Malaria: Less Investment = More Suffering, More Death

If we needed more evidence that the funding cuts at the Global Fund to Fight AIDS, Tuberculosis and Malaria were going to be detrimental to people's lives, a new study published this week makes it clear: Providing funding to fight malaria makes malaria go away. Cutting funding for malaria makes malaria come back.

The study, "Malaria resurgence: a systematic review and assessment of its causes," was published on April 24 in Malaria Journal by a team of researchers from the Clinton Health Access Initiative, Johns Hopkins University, the University of California at San Francisco, and the Center for Disease Dynamics, Economics & Policy.

The authors reviewed the scientific literature on malaria for all cases of "resurgence events" -- instances where malaria was declining but then came back. They then asked some simple questions: What made malaria come back? Was it due to a weakening of the local malaria control program? Was it caused by other factors that made malaria easier to transmit? Was it due to other complicating factors like an increase in drug resistance that made malaria harder to eliminate?

The researchers found 75 instances of malaria resurgence in 61 countries since 1930. Of the 75 instances of malaria resurgence, 68 of them (91 percent) could be explained at least in part by a weakening of the malaria control program. Of those 68 cases where the malaria program was weakened, more than half the time a lack of resources was the cause (39 out of 68, or 57 percent).

The authors write that as substantial new financial resources have become available to fight malaria since 2000, malaria has decreased considerably in many parts of the world. But in the past, malaria has returned when malaria control programs have been weakened -- and they've usually been weakened when resources dried up.

This is alarming.

Why? Because malaria control programs all over the world are presently facing a funding crisis, due to a freeze in grant funding from the largest international funder of malaria programs.

The Global Fund to Fight AIDS, Tuberculosis and Malaria is the world's leading source of international financing to support malaria control programs in the world. The Global Fund has distributed 230 million insecticide-treated bed nets to protect people from being bitten by malaria-carrying mosquitos over the past decade.

The Global Fund relies on financial contributions -- primarily from governments, but also from foundations and the private sector. But in the last year, key donor governments began failing to fulfill their pledges to the Global Fund, leaving the agency short on cash. In November of last year, the Global Fund announced that due primarily to funding shortfalls, it would not be able to fund new programs or expand existing programs until 2014.

Noting the projected declines in available resources for malaria control over the next few years, authors of the malaria study write that there is an "existential risk to control programs caused by this deterioration in funding."

The authors conclude by calling on malaria control programs to "develop practical solutions to the financial and operational threats to effectively sustaining today's successful malaria control programs."

Translation: brace yourselves.

In the meantime, advocates have been calling on donor governments to convene an emergency financing meeting at the upcoming meeting of the G20 in June, where donors can commit to injecting new resources into the Global Fund that will sustain the response to malaria, as well as to TB and to HIV/AIDS. This possibility -- that donors will stop having "impact denial" (to quote a colleague) and step up to fully fund the Global Fund -- is looking more and more remote.

The consequences of failure to sustain and increase investments are straightforward for all three diseases. For malaria, the evidence shows it will return even where it has been fought successfully and immense human suffering and death will return along with it.

Kolleen Bouchane is the Director of ACTION, a global partnership of advocacy organizations whose mission is to influence policy and mobilize resources to fight diseases of poverty and improve equitable access to health services.