In the wake of last week’s Kigali Summit on Malaria and Neglected Tropical Diseases, getting malaria elimination back on track is a top priority says a senior Bill and Melinda Gates Foundation official – in addition to ensuring the world learns from the COVID pandemic that “global health” is truly a global matter.

The world has lost years of progress on malaria control thanks to the COVID pandemic, with malaria mortality close to what it was almost a decade ago, Philip Welkhoff, Director of the Malaria Program at the Bill & Melinda Gates Foundation, told Health Policy Watch, just after the conclusion of the Kigali Summit. 

“Malaria is really unforgiving. And when there are disruptions in either access to care or some of the routine services, that malaria burden will go up. Because of COVID, we’ve gone backwards,” Welkhoff said, in an interview. 

But Welkhoff is determined to get the world back on track now. Last week’s Kigali Summit on Malaria and Neglected Tropical Diseases, saw a new US$140 million, four-year commitment by the Gates Foundation to support new malaria research initiatives as well as amplified control measures in terms of diagnostics, drugs bednets and health system strengthening. 

14 million more cases in 2020 

Last December, the WHO’s World Malaria Report 2021 highlighted just how dramatically COVID had disrupted malaria services in the first year of the pandemic. There were 14 million more malaria cases in 2020 as compared to 2019, and 69,000 more deaths. The year 2020 saw a total of 241 million malaria cases leading to 627,000 deaths worldwide. 

“Approximately two-thirds of these additional deaths (47,000) were linked to disruptions in the provision of malaria prevention, diagnosis and treatment during the pandemic,” WHO concluded.

The Sustainable Development Goals, associated with WHO’s malaria strategy, include achieving a 90% reduction in global malaria incidence and mortality rates by 2030.  

Now progress towards that goal  is substantially off track. In 2020, the global malaria case incidence rate was 59 cases per 1000 people at risk against a WHO target of 35/1000 for 2020 —  40% above the target.  The global mortality rate was 15.3 deaths per 100,000 people at risk against a WHO target of 8.9/1000 — or 42% higher.

Drive down burden aggressively – and then advance elimination

With 2030 just eight years away, achieving the 2030 SDG goals will be capital-consuming, considering the cost of health commodities involved. Welkhoff points out. 

He is therefore looking forward to a successful donor response in September to the replenishment drive of the Global Fund to Fight AIDS, Tuberculosis and Malaria, which is the primary funder of malaria drugs, diagnostics and bed nets.  The Global Fund aims to raise US$ 18 billion from donors then for its 2024-2026 budget cycle.

“But then there’s many things that we can build on from there. This is a very critical moment in this fight against malaria,” he said.

He notes that current malaria funding is estimated to save more than 500,000 lives annually – cutting the burden of malaria mortality by half. 

Scaling up new bednet technologies and fighting resistance to ACTs

New funding will also help in the fight against insecticide resistance, including the introduction of bed nets impregnated with new ingredients that kill mosquitoes more effectively. 

“So we want to start introducing and scaling up these nets. We are [also] starting to see the beginnings of drug resistance in parts of Africa to the Artemisinin combination therapies (ACTs). So this is going to need funding, to make sure that we don’t lose these drugs that each year save so many lives.”

The COVID-19 pandemic has also highlighted the need for the prioritization of local leadership. In that vein, increasing national government involvement in malaria control is all the more critical.   

“I think we’re going to see further steps in that direction with this next set of funding,” he told Health Policy Watch.

Reimagining global health and NTDs

From the COVID-19 pandemic to the latest Monkeypox outbreak, there are calls for more collaboration on disease outbreaks that can now rapidly spread across vast distances. This means reimagining risks posed by neglected tropical diseases (NTDs) to global health, including parts of the world where such diseases do not currently pose any major threats, Welkhoff noted. 

Lessons learned in the pandemic should motivate actors from the global North and South to work even more closely together to drive down existing disease threats, he observed.  

“We do have to work together to drive down these diseases as much as possible. And they shouldn’t be neglected. I think the lessons of COVID and many other diseases is that we as a world need to really recognize how interconnected everything is,” Welkhoff said.

Image Credits: WHO, Samson Wamani , Courtesy of BMGF, The Global Fund , Paul Adepoju , WHO.