World Malaria Day 2018

25 April 2018, New Delhi, India

Dear colleagues and friends,

You have already heard from Dr Swarup that this is the last public health event in this building. It is nevertheless an event of deep importance.

As many of you will appreciate, malaria is a disease that has affected the South-East Asia Region for millennia. Today it is a challenge we know we can beat.

Being ready to do just that – to beat malaria – is the theme of this year’s World Malaria Day. That theme reflects our collective drive towards the Region’s 2030 elimination target, and is also aligned with the recently signed Ministerial Declaration on Accelerating and Sustaining Malaria Elimination in the South-East Asia Region.

In recent years we have made remarkable progress. As detailed in the 2017 World Malaria Report, since 2010 the Region’s reported malaria incidence has been slashed by half. Associated mortality has declined by 60%. Two countries in the Region – Maldives and Sri Lanka – have already beaten indigenous malaria transmission and been certified malaria-free.

A number of the Region’s Member States are ready to do the same.

In 2016 four Member States recorded fewer than 10 000 cases. Bhutan and Timor-Leste have reported zero malaria deaths since 2013 and 2015 respectively. Eight of the Region’s nine malaria endemic countries are on course to reduce malaria cases by at least 40% by 2020. Three Member States – Bhutan, Nepal and Timor-Leste – are identified as having the potential to interrupt local malaria transmission by the same date. Importantly, all have taken steps to align national malaria control programmes with the WHO Global Technical Strategy for Malaria, which came into effect in 2016 and will guide global efforts through to 2030.

Nevertheless, dear colleagues, the South-East Asia Region remains the second most malaria-affected Region in the world. Across our Region 1.35 billion men, women and children are at risk of the life-threatening disease. Our Region accounts for 58% of the global burden of Plasmodium vivax malaria, while in 2016 63% of the Region’s malaria cases were from Plasmodium falciparum – the most deadly malaria parasite.

At the same time as celebrating our historic advances, then, we must also reflect on the need to confront the many challenges we face. Notably, we are not alone in facing those challenges. Indeed, after years of steady progress the global fight against malaria appears to have stalled. Since 2010 the malaria incidence rate fell by 18% – a pace too slow to reach the 2020 target of a 40% reduction in malaria incidence. In 2016 the number of estimated malaria deaths worldwide was largely the same as in 2015, while the number of reported malaria cases increased.

It follows that both globally and in our Region progress must be accelerated. Focus must be renewed. And our collective willingness to go the extra mile must be aligned with the gravity of the situation and the life-changing outcomes we are striving to achieve.

As outlined in WHO South-East Asia’s Regional Action Plan, a series of key, locally tailored interventions is needed to drive progress, both in areas and communities that remain high-burden as well as those where the problem is almost eliminated.

First among these interventions is expanding the activities of national malaria programmes to difficult-to-reach, disadvantaged or neglected communities at high risk of the disease, including tribal, migrant or mobile populations. That means providing them access to the full package of malaria interventions, including long-lasting insecticidal nets or indoor residual spraying, diagnostic testing and effective treatment. It also means intensifying community engagement so as to better understand local needs and calibrate elimination interventions accordingly. Among these groups, pregnant women and children under-5 need special attention, including increased access to antenatal services.

Strengthening surveillance and harnessing the full power of available tools and treatments is likewise essential. Though surveillance should be strengthened Region-wide – including via cross-border initiatives – where feasible it should be transformed so as to facilitate elimination, particularly in countries that are striving to eliminate the disease by 2020. The same applies to those in the Greater Mekong Subregion such as Myanmar and Thailand that aim to eliminate the falciparum parasite by 2025. This should be part of a larger push to harness the full power of effective, evidence-based tools and treatments. A more practical approach to case management of vivax malaria, for example, is needed with respect to the safe and effective use of primaqine, particularly since the South-East Asia Region has the majority of the world’s vivax malaria cases.

Ensuring national malaria programmes are provided sustainable funding is similarly paramount. Unless domestic financing is increased Region-wide, the prospect of malaria’s deadly resurgence is a distinct – and alarming – possibility. As more of the Region’s Member States transition away from dependence on international funding, high-level leaders must recognize the benefits beating malaria will bring, not only to their citizens’ health and wellbeing, but to sustainable development as a whole.

Dear colleagues and friends,

Even as drug resistance threatens the malaria elimination agenda – both in our Region and globally – the resistance of mosquitoes to insecticides is also widespread. As outlined in WHO’s Global Vector Control Response, which applies from 2017 through to 2030, high-quality monitoring, alongside the judicious use of insecticides, is crucial to overcoming this barrier. Malaria-endemic countries in our Region must take heed.

I also take this opportunity to note the need to hasten malaria control efforts in India, which is home to 80% of the Region’s malaria cases. Notably, India is the only country outside sub-Saharan Africa among the 15 countries that account for 4/5ths of the global malaria burden. While India’s malaria incidence is declining with great success in some states, the pace of progress must be quickened. I have confidence that health authorities country-wide will make that happen. To help them do that, I am pleased to note that WHO is currently developing a global initiative to support high-burden countries accelerate progress.

With that in mind, I commend the Region’s Member States for their resolve to achieve our common 2030 goal by reducing malaria in high-burden areas and communities at the same time as overcoming last-mile challenges. As each of them expressed in a Ministerial Declaration on Accelerating and Sustaining Malaria Elimination in the South-East Asia Region in November, a unique opportunity exists to eliminate malaria from our Region by 2030 at the latest, especially given recent progress. Their commitment is both necessary and highly encouraging.

It is a commitment each one of us should reflect on today as we focus on being ‘Ready to Beat Malaria’. I take this opportunity to reiterate that WHO South-East Asia is indeed ready to do that, and will continue to support Member States across the Region achieve our goal.

As reflected in our activities to date, we will do so by providing practical and strategic guidance where needed, as well as by keeping our joint malaria elimination target front-of-mind and emphasizing the winning mentality required to achieve it. With sustained, high-level commitment we can eliminate malaria Region-wide by 2030 at the latest. We can free millions of people across our Region from a disease whose burden has weighed so heavily for so long, but whose burden we are now ready to beat for good.

Thank you very much. I wish you an engaging and informative World Malaria Day.

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