Opening speech at the launch of the national malaria elimination framework
by Dr Poonam Khetrapal Singh, Regional Director, WHO South-East Asia
10-11 February , 2016, New Delhi
Honourable Shri J.P. Nadda Hon’ble Union Minister of Health & Family Welfare
Dr Mark Dybol, Executive Director, Global Fund for AIDS, TB and Malaria
Dr Nafsiah Mboi, Envoy of the Asia Pacific Leaders’ Malaria Alliance
Distinguished Participants, Ladies and Gentlemen,
Friends of Malaria Elimination on the dais and in the audience,
The world has reached a critical juncture in the fight against malaria. In recent years the worldwide campaign against malaria has both picked up momentum and produced impressive results. Most importantly, Target 6 of the UN Millennium Development Goals, which aimed to halt and reverse the global incidence of malaria between 2000 and 2015, has been achieved. In continuation of this momentum, global leaders at the UN General Assembly last year pledged to eliminate malaria epidemic completely by 2030 as a part of the Sustainable Development Goals. Therefore, it is critical that we redouble our efforts to achieve this goal.
It gives me immense pleasure to share with you that the WHO South-East Asia Region has done well in the global campaign against malaria. In addition to halting and reversing malaria epidemics, an 85% decline in malaria mortality rates has also been achieved as compared to the situation in 2000. India, in particular, has made tremendous progress, bringing down total deaths by 39% and burden of malaria cases by 37% during the era of the MDGs. Other countries in our Region are also making good progress with malaria control and elimination activities.
Recently, I presented the certification for malaria elimination to the President of Maldives in recognition of their efforts that have kept the island nation free of malaria for 30 years. Likewise, since 2012 Sri Lanka has also reported no locally acquired malaria cases and has remained malaria free. Although malaria continues to occur in Nepal, malaria deaths have not been reported from Nepal since 2012. And the number of indigenous cases has fallen to almost insignificant level in Bhutan with no death reported since several years. Similar decline of malaria cases is also seen in Democratic Peoples’ Republic of Korea.
I would like congratulate the Government of India for its progressive efforts towards the elimination of malaria. India is the first country in the Region to adopt the targets related to SDG 3 by launching this National Framework for Malaria Elimination 2016–2030. The Framework provides a realistic roadmap towards elimination with a phased strategy, enabling those states with low incidence rates to take it up first, followed by those with higher-incidence.
I would like to emphasize that this is important not only for India, but will also have a positive impact on the global efforts towards a malaria free world. Outside of Africa, India accounts for the largest number of malaria deaths and new cases annually. What happens in India here will have tremendous impact on the speed and certainty with which the world can achieve global elimination of malaria.
Further, about 44% of all malaria cases in India occur in areas located along its national frontiers. Elimination of Malaria in the frontier districts would directly influence the transmission in five neighbouring countries, namely Bhutan, Bangladesh, Myanmar, Nepal and Sri Lanka. The South-East Asia Region, and especially the countries bordering India, cannot eliminate malaria without India achieving this goal first.
One significant, and tangible, impact of elimination would be the escalation in inclusive growth of the populations otherwise left behind in the development index of the country. Although US$ 1.25 billion has been spent on malaria elimination in the last one decade, there are still reports of 17 million estimated cases with 26 000 deaths annually in the country. Of these 80% are confined to populations residing in tribal, hilly and inaccessible areas.
India’s gains from the elimination of malaria will also go beyond just saving countless lives, and extend to the economic realm. In 2012, it was estimated that the total economic burden of malaria in India was around 1.94 billion dollars. Similar estimates for India during the late 1990s showed that for every rupee invested in malaria control there could be expected a direct return of Rs 19.70. This means that implementing the National Malaria Elimination Framework 2016–2030 will translate into benefits exceeding 20 times the investment and costs.
However, I would like to point out that “business as usual” will not suffice if we are to achieve these ambitious goals. The task of malaria control and subsequent elimination will be faced with many challenges. The SEA Region experienced the lowest decline in cases of new infection in this decade compared with other regions of the world. The 2015 Global report on malaria revealed a 55% gap in India’s resources for malaria elimination.
A sense of urgency is a must to continue the momentum towards India’s malaria elimination goal. Early diagnosis of the problems and speedy corrections are imperative, without having to wait for annual survey reports. Real-time monitoring and efficient redressal of programmatic bottlenecks are essential if elimination is to succeed.
India has a vast pool of technical expertise whose potential must be tapped to deal with the huge burden of plasmodium vivax malaria,and the rapid development and spread of mosquito resistance to insecticides, as well as multidrug resistance, including to artemisinin resistance now seen in the Greater Mekong Sub-Region.
Achieving the goal of malaria elimination would need a paradigm shift in the approach to the problem. India has never been short of innovation, technological expertise or management excellence in the past in all areas of health, and specifically in malaria. The malarial parasite was not only first discovered in India, but the first Nobel Prize for Medicine was also awarded for work carried out in this country. Chemo prophylaxis was in practice since the early 1850s and a study on the economic impact of malaria, possibly one of the first health economics studies in the world, was carried out in India in 1911.
This is a crucial moment for all of us. We are presented with a “make or break” opportunity for the country and the Region. I pledge my full personal and WHO’s support for this effort, and in particular to facilitate and enable the implementation of cross-border programmes with Member States and with partners such as Global Fund and APLMA.
Nothing stops us from aiming for an even quicker time schedule for the elimination of malaria. Many of you are aware that a bulk of malaria resistance cases historically emerged from the Greater Mekong region and spread all over the world. Recent studies on artemesinin resistance show that the faster we achieve the targets of malaria control and elimination today, the more will we be saving our precious resources for tomorrow.
I would like to encourage India to critically examine how we can fast-track some of the operational targets in five years’ time, without waiting for the threshold of 2025. The earlier we eliminate such diseases, the more we can save resources for the emerging threats of NCD as well as for building a stronger health system. Malaria elimination, though an ambitious target, is possible and achievable in this Region. We will make it a success by working together with renewed commitment.