Paralyzed progress in eliminating malaria

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On his final report in the E-2020 initiative, the World Health Organization (WHO) announced its progress in its goal of eliminating malaria around the world. But critics are accusing progress has stalled.

The E-2020 initiative supported the efforts of twenty-one countries to eradicate malaria. In a remarkable success, especially during the COVID-19 pandemic, eight E-2020 member countries reported zero cases of malaria in 2020. The next WHO goal is the elimination of malaria in 20 years. these countries by 2025.


Dr. Nicholas White

While applauding these successes, in an interview with Medscape Medical News, Sir Nicholas J. White, Professor of Tropical Medicine at Mahidol University, Salaya, Thailand, and Oxford University, Oxford, UK, also put these achievements into perspective. On the one hand, the original 2020 target was the elimination of malaria in ten countries. White acknowledged that there had been “substantial reductions in global morbidity and mortality” from 2000 to 2015, but noted that these advances have not been sustained.

White added: “There has never been a really good and detailed investigation into why progress has stalled” in heavily burdened countries.

White also provided an important historical context, explaining that “100 years ago, malaria was almost a global disease. There were few places in the world that did not have it. You had malaria as far as the Arctic Circle. You had malaria in the United States United States , especially in the Tennessee Valley in the southeastern United States. The Centers for Disease Control was specifically formed to combat malaria and malaria that interferes with the construction of the Erie and Ottawa Canals. “

Kim Lindblade, PhD, head of the WHO World Malaria Program’s malaria eradication team, addressed these concerns Medscape Medical News. “It is not entirely clear why [progress] “It’s stalled,” he said. “There are many possible reasons for this, including stagnant funding.”

Lindblade added that countries with a lot of burden “face great challenges. [Since 2015] there is this stagnation. We are fighting population growth and countries need to get back on track to continue lowering their malaria burden. So that’s the big goal right now: to reorganize efforts to help countries achieve the goals of the World Health Assembly. “

Asked how these countries might approach the problem differently, Lindblade said Medscape Medical News that in the recent past there was “almost a one-size-fits-all strategy. Now we are examining the conditions at the district or provincial level much more closely and we say: What does this particular district or province need? “It’s adapting a lot to the environment and the specific epidemiological situation … and I think that’s got a lot of people excited.”

Due to travel restrictions and blockages due to COVID-19, the number of imported cases of malaria has decreased. This is the good news. But the pandemic has made it difficult to eliminate it in other ways. For example, the delivery of insecticide-treated bed nets has been delayed in some areas, as has it also led to indoor spraying. People in many areas have stopped seeking medical attention. Diagnostic capabilities have been reduced due to the diversion of health personnel to address the COVID-19 crisis.

Still, some of the successes in eliminating malaria have been amazing. Iran, for example, reduced its cases from about 98,000 in 1991 to 12,000 just ten years later. Since then, Iran has established rapid response teams equipped with insecticide-impregnated networks, rapid diagnostic tests and antimalarials. A network of more than 3,700 community health volunteers has been formed and deployed across the country.

A key element in the success of Iran – and some other countries – is the political will to fight malaria. This translates into funding. It should be noted that the most successful countries provide free primary care to everyone, regardless of their legal status or residence. Volunteer migrant workers are trained to diagnose malaria and educate their colleagues about the disease and prevention strategies.

Malaysia and China are examples of two countries at risk of importing malaria through their numerous people working abroad in malaria-endemic regions. They have had to increase vigilance.

Although Malaysia has eliminated most species of malaria (those transmitted by humans), they still have problems with the malaria parasite that hosts monkeys.

The WHO report highlights the lessons learned through its E-2020 program. Two key criteria are political commitment and associated funding. Then there is surveillance and efforts to reach everyone, even in geographically remote or marginalized communities. Close monitoring also allows strategies to be modified to local needs.

Countries need to cooperate, especially in border areas and in terms of communications. The WHO stressed the need for countries to have an integrated response in their approach to malaria, including precise surveillance, diagnostic testing, treatment and sound education in preventive measures.

While these successes were not so evident in some heavily burdened countries, White applauded their perseverance and noted: “It is quite difficult to maintain political momentum … This end to maintain motivation, maintain support and getting rid of something is hard. “

White and Lindberg have not disclosed any relevant financial relationship.

WHO. Zeroing In on Malaria Elimination: Final Report of the E-2020 Initiative. Published online April 21, 2021. Full text

Judy Stone, MD, is an infectious disease specialist and author of Resilience: One Family’s Story of Hope and Triumph Over Evil and conducting clinical research, the essential guide to the subject. You can find her at drjudystone.com or on Twitter @drjudystone.

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