The World Health Organization (WHO) 2017 World Malaria Report (WMR) offers an in-depth analysis of 2016 trends in malaria, highlights a reversal in gains in some countries, and reaffirms the 2015 call for significantly increased investment.

Although substantial progress in scaling up malaria control interventions continues, progress on reducing malaria cases and deaths has slowed, and in some countries, reversed. An estimated 216 million cases and 445,000 deaths from malaria occurred in 2016, largely unchanged from 2015.

Just 15 of the 91 countries with indigenous malaria transmission now carry 80 percent of the global malaria burden. These include the largest and most complex countries, such as Nigeria and Democratic Republic of Congo, pointing to the need to intensify further efforts in high burden countries and highlighting the challenges of making progress in areas of social instability.

Financing Shortfall

A significant concern raised in the Report is the level of investment. Per WHO’s Global Technical Strategy for Malaria 2015–2013, $6.5 billion will be required annually by 2020 in order to meet the 2030 targets. The $2.7 billion invested in 2016 is just 41 percent of the estimated need. Although global funding for malaria has plateaued, the Report notes increased U.S. financial commitment, enabling the U.S. President’s Malaria Initiative (PMI) to expand to five West African countries with a high malaria burden.

The U.S. Government’s investments alone will not be enough to get malaria efforts back on track. The global malaria community must work to improve the financial landscape by mobilizing new resources – increasing domestic funding, finding innovative financing solutions, expanding the base of traditional donors, and growing private sector investment.

PMI Expansion

PMI’s country expansion will benefit almost 90 million additional people at risk of malaria. With the addition of five high-burden countries in West Africa, the U.S. contributions to effective malaria prevention and control will help protect more than half a billion people from the disease, stretching from the Sahel to the Horn and down to Southern Africa.

Achieving Results

A new study in the journal PLOS Medicine conducted by independent researchers from the Imperial College London estimates that PMI-funded interventions will avert an additional 162 million malaria cases and save nearly 700,000 lives over the next four years. The lead author said, “PMI is a highly cost-effective way to save lives. There is no better investment in malaria control.”

Insecticide and Drug Resistance

Another positive note is that global trends in malaria burden do not appear to be the direct result of drug or insecticide resistance.

Insecticide resistance, though, may have had an indirect effect on the increase in malaria burden. Because resistance to pyrethroid insecticides is now widespread throughout sub-Saharan Africa, countries have had to switch to using higher-cost insecticides for indoor residual spraying (IRS). As a result, countries have had to make the hard choice of reducing the number of houses sprayed to offset the higher cost insecticides, leading to a reduction of the population protected globally by IRS by almost half, compared to 2010.

In response to this challenge, PMI has partnered with UNITAID, the Global Fund to Fight AIDS, Tuberculosis and Malaria, and other partners to implement a program to subsidize the cost of newer insecticides, decreasing the price charged to countries. Through these efforts countries have been able to maintain or in some cases increase the population protected by IRS.

PMI maintains robust drug and insecticide resistance monitoring platforms to help detect any resistance issues and make programmatic changes as necessary to avoid a problem. These systems provide essential information to help the global malaria community keep ahead of these developing challenges.

Call to Action

Despite past success, we have a sobering reminder that there is much work left to do. The United States has been a driving force and indispensable partner in the effort against malaria, and we rededicate ourselves in the global effort to end malaria for good.