Malaria eradication by 2050 is wishful thinking

There is a lot of hype about the recently released malaria eradication report; already high- ranking politicians from the West are visiting African countries to market the report. It is a scientific report hence it should be analyzed scientifically and with honesty.

The report acknowledges that the eradication attempt in mid-20th century was a noble but flawed attempt.

So what has changed drastically that eradication should now be considered seriously. In this regard the report mentions that this is an ambitious undertaking but necessary and achievable.

Global funding has increased from $1.5 billion in 2000 to $4.3 billion in 2016. This is a gross increase and not a net increase.

Malaria endemic countries have decreased from 106 to 86 but none from hotspots in sub-Saharan Africa. Annual incidence rate declined by 36 per cent and mortality by 60 per cent thus according to the report eradication is feasible, affordable and worthwhile.

The report does not indicate the proportional decrease in anti-malarial medication consumed. If malaria has decreased and I believe it has there should be proportional reduction in anti-malarial medication consumed, if not then there is a serious threat of developing resistance to the combination therapy.

The estimated financial input must be $2.0 billion every year (25 per cent from donors and remaining from local sources) and the progress in information technology and new promising tools will be instrumental though as of now there is very patchy evidence that IT is having the desired and expected positive impact.

The report mentions three main threats, inadequate use of data to inform strategies, poorly incentivized staff and disengaged communities.

This is in a nutshell the reflection of the report. So why am I saying that eradication by 2050 is wishful? I think some of the major threats to malaria control and eradication have either not been addressed or have been tackled rather superficially.

Sub-Saharan African countries are currently faced with a serious epidemic (which has just started) of non-communicable diseases thus in reality there is the ongoing burden of infectious diseases and now a serious burden of NCDs.

It’s well known that the burden of NCDs is very expensive financially and expecting poor countries to contributing 75 per cent for malaria eradication is being unrealistic. Increasingly more funds will be needed for NCDs thus less will be available for other priorities. This is a major threat and there is a need to look at the health sector in a more holistic manner especially the improvements in health systems. Therefore the estimated costs of malaria eradication will not be realized thus the failure.

The next threat is climate change; malaria transmission is an intricate function of climatic factors, which non-linearly affect the development of vectors and parasites.

Each year, tens of millions of people across the globe are driven from their homes by floods, storms, droughts, and other weather-related disasters.

And as the adverse effects of global climate change induce more extreme weather, growing food insecurity, and rising sea levels this number is expected to rise.

Tragically, it is the world’s poorest and most vulnerable communities that are hardest hit.

I do not think replacing fossil fuel is round the corner; it will take much longer to mitigate the impact of climate change. Thus climate change will promote malaria and will precipitate fatal epidemics.

The next threat is emerging infections like Ebola fever, which we now know, can destroy the health systems of the affected country.

Along the coast of East Africa there is an ongoing epidemic of Dengue fever, which was never a threat in the past, my political friend thinks it is bioterrorism, which is completely false.

These emerging and unpredictable infections come with a great financial cost to the already constricting health budgets of poor countries.

The report talks about promising new tools and I agree that there will be new technologies but I will not base my reasoning on promises, we need scientific evidence, which is never based on assurances and pledges.

In the last 20 years or so, it is the same technology of insecticide treated bed nets, rapid diagnostic tests and ALU for treatment; there has been nothing new.

The recently reported malaria vaccine is in phase IV trial in three African countries. Its protection is less than 40 per cent and maybe much less in real life situation while the population is used to 100 per cent protection from vaccines, this is the discordance. Indeed new tools are needed because the mosquito and the parasite are both changing.

I think the international focus should be on poverty reduction. The malaria global map of the nineties is a mirror image of global poverty map. Poverty reduction in SSA goes hand in hand with corruption reduction.

Instead of malaria eradication board that the report suggest we need an international board to look into how to return the stolen funds from Africa. Alleviate poverty and malaria will disappear.

Malaria is my lifetime career and I would like to see malaria eradication not in thirty years but even less but it should be in reality and not via politically glitzy reports.

Zulfiqarali Premji is a retired MUHAS professor. His career spans over 40 years in academia, research and public health.