Shrinking the Malaria Map

UCSF Global Health Group’s Malaria Elimination Initiative (MEI)

Malaria elimination highlights from World Malaria Report 2017

20 December 2017

The World Malaria Report tracks global progress towards the goals set out in the Global Technical Strategy for Malaria 2015 – 2030. This year’s report paints a challenging picture, showing that funding for the malaria response has plateaued and the world is not on track to achieve its 2020 targets. Malaria cases have gradually risen since 2014, with the largest increases occurring in Africa and the Americas. Gaps in coverage with lifesaving tools remain, with bednet coverage less than 50% in some African countries. In addition, indoor residual spraying of households has decreased precipitously in all malaria endemic regions.

However, there are some bright spots in the report. The WHO 2017 World Malaria Report shows that many low burden countries are continuing to make steady progress towards elimination. In the Asia Pacific, the number of countries with less than 10,000 indigenous cases has doubled over the last five years, putting the region on track to achieve a malaria-free Asia Pacific by 2030 – a goal towards which all 21 malaria endemic countries in the region are working.

Other key points from the 2017 WHO World Malaria Report include:

Progress towards elimination

  • Globally, more countries are moving towards elimination: in 2016, 44 countries reported fewer than 10,000 malaria cases, up from 37 countries in 2010. Kyrgyzstan and Sri Lanka were certified by WHO as malaria free in 2016.
  • In 2016, WHO identified 21 countries with the potential to eliminate malaria by the year 2020. WHO is working with the governments in these countries – known as “E-2020 countries” – to support their elimination acceleration goals.
  • Although some of E-2020 countries remain on track to achieve their elimination goals, 11 have reported increases in indigenous malaria cases since 2015, and 5 countries reported an increase of more than 100 cases in 2016 compared with 2015.
  • Many countries are continuing to make steady progress towards elimination, particularly those in the Asia Pacific and the Americas. The number of countries in the Asia Pacific region with low transmission (e.g. with less than 10,000 indigenous cases) has more than doubled since 2010 (rising from 5 to 11 countries).
  • New evidence confirms that if efforts are intensified, Asia Pacific will be on track to achieving its goal of eliminating malaria by 2030. According to new research from the MEI, if resources and activities are accelerated, malaria could be eliminated across the region even sooner.
  • Additionally, in sub-Saharan Africa, five high burden countries made large decreases (of at least 50,000 cases) in malaria cases, including Gambia, Ethiopia, Zambia, Senegal, and Madagascar.
  • In addition, a number of African countries have achieved impressive improvements in diagnostic testing and surveillance. Since 2010, more than 1.3 billion rapid diagnostic malaria tests have been distributed in Africa and many countries have increased their reporting rates to the national surveillance systems.

Challenges to achieving 2020 goals

  • However, the new World Malaria Report shows that overall, the world is not on track to achieve the goals set out by the Global Technical Strategy – specifically, a 40% reduction in case incidence and mortality by 2020.
  • Many countries have reported increases in malaria cases, particularly those that already have a high burden of malaria. Globally, malaria cases have marginally but consistently increased over the last three years, with 211 million cases in 2015 and 216 million cases in 2016 – numbers that mark a return to 2012 levels. (During this same time period, the number of malaria deaths has slightly decreased, down from 446 000 in 2015 to 445 000 in 2016.)
  • According to WHO, some of the challenges impeding countries’ abilities to stay on track and advance towards elimination include lack of sustainable and predictable international and domestic funding, risks posed by conflict in malaria endemic zones, anomalous climate patterns, the emergence of parasite resistance to antimalarial medicines and mosquito resistance to insecticides.
  • The report also shows that malaria funding for the global malaria response has plateaued since 2010, reaching USD 2.7 billion in 2016 – less than half of what is estimated by the GTS will be required by 2020. In some cases, there appears to be a strong association between declines in funding and increases in malaria cases. For example:
    • Papua New Guinea saw nearly a 70% decrease in funding per capita population at risk in 2011 – 2013 and 2014-2016, and a corresponding increase in cases by 600,000 between 2015 – 2016.
    • Afghanistan saw nearly a 55% decrease in funding per capita population at risk in 2011 – 2013 and 2015 – 2016, and a corresponding increase in cases by 300,000 between 2015 – 2016.
  • The World Malaria Report 2017 signals a clear need for greater investment in malaria control – particularly at the domestic level. Gaps in the coverage of existing tools that prevent, diagnose and treat malaria must be urgently closed. Equally important is the need for robust investment in the research and development of new tools.
  • The next two to five years are critical to accelerating progress towards the regional elimination goals in Asia Pacific, southern Africa, and Latin America. Given the scarcity of resources, malaria endemic counties must think differently and not accept a ‘business as usual’ approach.