The Strategic Advisory Group on Malaria Eradication (SAGme) of the World Health Organization (WHO) released a new report on Monday, April 20th, following three years of studies and analysis of future projections for malaria, including the feasibility and potential cost of clearing malaria parasites from the entire globe. The report reflects the work led by an expert group convened by former WHO Director-General Margaret Chan.
Over three years, this 13-member group examined how a variety of factors – biological, technical, financial, socioeconomic, political, and environmental – along with anticipated “mega-trends” in urbanisation, population growth, mobility and poverty, among others, may affect the evolution of malaria and therefore determine the feasibility of eradicating this disease. While SAGme unequivocally supports the goal of malaria eradication as set out by the World Health Assembly in 1955, its key conclusion is that eradication is far out of reach and that immediate efforts should be directed to getting back on track to achieve the 2030 goals. “Even with our most optimistic scenarios and projections, we face an unavoidable fact: using current tools, we will still have 11 million cases of malaria in Africa in 2050,” the report states.
The report, entitled “ Malaria Eradication: Benefits, Future Scenarios and Feasibility ”, acknowledges the current stagnation of progress against malaria, with no improvements in the global situation observed between 2014 and 2018 and a founding gap of more than three billion euros each year. Its key recommendations include updating the Global Technical Strategy for Malaria (2016-2030) ; strengthening the health systems of endemic countries; ensuring the highest political commitment and adequate funding; developing robust surveillance systems so as to adapt strategies to evolving epidemiological trends; and engaging malaria-affected communities in the planning, implementation and evaluation of interventions. Additionally, SAGme declares that one of the highest priorities should be a renewed research and development (R&D) agenda “that improves the knowledge base and products without which eradication will not be achieved”.
After the publication of the report, the WHO Malaria Policy Advisory Committee (MPAC) released a statement agreeing with its key conclusions. The statement called for support for a two-pronged approach aimed at reducing the burden of malaria in the small group of countries where most global cases and deaths occur, as well as progress towards elimination in countries with very few remaining malaria cases. MPAC also committed to “advise on the development of a decision-making framework to help identify the appropriate conditions under which a time-limited malaria eradication campaign could be launched at some point in the future”.
The SAGme report was finalized before the current COVID-19 pandemic. However, it did analyse epidemics as a potential threat to malaria eradication, and concluded that while they may cause short-term setbacks, malaria eradication could still be achieved. On the day of its release, MPAC called on governments to “ensure that they do not neglect the fight against malaria (and other endemic diseases) as they tackle the COVID-19 pandemic.”
SAGme’s analytical work was supported by several institutions including the Barcelona Institute for Global Health (ISGlobal) in its role as a WHO Collaborating Centre for Malaria Control, Elimination and Eradication . Regina Rabinovich and Matiana González-Silva, director and coordinator of the ISGlobal Malaria Elimination Initiative, respectively, contributed with the paper, “Some lessons for malaria eradication from the Global Polio Eradication Initiative”. The report also mentions the Malaria Eradication Research Agenda (malERA) as the blueprint for the research and development community in regard to the “tools, strategies and enabling technologies that need to be developed”. This R&D agenda was led by the MESA Alliance, an ISGlobal-hosted collaborative platform that promotes the examination of scientific evidence in different strategic contexts to ensure that global programmes being implemented on the ground are evidence-based.