Malaria prevention works: let’s close the gap

By Dr Poonam Khetrapal Singh, WHO Regional Director for South-East Asia

The world has made significant progress in reducing malaria’s deadly burden. Between 2000 and 2015 the incidence rate of malaria is estimated to have decreased by 37%. Malaria mortality was slashed by 60%, with the Millennium Development Goal (MDG) of halting and reversing malaria incidence convincingly met.

The South-East Asia Region is part of this story. The Region reached the malaria-related MDG targets. More recently, between 2010 and 2015 it cut case incidence by an estimated 54% and the malaria mortality rate by an estimated 46%. In 2015 and 2016 respectively, Maldives and Sri Lanka were certified malaria-free – a stunning achievement.

But further progress must be forged. Malaria remains endemic in nine of the Region’s 11 countries. Multi-drug resistance – including to artemisinin-based combination therapies – is an ever-present threat, as is resistance of malaria-transmitting mosquitoes to insecticides. Across the Region, domestic funding for malaria prevention and control has declined, even as the need for more innovative and localized solutions has increased. Renewed focus is needed.

As the theme of this year’s World Malaria Day emphasizes, enhancing prevention is a critical means of closing the gap and ending malaria for good. Though policy must always respond to local needs, there are powerful strategies that can accelerate gains.

Key among them is vector control. By controlling the mosquitoes that transmit malaria (and our exposure to them) we can significantly diminish malaria transmission and hence disease burden. Two highly effective ways to do this is by ensuring affected communities have access to long-lasting insecticidal mosquito nets, and by carrying out indoor residual spraying. In 2015 alone indoor residual spraying was estimated to protect 106 million people worldwide, including upwards of 41 million in India.

Ensuring these tools reach vulnerable groups is essential. Malaria transmission in the Region occurs primarily among hard-to-reach, often disadvantaged or neglected communities, including tribal and migrant or mobile populations. These communities must be empowered to act, and must be fully engaged in programme implementation. Even within these communities, special efforts must be made to protect pregnant women and children under five years of age. There are a number of strategies that can do this and which antenatal services in high-risk areas should be in a position to deploy.

As part of a wider push, countries should invest in and harness the latest technological advances. New vector control interventions, improved diagnostics and new anti-malarial medicines all hold out the prospect of accelerated progress. Meeting the Region-wide target to eliminate malaria by 2030 requires agile thinking and a willingness to be bold, meaning all avenues must be explored, and all effective tools embraced. This is particularly important given the threat posed by multi-drug and insecticide resistance.

The South-East Asia Region has shown what it can achieve. A malaria-free Region is possible. Through strong political commitment, integrated strategies aimed at reaching the unreached, and a willingness to harness the power of cutting-edge tools, malaria’s centuries-long burden can be lifted. The principle of prevention is key.

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