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The Bill and Melinda Gates Foundation has been pushing for the elimination of malaria disease in Africa. What is the progress so far?
Our grants have helped to drive progress in several areas, including the development of new Artemisinin combination therapies, vaccine research and innovative approaches to vector control.
This work takes time, but it is accelerating the development of a new set of tools that hold promise in the fight against malaria in Africa.
There has been a reduction in cases and deaths since 2000, thanks to effective interventions and increased political commitment. The Global Fund and bilateral donors have helped scale up lifesaving interventions across Africa.
The widespread uptake of bed nets, antimalarials and rapid diagnostics has been tremendous and has led to a 60 per cent decline in deaths over the past 15 years. This equates to nearly seven million lives saved — most of them in sub-Saharan Africa.
This has been one of the greatest global health success stories of our time. Particularly exciting are tools that have longer duration, like new indoor residual spray insecticides, and new bed nets that have two active ingredients to slow the rise of mosquito resistance.
What’s the biggest challenge in the fight against malaria in Africa?
Sustaining progress. Malaria is fighting back: Putting more than half the world at risk and threatening to rapidly unravel our progress.
The number of malaria cases increased from 211 million in 2015 to 216 million in 2016 – the first increase in a decade.
East Africa has been hit particularly hard, with Rwanda, Tanzania and Uganda seeing some of the highest increases. But the past decade has put us on a path that makes ending malaria possible. With renewed focus and the right tools, resources and leadership, we can end this disease for good.
Most governments and donors have shifted to what they consider more urgent issues. Why is this so?
Since 2010, global funding for malaria has been relatively stable, and donor contributions — primarily from the Global Fund to fight Aids, TB and malaria — the US and the UK account for the majority of funding for malaria control and elimination.
Despite this, the current funding levels will not be enough to reach global milestones. Many governments in countries with the highest burden of disease have an important role to play by prioritising financing and scaling up malaria interventions.
One of the reasons for the Malaria Summit in London is to bring leaders together from all sectors across philanthropy, business, science, civil society and government, to shine a spotlight on the progress made so far and to redouble our commitment to the fight against malaria.
What new malaria elimination initiatives are you aiming to support in East Africa?
The Gates Foundation is committed to investing in new tools and approaches such as novel insecticides and innovative financing mechanisms to eliminate malaria.
Will better drugs, insecticides, and new ways to kill mosquitos be enough to eradicate malaria in Africa?
Eradication will only be possible with the commitment and leadership of a diverse set of partners and governments, and we are focused on working with all partners to reach this goal. Ending malaria in Africa is the challenge of a generation.
It will require new investments to increase the effectiveness of current tools and hasten development of next generation insecticides, drugs and vaccines. Strong political will and increased domestic spending on health are also vital to keep up momentum for achieving a malaria-free world.
Fortunately, we already have many of these: tools that work well, new tools in the pipeline to address challenges, strong political commitment and lessons learned from prior efforts. Successfully eradicating malaria will yield enormous health and economic benefits. When people live healthier lives, they are better able to work and go to school to improve their families’ economic prospects.
Is malaria vaccine development therefore still on the Gates’ agenda?
The Gates Foundation remains committed to supporting the development of malaria vaccines. While we have a first-generation vaccine that will soon enter the field in three African countries, we have high hopes for next generation vaccines that could have the potential to play a key role in eliminating malaria in regions of the world with the highest burden of the disease.
The current vaccine candidate, RTS,S, funded by the Foundation, has shown to have a very modest duration. Its efficacy diminishes after a year and it requires four doses. Is the vaccine in its current form a tool that you would continue to put money in?
RTS,S is an important step in malaria vaccine research and is among the tools for malaria burden reduction by those involved in malaria control.
The Malaria Vaccine Implementation Programme will give us a better sense of the potential of the vaccine in a real-world setting.
The work on RTS,S has energised the search for next-generation vaccine candidates, including vaccines with the potential to block transmission as well as prevent infection.
Which strategy on eradicating malaria in Africa is working and where should focus now shift to?
Even though Africa has the highest malaria burden, recent successes show that it is possible to drive down cases and deaths.
Several countries have made tremendous strides to eliminate malaria, including Zambia, which committed to eliminating the disease by 2021, and Swaziland, which reduced the number of malaria cases by 92 per cent from 2002 to 2016 and aims to eliminate malaria by 2020.
In Kenya, indoor residual spraying of homes in high transmission areas and distribution of insecticide-treated nets have reduced malaria cases by about 80 per cent in the country’s high-transmission western highlands.