Fight against malaria ‘flatlining’ as disease resurges in Africa


The eradication of malaria is now at a “crossroads” as developments made in the early-2000s have stagnated, said health experts and organizers of a London summit attended by royalty, heads of state, and philanthropists.

While ridding the entire world of malaria is “ambitious,” Bill Gates, Microsoft founder-turned-philanthropist said at the summit, new investments and prevention methods are needed to push the efforts as progress stalls.

“If we don’t keep innovating, we will go backwards,” he said, noting that regression risks the lives of one million children a year.

Speaking about UK and the Commonwealth plans to collaboratively address malaria, Britain’s Prince Charles said in a keynote address that “it is tragically evident that much still remains to be done” and committing to change was “”vitally important.”

The Prince, who has traveled to malaria-afflicted areas, made what he called a “plea” for an integrated approach to combat malaria over the next generation. Fighting malaria was not part of some “a la carte” menu, he said, warning that it is not a charitable cause that can be picked up and dropped sporadically.

For the first time in 10 years, worldwide malaria cases have stopped decreasing. Despite significant developments to combat the disease between 2000 and 2015, when 62 percent of cases were defeated (WHO), 2016 saw 216 million cases of malaria in 91 countries, five million more than in 2015.

Dwindling political attention, insecticide resistance, and plateauing global funding have been attributed to stalling progress.

Nigerian novelist Chimamanda Ngozi Adichie speaking to the audience at a malaria summit in London as part of the Commonwealth Global Heads of Government meeting. Photo by: Malaria No More UK

The mosquito-borne disease kills half a million people every year, and mostly affects pregnant women and children under five. A child dies from malaria every two minutes, according to a report by advocacy group Malaria No More which is organizing the summit. Africa accounts for over 90 percent of global malaria cases and 91 percent of malaria deaths.

Cases of malaria have decreased over the past half-century, but half of the world’s population is still at risk. At least 10 countries on the African continent, including Nigeria and the Democratic Republic of the Congo, are facing increasing cases of malaria, after other places, including Burundi in East Africa and Gauteng Province in South Africa, had outbreaks in 2017.

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Royals, philanthropists, celebrities, and heads of government, business and health came together in central London on April 18 to announce renewed efforts to tackle the disease, to encourage Commonwealth leaders to commit to halving cases of malaria by 2023, and to urge world leaders to pledge more money towards prevention.

Commonwealth leaders such as Peter Mutharika, president of Malawi and Uhuru Kenyatta, Kenya’s president,  committed to halving cases of malaria by 2023, with many others hoping to eliminate it completely in the following decade.

Halving the number of those affected the disease would prevent 350 million cases of malaria and save 650,000 lives, said James Whiting, executive director of Malaria No More. Efforts to treat malaria need to get “back on track” said Whiting during a press conference call.

The summit, organized by Malaria No More in conjunction with the Bill and Melinda Gates Foundation and supported by British Prime Minister Theresa May, pledged investment of over $3.8 billion (£2.7 billion) to pay for innovation in malaria research and treatment.

The summit coincides with the Commonwealth Heads of Government Meeting in London, a biennial convening of 53 Commonwealth leaders, whose countries are disproportionately affected by malaria.

Big messages from the malaria summit:

1. More needed to combat malaria globally

Almost every speaker at the summit framed their comments around the dramatic need for Commonwealth investment and commitment to tackle malaria to prevent a regression in treating and defeating the disease and a resurgence of cases. The overarching message of the summit was that the number of people globally affected by malaria has fallen dramatically overall but complacency and lack of developing new tools has stagnated progress.

Technology mogul and philanthropist Bill Gates said the setback symbolized by the rise in cases of malaria is a “signal” about the need for new tools and a reworking of malaria strategies to relax the “unacceptable” malaria burden in Africa. Given the increase in cases in parts of the continent in recent years, without further progress, that backwards streak could accelerate, said Gates. “If we don’t keep innovating, we will go backwards,” he said.

However, the Microsoft founder said there are not enough funds available to spend freely on all the insecticides, diagnostics, and drugs needed. “We don’t have enough money that we can spend on all those things, [so] we have to be very smart.”

Dr Tedros Adhanom Ghebreyesus, director of WHO, said the main challenges to malaria developments are drug resistance, mosquitoes invading new places due to climate change, and slow progress in new technologies. Ghebreyesus, who has had malaria twice, said “progress has been stalled” and finance is on the decline. But moving forward requires political commitment and recognizing the “power of communities” in combating the disease.

Bill Gates showing a new type of mosquito net on stage at the Malaria Summit London. Photo by: Malaria No More UK

2. Innovations aplenty

Besides vaccines, other solutions to combating malaria include technology-infused innovations.

The “newest frontier” against malaria is gathering data about malaria cases, and by using digital surveillance, such as GPS tracking the locations of where those infected are, said Bill Gates. Other pioneering techniques to combat malaria include the process of spraying the inside of dwellings with an insecticide to kill mosquitoes that spread malaria known as Indoor Residual Spray (IRS). One IRS tool featured in the talk, mSpray, led to a 15 percent decrease in malaria incidence in Zambia in the areas where it was implemented. It works by using satellite imagery and geographic information software, which has better quality spray coverage than traditional methods.

Gates also presented newer versions of traditional prevention methods, such as a new bed net on stage that keeps mosquitoes from biting people during the night, and an outdoor biting sheet that uses fruit juice to attract mosquitoes that feeds them insecticides.

A potentially revolutionary project to release genetically-modified mosquitoes that can make malaria-carrying mosquitoes infertile and unable to spread malaria parasites, is in the works. Using gene-editing technology, scientists have worked on the “antimalarial” mosquitoes and Gates said he is “hoping” the initiative will see trials in the coming few years.

3. Hope not lost – new treatments on the horizon

Successes made in some regions should renew hope for others, said Julie Bishop, Australia’s minister for foreign affairs. She noted Sri Lanka and the Maldives, which have been declared malaria-free by WHO in the past two years. Making malaria eradication a “regional reality” will make it a “global reality,” said Bishop.

Renewed attention on malaria “is exactly what the malaria community needs,” says a hopeful Nadine Schecker, head of communications at Novartis, the Swiss global healthcare company that has announced an investment of $100 million into new malaria drugs. Novartis’s recent work has focused on developing antimalarials for children, including a sweet-tasting tablet that dissolves in liquid. Children are the most impacted by malaria but have “too little access” to treatments, Schecker told WikiTribune.

4. Pledges for progress

  • Governments, leaders, businesses and philanthropic organizations together pledged investment worth over $3.8 billion (£2.7 billion).
  • A joint initiative was announced by the Innovative Vector Control Consortium, which produces insecticides for mosquito control, and the Gates Foundation, Bill and Melinda Gates’s philanthropic group, to eradicate malaria by 2040. Mitsui Chemicals, Sumitomo Chemical Company, and Syngenta, launched “ZERO by 40”, to provide research, development and supply of innovative vector control solutions to help end malaria.
    • Pharmaceutical company Bayer also commited to the initiative help eradicate malaria by 2040.
  • The UK government pledged £500 million ($700 million) a year for the next three years to help fight malaria.
  • The Bill & Melinda Gates Foundation is set to invest an additional $1 billion (£700 million) to fund malaria research and development every year until 2023.
  • Pharmaceutical company Novartis pledged to invest $100 million into research and developing next-generation antimalarials. It said while the disease is “preventable, treatable and curable,” malaria takes a devastating toll on families, especially in Africa. The company pledged to invest $100 million into research and developing next-generation antimalarials.
  • Dr Barnabas Sibusiso Dlamini, prime minister of Swaziland, said the Southern African country has doubled financing of Indoor Residual Sprays, and pledged to “vigorously engage” its private sector for advances.
  • President of the Republic of Kenya, Uhuru Kenyatta announced commitments to introducing a life-saving vaccine for children by the end of the year in endemic areas of his country.

View the full list of commitments made at the summit (PDF).

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Personal story: British Olympian nearly died from the disease

Ten months before winning a bronze medal in Brazil in 2016, track and field athlete Anyika Onuora was hospitalized. After visiting family in Nigeria in October 2015, the 32-year-old experienced fevers, vomiting, fatigue and a bone-chilling cold wave. Coming back to England she found out she’d contracted malaria during her two-week holiday and was unable to walk. She kept this to herself for months, only revealing her “life-changing” experience to her team mates and publicly last year. She spoke to WikiTribune at the summit:

“[It felt] like death. It was a traumatic experience and was life-changing more than anything. When the doctors told me I was diagnosed with it, I wasn’t too sure how to react. Because I never thought I’d ever get malaria.

“At night, I couldn’t sleep because I’d wake up in a pool of sweat. I’d be shivering and shaking was was uncontrollable.

“It was a nasty, nasty experience but I’m one of the fortunate ones to live to tell my story and make a full recovery and progress in my career and be a professional athlete. It’s huge. It’s not like I do a 9-5 job. My body is my temple to me.

“It’s rough having to learn to do everything again, to walk, to jog, to run.

“I didn’t want [my malaria] to be used as an excuse. I kept quiet about it until I was ready to tell my story. I got a medal and the following year, I told my story.”

 

 

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