The World Health Organization's World Malaria Report 2012, released this week, underscores the continued progress against the disease coupled with the increasingly urgent threat of resurgence in the absence of increased funding.
The report notes that 50 countries are on track to reduce their malaria case incidence by 75% by 2015. In the course of one year, access to Rapid Diagnostic Testing has doubled, access to WHO recommended treatment -- Artemisinin Combination Therapy -- has increased by one third, and access to nets remains constant with last year's figures. These gains come as financing for the disease increased over 2011 levels.
At the same time, we know that mortality has declined by one third in sub-Saharan Africa over the past decade resulting in more than one million lives saved. Much of these gains have come in response to Secretary-General Ban Ki-moon's catalytic malaria goals of providing universal access of malaria control interventions to all at risk, with the ultimate goal of reaching near zero malaria deaths by the end of 2015.
Yet as the world approaches the final three years to achieve the 2015 target, we know that the funding crisis that has affected the entire world, especially with respect to the challenges that confronted the Global Fund to Fight Aids, Tuberculosis and Malaria, has also affected our efforts against malaria. There is a financial gap of approximately US$3.6 billion required to reach and sustain universal coverage of essential malaria interventions in Africa until the end of 2015.
As Dr. Chan notes in the forward of the report, "We cannot achieve further progress unless we ensure that sustained and predictable financing is available. We must act with urgency and determination to keep this tremendous progress from slipping out of our grasp."
Sustained and predictable financing is needed not only to ensure continued progress, but even more importantly, to prevent resurgence. As we reflect on the findings of the report, there is no greater harbinger for the future potential trajectory of morbidity and mortality than the infamous historical trends in Sri Lanka.
In that island nation, a robust malaria control program in the years after World War II reduced the burden of the disease from hundreds of thousands of cases and tens of thousands of deaths to virtual elimination. Yet after enjoying years of living virtually malaria free, the malaria control program was abandoned in the 1960s and a dramatic resurgence occurred almost immediately thereafter, erasing the hard fought gains against the disease. To bring the disease back under control, as Sri Lanka eventually did, meant reconstituting the program at the old baseline numbers, in the process losing the gains of the original investment both in terms of lives saved, and financial resources.
While the world is not considering abandoning the global effort to end malaria deaths by any stretch, the Sri Lanka incident exemplifies how fragile gains against the disease can be, and what is at stake if they are not protected. And much indeed, is at stake.
Since 2007, funders, led by The Global Fund to Fight AIDS, TB and Malaria (accounting for over half of all external malaria funding), The United States President's Malaria Initiative, the United Kingdom, and the World Bank, have invested over $10 billion in reversing the course of the disease, protecting hundreds of millions of children, women and men with lifesaving commodities.
Yet at this moment, it is no exaggeration to say that we stand on the precipice of a humanitarian crisis if we fail to urgently resolve this funding shortfall.
Closing this gap will require a perfect storm of increased traditional resources, increased endemic country prioritization, and increased savings associated with innovation - both technologically and financially. But it can be done.
Last week the Board of the Roll Back Malaria Partnership agreed to a series of immediate actions to redeploy resources to address these gaps, and this action plan should be followed without delay.
The Africa Leaders Malaria Alliance, comprised of over 40 Heads of State across the continent, is prioritizing this funding gap at the highest level.
ALMA is committing their upcoming Forum alongside the African Union Summit in January to examine innovative financing, domestic revenue generation as well as donor reprogramming.
Looking ahead, there is arguably no greater driver of what the future will hold for malaria control funding than the replenishment and recapitalization of the Global Fund in September of 2013.
At the same time, improving savings on our program costs is helping to ensure sustainability. Average net costs are now $3.25, down from a high of $7 just five years ago. Likewise treatment and testing commodities continue to be more affordable than in the past. In addition, as economic growth in Africa remains strong, endemic countries are beginning to commit more of their own resources than ever before. Ultimately, because of these and other factors, we can look to a downward trend in terms of the investment required from traditional donors should we achieve control and begin to lift the human and economic toll malaria takes.
Fortunately, many aspects of the solution needed to address this financial shortfall are already in place. Now we need to resolve to implement them.
It would be a grave calamity to allow millions of children to lose their protection and wipe away our US$10 billion investment to date by allowing resurgences to occur. It would undo years of good work that has improved lives on such a dramatic scale, propelled African economies dramatically forward, and has helped some of the world's most disparate countries form strong bonds. We cannot allow so much progress to come undone, when we have never been closer to reversing the course of malaria in such a profound way.
Ellen Johnson-Sirleaf, President of Liberia; Raymond G. Chambers, the United Nations Secretary-General's Special Envoy for Malaria and MDG Advocate.