By Jeffrey L. Sturchio and David Reddy
In a rural hospital in Ethiopia that cares for the poor, a fragile young girl called Zakhiya has recovered recently from severe malaria. In the six short years of her life, Zakhiya has battled a number of infectious diseases. Her struggle will probably continue throughout her childhood. But Zakhiya is fortunate: she has fought off malaria -- this time.
Almost three-quarters of a million children in 34 African countries are estimated to have been saved in the past 10 years, through the use of insecticide-treated mosquito nets (ITNs), indoor residual spraying, effective medicines and preventive treatment during pregnancy, according to a Roll Back Malaria Partnership (RBM) report.
An expansion of malaria control programs between 2008 and 2010 has resulted in the distribution of enough ITNs to protect more than 578 million people in sub-Saharan Africa, according to the World Malaria Report 2010, and indoor spraying has protected 75 million people, or 10% of the population at risk in 2009.
In addition, over 400 million treatments of Novartis' artemisinin combination therapy (ACT), Coartem, have been delivered over the last decade, while 229 million ACT treatments were procured worldwide in 2010 thanks to other companies and product development partnerships (PDPs).
Zanzibar has virtually no malaria cases today, compared to 18,000 only a decade ago. In 2009, Morocco and Turkmenistan were certified by the World Health Organization (WHO) as having eliminated malaria and the WHO European Region reported no cases of Plasmodium falciparum malaria for the first time.
These successes have been a collaborative effort of government, multilateral and non-government organizations and the private sector. But much of the leadership and funding has come from the U.S. government, through the President's Malaria Initiative, the Global Fund to Fight AIDS, Tuberculosis and Malaria and the Bill& Melinda Gates Foundation. These donors have helped drive an 18-fold increase in malaria funding between 2003 and 2010.
As we mark World Malaria Day on April 25, we have much to celebrate. But malaria remains a deadly killer, threatening half the world's population and taking nearly 800,000 lives a year. Malaria strikes society's most vulnerable, especially children under the age of five -- 85 percent of malaria deaths fall into this group -- and pregnant women.
Beyond the toll on human lives, this disease costs Africa US$12 billion in lost GDP every year and consumes 40 percent of all public health spending in malaria endemic countries in Africa, where lost productivity is estimated to reduce GDP by 1.3 percent per year. And malaria consumes up to one-quarter of household income in some countries.
PDPs have developed and delivered antimalarial medicines and are making headway in the development of vaccines and rapid diagnostic tests. However, as the death and disability toll makes clear, much more needs to be done if we are to defeat malaria once and for all.
New interventions are futile if they do not reach malaria patients and save lives. One of the most difficult challenges is to make novel health interventions affordable, accessible and available to those who need them most. Progress is being made, as illustrated by the distribution of 64 million treatments in 35 countries of a new and effective pediatric formulation.
However, with one child dying from malaria every 45 seconds, more must be done.
An emerging challenge threatens to undermine our progress -- resistance to ACTs. The fear is that like chloroquine, an older class of antimalarial drug that has lost its power, artemisinin will be rendered useless through the emergence of resistant parasites.
The first sign of artemisinin resistance has already emerged at the Thai-Cambodian border, and much is being done to contain its spread. But scientists know that drug resistance is inevitable, given the propensity of the parasite to mutate. Lack of patient compliance to drug regimens and the use of artemisinin on its own without a partner drug also increase the chance of parasite resistance taking hold.
Chloroquine resistance took 15 years to spread from its original source in Southeast Asia to Africa. Given that it takes 10-15 years to develop a new drug, it is clear that the time to develop new medicines for malaria is now. To that end, PDPs are working diligently to fill the malaria medicine chest with affordable alternatives. This important work needs continuous support.
In this long war to eradicate malaria we are at a tipping point. Malaria has been eliminated or is close to elimination in several countries. To stop efforts before the last parasite has been defeated is to lose the enormous gains already made.
We need to scale up what is already working and continue to develop new antimalarial tools. Coverage and utilization of existing prevention and diagnostic measures need to be sustained and expanded. The RBM report cited above estimates that an additional 3 million lives -- like Zakhiya's -- could be saved by 2015 if the world continues to invest in tackling the disease.
Read the Global Health Council's newly released Position Paper on Malaria.
David Reddy is the CEO of Medicines for Malaria Venture, a not-for-profit public-private partnership, established in Switzerland in 1999. He holds a PhD in Molecular Biology from the University of Auckland, New Zealand. His career encompasses 20 years of management experience in the healthcare industry, including successful leadership of drug development teams; licensing and alliance management; analytics and business planning; product and disease area management; and interfacing with governments, NGOs and patient advocacy groups in priority disease areas including HIV/AIDS and influenza.
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