Here I Am: Sir Richard Feachem on "Shrinking the Malaria Map"

Here I Am: Sir Richard Feachem on "Shrinking the Malaria Map"
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Since 2000, over 1 million lives have been saved from malaria. This World Malaria Day (April 25th) is an opportunity to pause and reflect on the gains that have been made and how to scale-up for even more progress going forward. The Global Fund is the major international funder of anti-malaria efforts, representing 60% of international financing and is responsible for some of the most critical interventions in the fight against malaria including the distribution of a total of 310 million nets to households.

Sir Richard Feachem is a renowned global health and development expert. He is the founding Director of the Global Health Group at the University of California, San Francisco, where he leads efforts to advise countries eliminating malaria. From 2002 to 2007, Professor Feachem served as founding Executive Director of the Global Fund to Fight AIDS, Tuberculosis and Malaria, and Under Secretary General of the United Nations. Over the years, Professor Feachem has developed a passion for malaria elimination. Today, I invited him to share some remarks with you on the tremendous progress that has been made in reducing the global malaria burden in the last decade, his vision for "shrinking the malaria map," and the importance of Global Fund support to reaching the ultimate goal: malaria eradication.

Sir Richard Feachem on Shrinking the Malaria Map

World Malaria Day (April 25, 2013) provides an excellent opportunity to renew global commitments to reducing malaria worldwide, and to eventual eradication of this historic scourge.

In the past century, roughly 100 countries have eliminated malaria (elimination is the ending of local malaria transmission in a country or geographical zone; eradication is the ending of all human malaria worldwide). In the last decade, progress in the fight against malaria has accelerated greatly, but there is still much to be done. Of the nearly 100 countries that still have malaria, 34 are eliminating. Some, like Sri Lanka and Swaziland, are close to becoming malaria-free. Others have a longer road, and many will eliminate by 2025. For the remaining countries with malaria transmission, control programs are driving down sickness and death, and elimination will become a feasible goal in the future.

Maintaining this momentum is critical. Recent gains have resulted from a surge of domestic and international political commitment to fighting malaria, the development of new technologies to control malaria, and increased financing from global donors, in particular the Global Fund to Fight AIDS, TB and Malaria, and the US President's Malaria Initiative (PMI). The Global Fund alone has disbursed over $5.3 billion to support malaria programs in 85 countries, radically transforming the malaria landscape.

The global malaria community has devised a three-part strategy to achieve eradication: (1) driving down malaria in countries with a high disease burden, particularly in tropical Africa; (2) progressively eliminating malaria in low burden countries on the geographic periphery of current malaria to shrink the malaria map; and (3) investing in research and development to bring forward innovative new drugs, insecticides, vaccines and other tools. To support this effort towards eradication, the global research community continues to build evidence that informs policy and implementation of malaria control and elimination in different settings. Much of this research is supported by the Bill & Melinda Gates Foundation, the US National Institutes of Health, and the Wellcome Trust. We should applaud this public-private partnership in generating new knowledge to accelerate progress against malaria.

While these successes should be celebrated, we must also recognize that there are key challenges which can slow current momentum towards malaria elimination and eradication. First, the threat of emerging drug and insecticide resistance must be actively confronted. Two groups, the Medicines for Malaria Venture (MMV) and the International Vector Control Consortium (IVCC), are spearheading efforts to develop new drugs and insecticides to respond to emerging resistance. Meanwhile a major consortium of donors, scientists, non-governmental organizations and national programs are working to stamp out, or at least contain, parasite resistance to artemisinin in the Mekong region. This effort in South East Asia is hugely important to malaria efforts worldwide.

Second, decreased political will at both the domestic and international level will absolutely derail momentum. History has proven that gains in reducing malaria can be fragile, and that success can be too easily reversed. Since the 1930s, 61 countries have documented malaria resurgences, many of which were the result of decreased political and financial commitments to ongoing malaria control. While it may be tempting to route resources to other priorities when the malaria burden is low, the consequences will be dire.

Finally, adequate financing for malaria is crucial. Increased commitments by donor countries to replenish the Global Fund are essential to ensure that it maintains its role as the key financier of the global strategy to eradicate malaria. There is a grave risk that funding will be allocated only to the poorest African countries with the highest burden of disease, thus potentially decreasing the funding dedicated to countries that have made great progress towards elimination, but still face potential resurgences of malaria. This must not happen. The success of malaria-eliminating countries will be critical to global efforts to shrink the malaria map, and eventually eradicate malaria. Support is needed for all endemic countries, regardless of malaria burden.

This year's World Malaria Day slogan - Invest in the Future: Defeat Malaria - challenges us to commit to maintaining the progress of the last decade. The ultimate goal is nothing less than zero human malaria on planet earth. While it is unlikely that I will witness this in my lifetime, the younger cohort of global health professionals will certainly see this achieved during their careers. With continued momentum, new tools, research, resources and commitment, we will finally have freedom from one of the deadliest diseases in history.


Lucy Chesire: TB-HIV advocate from Kenya Board Member of the Global Fund Board Communities Delegation.

About the Here I Am campaign: The Here I Am campaign is a global call on world leaders to save millions of lives by supporting a fully funded Global Fund to Fight AIDS, Tuberculosis and Malaria. Here I Am brings the voices of people that are directly affected by AIDS, TB and malaria into dialogue about decisions that affect their lives and the lives of millions of others in their countries. Through video testimonies from all over the world, campaign ambassador advocacy, online actions and on-the-ground mobilizations, the Here I Am campaign is building collective power to end three of the world's most deadly diseases.

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