as banning medicines that only consist of one drug (mono therapies) in favour of those that combine drugs to improve effectiveness and combat resistance.

This growth in political commitment and leadership in the fight against malaria is echoed at international levels. Global malaria spending has increased tenfold to 1.5 billion dollars per year - a great achievement, but still far short of the estimated six billion required to control malaria. While countries including the UK and US provide significant funding and remain committed to the fight, there is a concern that a decade of success in tackling malaria will mean the world's attention will wander rather than focus on sustaining and building on this for the future. Any wavering in our resolve now risks reversing our progress, reducing the likelihood of attaining the UN health-related Millennium Development Goals and constraining economic development in malaria affected countries.

Looking ahead, RBM estimates that a further three million African children can be saved by 2015 just by increased use of prevention tools such as mosquito nets and sprays. As a global community we have set ourselves very ambitious goals: to achieve near-zero deaths from malaria, the reduction of malaria cases by 75 percent, and malaria eliminated from ten countries including the WHO's European region by 2015. But these goals will only be achieved if we undertake an extraordinary intensification of the work we have collectively begun and make sure we all remain committed to seeing it through to its end; this means continuing the partnership between governments, the private sector, scientists, researchers and civil society. Behind each of these goals are the stories of every life saved or improved by the absence of malaria. We cannot afford to waiver in our efforts.



Sarah Kline is the Executive Director of Malaria No More UK. Her previous roles include running the MDG 'Call to Action' campaign at the Department for International Development, head of Public Affairs and Internal Communications at the Foreign and Commonwealth Office and five years as Oxfam's head of UK and EU relations.



"Malaria: Tackling a Historic Foe "