Amid all the gloomy talk of economic recession and dire warnings that the amount of money available for development aid is going to shrink, a report on the state of malaria research out on Tuesday is refreshingly upbeat. Investment has more than quadrupled in the past 16 years, it says, from $121m in 1993 to $612m in 2009. Yes, malaria is a massive health burden in many countries and was neglected for decades. But, it goes on – and this is worth quoting because it’s a rare moment of good news:
Fortunately, a dramatic increase in support for R&D since the mid-1990s means funders are now well on the way to achieving global malaria control, treatment and elimination goals and, with maintained commitment, should reap the rewards in the next five to six years.
The report comes from six different major organisations, including the Malaria Vaccine Initiative and Medicines for Malaria Venture. Speaking to Professor Awa Marie Coll-Seck, executive director of the Roll Back Malaria partnership, which co-ordinates the global effort, I was keen to know whether this means that the mosquito-borne disease that kills 750,000 a year – mostly small children – in developing countries is on the way out.
In the last few years, she said, the roll-out of bed nets to protect against mosquito bites at night, indoor spraying with insecticide, and better access to good treatment has enabled 40 countries to cut malaria deaths and cases by 50%. “This has put it in the minds of all people that it is possible to defeat this disease and have, one day, a malaria-free world,” she said.
Some countries have eliminated malaria completely – such as Morocco in the last two years. Others are making impressive progress, such as South Africa and Swaziland, where cases have dropped by 90%. This is the way it has to happen, with one region or country after another eliminating the disease. It will take time. “We will one day go towards eradication, but it is not now,” said Coll-Seck. “We are not saying tomorrow we will eradicate malaria. We have a long way to go. We need new tools and the financing of malaria must be sustained.”
Of course, the only disease the world has managed to eradicate is smallpox and that was thanks to a vaccine. Polio is forever tantalisingly close and never quite there, because not only a vaccine is needed but the capacity and will and money to reach all children with the vaccine. Huge efforts continue to be made in the remaining pockets – I saw the impressive mobilisation myself in India a year and a half ago(this is the piece I wrote). But even where eradication is elusive, vaccines can drastically cut the death toll of infectious diseases.
So one of the tools Coll-Seck mentions is indeed a vaccine. One of the big surges in malaria research funding has been for the development of GlaxoSmithKline‘s RTS,S vaccine, which is now in final trials in Africa and may give children 50% to 60% protection, we hope. Between 2004 and 2009, says the report, 28% of malaria research funding has gone into vaccines, with 38% into drugs, 23% to basic research but only 4% into vector control products – essentially new insecticides to replace the cheap but controversial DDT, which causes environmental damage if used outside – and 1% into new diagnostics. That reflects “donor funding preferences”, the report says. The two latter areas badly need more money, says Coll-Seck.
Once again, it is the Bill and Melinda Gates Foundation that has led from the wallet. Two organisations – the foundation and the US National Institutes of Health – “provided a striking half of global malaria R&D funding in 2007-09, and were responsible for 85% of the global increase in malaria funding”, says the report.
So what are the hurdles ahead, I asked Coll-Seck. Sustained finance is still the number one priority, she says. Funding overall for malaria (not just research) plateaued in 2010. Some 70% of it comes through the the Global Fund to Fight Aids, Tuberculosis and Malaria, which is struggling to keep donations up. The second issue is resistance to the only drug that works well – artemisinin – which has been found on the Thai/Cambodia border, underlining the need for new drugs and the importance of using those we have properly. And the third, she says, is maintaining a strong and well co-ordinated partnership between all the countries and organisations involved in the fight against malaria.
So there is much more to do and much further to go, and eradication may be no more than a distant dream – but heartening to see such progress.