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In a year with multiple newCOVID variants, monkeypox, and concerns for future pandemic preparedness, malaria– the world’s oldest disease – remained high on the agenda at the 2022 The American Society of Tropical Medicine &Hygiene (ASTMH) Annual Meeting last month. This meeting drawstop experts from around the world to discuss advances in global health, fromthe latest technological advances to local knowledge from remote fieldlocations.
At this year’s ASTMH AnnualMeeting, the symposium hosted by Save the Children US andco-chaired by AfricanLeaders Malaria Alliance (ALMA) entitled ‘Overcoming Neglected Challenges to Malaria Eliminationto Reach the Last-Mile,’ featured a prominent groupof speakers to discuss diverse issues relating to gender equality, climatechange, political instability, drug resistance, and COVID-19 in the context ofmalaria. The last mile of malaria elimination may be the hardest milestone to crossand will require taking a hard look at these challenges which have previouslybeen neglected to reach the most vulnerable communities.
Underpinning gender inequality, climate change, political instability, drug resistance, and COVID-19 is inequity, which is the result of varied and often complex intrinsic social, political and economic forces as well as discrimination. Addressing these issues requires not only good data and information, but also intentionality and inclusion of those most affected.
IreneKoek, Save the Children
Outlook on Malaria’s NeglectedChallenges
While once a global epidemic,malaria has now become a disease of the poor. Even without sophisticated new technologiesand innovations, the Global North was able to eliminate the disease decadesago, and we have even made great progress in the Global South – cutting deathsdue to malaria by half in the past 20 years. And yet, 400,000 people still dieeach year of malaria.
Today, malaria cases are disproportionatelyfound in the world’s most vulnerable communities, from South America to Africato Papua New Guinea. To reach these affected people and complete the last mileof malaria elimination, we need to use tailored, inclusive approaches that bridgecross-cutting issues and account for future challenges.
Whyare we still talking about the same challenges in some of the same places forso long, when we have already successfully eliminated malaria in so many otherplaces? Perhaps it is about our failure to effectively translate the science ofmalaria elimination for people who live where the pavement ends.
Dr Sarthak Das, Asia Pacific Leaders Malaria Alliance
An Inclusive Approach
To reach vulnerablecommunities, we must include vulnerable communities in every stage of the malariaprogramme lifecycle. This includes women and girls, who have traditionallyfaced the worst possible malaria outcomes while also playing an essential rolein providing health services to address malaria.
Malariaand gender inequalities work in tandem to have long term consequences on womenand the communities they live in, which compromises girls’ schooling,nutrition, and language that limits their earning potential.
Dr Alaa Murabit, Bill& Melinda Gates Foundation
Continued outreach in at-riskareas, including regions mired by political instability, is also essential toensuring the gains against malaria are not lost due to conflict or emergencies.As seen in the current example of Myanmar, the risk of violence can lead tomassive shifts in human behaviour and policy goals which negatively impact malariaobjectives if programmes are unable to remain abreast of the situation andinnovate.
The people from malaria free areas are moving to theendemic areas in the forest and the border areas. Significant restrictions arealso imposed, and the importation delays and commodity shortages arecontributing the most to the increasing disease burden.
Dr Min Min Thein, Savethe Children Myanmar
Plan for Existing and FutureChallenges
While we aim to end malaria by2030, a lot can change before then; malaria programmes must take that intoaccount. With climate change looming,itis important for malaria programmes to reduce their carbon footprint and alsoplan for how to continue delivering on malaria services even as extreme weatherevents will become more frequent. The reality is malaria programs deal withclimate and weather every day—we know what needs to be done and we have the toolsto do it, with or without the risk of climate change. The real problem will becontinuing to move commodities during weather emergencies, such as in the caseof the recent flooding in Pakistan.
Weatherdetermines both the parasite developments in mosquitoes and the entire mosquitolifecycle, from egg laying on to adult survival.
Dr Rick Steketee, U.S.President’s Malaria Initiative
Drug-resistant malaria also remains an ongoing fight.While nations in the Greater Mekong Subregion successfully turning the tideagainst artemisinin-resistant malaria parasite strains, similar challenges arenow spreading in Africa. Investments in malaria surveillance and identificationis important to detecting these new outbreaks, while research and developmentfor new treatment options is important for victory in the long term.
So, this is the greater goal: protecting futuretreatment options.
Dr Chanaki Amaratunga, Mahidol-OxfordTropical Medicine Research Unit
Finally, preparing for future pandemicsmust also be a priority for malaria programmes. As we have seen with COVID,many countries experienced setbacks in meeting their malaria targets due to thechanging protocols and shifting of resources towards addressing the newpandemic. However, we also saw that some nations were able to innovate and integratein order to meet the demands of multiple health challenges. Adopting awhole-of-government approach and sustained leadership at local and nationallevels now to prepare for future health emergencies is key.
Many countrieswere able to adapt interventions and integrate their COVID responses withmalaria.
Dr Sarthak Das, Asia Pacific Leaders Malaria Alliance
Finishing the last mile of malariaelimination requires reaching the hard-to-reach. To achieve this, malariaprogramming must incorporate many cross-cutting themes which welcome diversevoices and plan for present and future challenges in gender, climate change,political instability, drug resistance, and future pandemics. We cannot endmalaria alone.
APLMA thanks everyone who took part inthis symposium and looks forward to putting these discussions into practicetogether. For moreinformation on this symposium, visit the ASTMH event website below.
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