A new declaration by health ministers from African countries that have the highest malaria burden has reaffirmed the “unwavering commitment to the accelerated reduction of malaria mortality”.

The declaration, issued Wednesday by ministers convening in Yaoundé, Cameroon at an African-wide WHO conference on malaria, aims to revitalise the campaign to drive deaths from malaria further downwards – following the setbacks of the COVID-19 pandemic.  

Public health experts speaking with Health Policy Watch, however, described the declaration as largely a rehash of previous statements.  The declaration made no new commitments either to concrete targets for vaccine scale-up or health sector investments in combating the deadly disease that still kills 580,000 people annually, 95% of those Africans mostly under the age of 5.

Dr Matshidiso Moeti, WHO Regional Director for Africa, however, described the declaration as a milestone. 

“We welcome today’s ministerial declaration, which demonstrates a strong political will to reduce the burden of this deadly disease. With renewed urgency and commitment, we can accelerate progress towards a future free of malaria,” Moeti said, speaking from Cameroon to a press conference.

In 2022, the Africa Region was home to 94% of malaria cases (233 million) and 95% (580,000) of malaria deaths.

A Malaria Ministerial Conference is underway in Cameroon to strengthen political and financial commitments for an accelerated malaria response in high-burden countries. pic.twitter.com/jkvi07u6TV

— WHO African Region (@WHOAFRO) March 6, 2024

In 2022, some 233 million people were infected with malaria, 94% of cases in the African region. The ministers pledged to further invest in data technology, as well as malaria control efforts and elimination, and enhance malaria control efforts at national and sub-national levels. 

“This declaration reflects our shared commitment as nations and partners to protect our people from the devastating consequences of malaria. We will work together to ensure that this commitment is translated into action and impact,” said Manaouda Malachie, Minister for Health of Cameroon at the meeting.

The countries pledged “to hold each other and our countries accountable for the commitments”.

Hot air – or stepping stone?

The 2023 Africa Malaria Progress report by African Leaders Malaria Alliance cited a growing number of threats to achieving the goal of eliminating malaria as a public health threat in Africa by 2030.

“Despite political will and knowing how to defeat malaria, we lack the resources necessary to fully implement our national malaria strategic plans, sustain essential life-saving malaria services, and deploy new and more effective interventions to address increasing biological threats,” the report’s foreword stated. 

The report called on African leaders “to act now to drive accountability, action, advocacy, and resource mobilisation to end this disease once and for all”. 

Just 11 African countries carry nearly 70% of the global burden of malaria, progress against malaria “has stalled since 2017” due to factors that include humanitarian crises, low access to and insufficient quality of health services, climate change, gender-related barriers, biological threats such as insecticide and drug resistance and global economic crises.

The new declaration also highlights the need to address the contributions of fragile health systems and critical gaps in data and surveillance that have compounded the challenge of controlling malaria in several African countries.

Behind the scenes, WHO and malaria implementation partners are hoping that the COVID-19 experience that demonstrated the need for more investments in healthcare, would convince the countries to willingly increase their own spending on health.

According to Moeti, the ministers and the partners in attendance understood the needs for more investment and financial resources. “We need more money to do this work.” In addition to funding, there is also the need to apply the lessons learned. “We need to apply science in a way that informs not only what we do at the national level, but very much at the local level,” Moeti stressed. 

She called for the use of data to differentiate between different situations and to be able to target and focus interventions to have the optimum impact. “We need our health system to have investments that make them more responsive, more able to deliver the services effectively, and detect cases early.”

SMART action plans 

In order to build action out of the declaration, the RBM Partnership  announced it will be convening parliamentarians, opinion leaders and civil society from high burden countries at a parallel regional forum – to discuss more concretely how to achieve their commitments and accelerate action. This is supposed to lead to the co-development of SMART action plan, RBM said in a statement. 

“Participants have also been undergoing training on the strategies, existing tools and funding for malaria control,” the RBM Partnership stated.

The partnership’s CEO, Michael Charles, noted that if so-called “High Burden High Impact” can make significant inroads, this will drive down malaria incidence globally. . 

“Collaboration plays a crucial role in promoting a coordinated African response to malaria, and we’re delighted to be working alongside partners to convene key decision makers to translate the Yaoundé Declaration into a concrete action plan that will enable these countries to quickly accelerate anti-malaria activities, stay accountable, and meet the commitments they have just made,” he said.

Consolidating progress

In spite of the bottlenecks, progress against malaria is being recorded including a number of recent malaria-free certifications by WHO, the most recent being Cabo Verde. 

With half of the world’s population at risk of malaria, however, the RBM Partnership added that biological threats and climate change are further increasing the malaria challenge, and current investment levels and coverage of malaria interventions will not be sufficient to achieve the 2025 Global Technical Strategy for malaria milestone of a 75% reduction in mortality rates and case incidence. 

It added that progress towards the corresponding third Sustainable Development Goal (SDG) 2030 targets is also “off track”. But with current tools – such as vector control, preventive chemotherapies and vaccines – the lag could be overcome, the Partnership said.  

“With a combination of efforts, it will be possible to lower malaria case incidence and significantly reduce mortality in these High Burden High Impact countries, and minimise the global threat,” it concluded.

Image Credits: World Health Organization, Malaria Ministerial Conference in Yaoundé, Cameroon, WHO/@MoetiTshidi.