Op-Ed Contributors: Sir Richard Feachem is director of the Global Health Group at the University of California, San Francisco, and former executive director of the Global Fund to Fight AIDS, Tuberculosis, and Malaria.
Dr. Richard Nchabi Kamwi is the Elimination 8 (E8) Ambassador and former Minister of Health of Namibia.
Dr. Nafsiah Mboi is the Leaders' Envoy for the Asia Pacific Leaders Malaria Alliance (APLMA), and former Chair of the Board of the Global Fund to Fight AIDS, Tuberculosis, and Malaria and Minister of Health of Indonesia.
Governments and donors must intensify funding to wipe out malaria
It is incredible to think that just over a century ago, malaria stretched from the Arctic Circle to the southern tips of Africa and South America. Since then, half the world's countries have eliminated the disease, most in the past 70 years. Countries where malaria remains are making astonishing progress. More than 30 countries, primarily in Latin America, Southern Africa and Asia-Pacific, are working to eliminate it by going from low to no malaria transmission.
More than 20 of these countries are on track to end transmission of the disease entirely by 2020, paving the way for the global eradication of malaria within a generation. The single greatest threat to achieving a malaria-free world is a reduction in funding or political support before the job is done. All too often, malaria programmes are victims of their own success. Malaria-related deaths and illnesses decline, the problem becomes invisible and resources are shifted elsewhere. History shows us that when governments or donors cut funding or close down malaria programmes too soon, the disease comes roaring back.
Consider Sri Lanka. The country went from about 5.5m cases in 1934-1935 to fewer than 20 per year in the early 1960s, thanks to its aggressive malaria programme. Prematurely assuming that the job was done, the government scaled the programme back. By 1969, the country was battling a devastating and deadly resurgence of over half a million cases.
Between 1936 and 2004, there were more than 70 similar resurgences in 61 countries-almost all due, at least in part, to the weakening of malaria programmes and the withdrawal of funding. Since 2000, Sri Lanka has again made malaria a priority, building a strong programme to combat it. The country's last recorded local malaria case was more than three years ago. Maintaining momentum is essential to realising a malaria-free world. Just as strong immunisation programmes keep measles and other vaccine-preventable diseases at bay, strong, well-funded malaria programmes are critical to ending the transmission of malaria and preventing its reintroduction. But this momentum is in jeopardy.
In malaria-eliminating countries, nearly 80 per cent of funding for this work comes from national governments. This is particularly important at a time when financial support from external funders is waning. But as countries experience fewer cases of malaria, as illnesses decline and communities start to forget the fevers, chills and deaths, the urgent need to fund a malaria programme fades. We cannot let this happen. Countries must continue to fund and maintain their malaria programmes, or otherwise face risk of resurgence and an unravelling of hard-won progress. Similarly, international support remains crucial, especially for countries that are unable to fully fund their malaria programme.
The Global Fund to Fight AIDS, Tuberculosis and Malaria-the financial muscle behind the global effort to fight malaria-shares a vision of a world free of the burden of malaria. While the Global Fund prioritises investments in poor countries with a high disease burden, it also recognises that the job is not yet done in countries that have made dramatic progress. Along with international partners, the Global Fund is working to ensure investments accelerate, achieve and sustain elimination.
As recent global and regional roadmaps have outlined, we will achieve eradication by progressively shrinking the malaria map, country by country and region by region. Central to achieving these goals are thriving regional initiatives, including, among others, the Asia Pacific Leaders Malaria Alliance, the African Leaders Malaria Alliance and the Elimination Eight Regional Initiative in southern Africa. Eradicating malaria will require nothing short of unwavering support at all levels: national, regional and global. Not only will national governments and international donors need to step up; regional economic powerhouses-such as China and Malaysia-in malaria-endemic regions have an opportunity to invest in achieving a malaria-free region, which will strengthen health security and promote economic growth.
Annual global investments will need to increase to at least $6.4bn by 2020 to continue progress in all malaria-endemic countries. Until we have chased down and shut down the last pockets of malaria transmission, national governments, regional powerhouses and international donors must continue to fund vigilant malaria programmes. Ending malaria for good is possible, and we know what's needed. Now it's up to us collectively to make it happen.