Malaria progress threatened by Ebola, drug resistance, says WHO

A village malaria worker carries out a blood test at his home in Pailin province, some 350 kilometres northwest of Phnom Penh. The number of people dying from malaria has almost halved since 2000, although progress in west Africa risks being reversed by the Ebola outbreak, the World Health Organization said on Tuesday.

The past decade has seen major gains in the fight against malaria, with steadily declining cases, “dramatically” fewer deaths, and the global mortality rate nearly halved since 2000, according to a new report from the World Health Organization.

But progress is fragile and there are many emerging challenges — including anti-malarial drug resistance and the Ebola outbreak in West Africa, which has completely overwhelmed local health systems and had a “devastating impact on malaria treatment” in the region.

Malaria is a preventable, curable parasitic disease transmitted by mosquito bites. In 2013, the disease caused an estimated 198 million infections and 584,000 deaths — 92 times greater than the death toll from this year’s unprecedented Ebola epidemic. Malaria is particularly deadly for children — in Africa, a child dies every minute from malaria, according to WHO. The disease killed an estimated 453,000 children under age 5 last year.

But many bright spots can be found in the latest global report on malaria, which the WHO released on Tuesday.

“We can indeed make remarkable strides against this complicated enemy,” the WHO’s director-general, Dr. Margaret Chan, wrote in a foreword to the report. “We should act with urgency and resolve, and remain focused on our shared goal: to create a world in which no one dies of malaria.”

Global progress has been largely driven by advances in Africa, where 90 per cent of malaria deaths occur. Since 2000, Africa’s mortality rate from malaria has dropped by 54 per cent and the number of new infections in sub-Saharan Africa continues to steadily decline despite massive population growth. Last year, malaria caused 128 million infections in sub-Saharan Africa; in 2000, there were 173 million.

The UN health agency said more countries are now moving toward eliminating malaria, with two (Azerbaijan and Sri Lanka) reporting zero cases for the first time last year. More people are accessing diagnostic tests and effective interventions, such as insecticide-treated mosquito nets. Last year, nearly half of the at-risk population in sub-Saharan Africa had access to a mosquito net, up from just 2 per cent in 2004.

The WHO warns, however, that progress is fragile.

The three countries hardest hit by Ebola (Guinea, Liberia and Sierra Leone) accounted for 6.6 million malaria cases last year but the deadly epidemic has closed the majority of in-patient health facilities and malaria patients are likely missing out on treatment. According to the latest figures, the Ebola epidemic has now infected 17,800 people and killed more than 6,330 since March.

Millions of people still have no access to diagnostic tests and treatment for malaria, particularly pregnant women and children under 5, who are most at risk. While malaria funding has tripled over the last decade, current commitments are still only half of the $5.1-billion (U.S.) target, the WHO said.

A particularly alarming development in the malaria fight has been the emergence of drug resistance, both against insecticides commonly used to kill malaria-carrying mosquitoes and against artemisinin — a plant extract that, in combination with other drugs, has become the standard treatment for malaria. Five countries in the Greater Mekong region of Asia have now detected resistance against artemisinin, including Thailand and Cambodia, where resistance to other anti-malarial drugs has emerged in the past and spread around the world.

Losing artemisinin would be a “major setback” for the fight against malaria, said William Moss, a professor of epidemiology with the Johns Hopkins Malaria Research Institute.

“The great fear is that these resistant parasites might get into sub-Saharan Africa, where obviously the burden of malaria is greater,” said Moss, who was not involved with the WHO report. “If we lose (artemisinin), we don’t have an alternative drug to treat the parasite that we could take off the shelf.”