Tropical Health Matters

Eliminating malaria, let along eradicating it, does not come cheap. In places like Zanzibar that have seen “prevalence rate come down from 35 percent before 2008 to below 1 percent,” there is worry that success may actually discourage continued support.

Zanzibar is right to worry. As its malaria control program staff observed, “Malaria prevalence was reduced to 1-2 percent in the 1970s, and then people relaxed.” Sri Lanka had similar experiences:

History shows that malaria control efforts must be sustained to be effective. Sri Lanka is an example of a country where malaria roared back after nearly being eliminated in 1963. But those eradication efforts were not sustained and by 1990 there were a quarter of a million cases. Fortunately malaria control was stepped up again and levels have dropped once more to just 673 cases reported in 2008.

Zanzibar’s worries are real. Even though progress is happening, IRIN noted that the malaria program says it has reached only 60% of households with indoor residual spray and 40% of pregnant women with intermittent preventive treatment. Achieving and maintaining targets of 95% and 80% respectively will take continued financial commitments. As a spokesperson net manufacturer Vestergaard Frandsen said, “We can’t afford to let funding backslide and threaten this progress.”

In addition to maintaining interventions, Zanzibar is in a position to show the additional costs of monitoring and documenting elimination. This includes establishing and maintaining its Malaria Early Epidemic Detection System. Again, the Zanzibar malaria control program warns that, “Each district also needs its own surveillance and response team and there is a need for more trained personnel. To set up this system you also need a lot of money.”

Dr. Steven Phillips, medical director of global issues and projects for ExxonMobil is optimistic about the major increases in malaria funding globally, but also is cautious…

You can imagine with the economic headwinds, with the global downturn and also with a lot of competing priorities that donor governments have, the real question is will this level of finance be sustained? And if it’s not sustained what’s going to happen to the progress?

The Global Fund also offers a word of caution: “Despite remarkable progress in the past few years, any reduction in the flow of funding to fight the disease could put recent achievements at risk.” They estimate that $20 billion raised between 2011-13 would meet “72 percent of global need in 2015 for insecticide-treated nets for malaria, but they also are considering less ambitious scenarios like $13 and $17 billion.

In fact, lack of major donor support for low transmission areas like Botswana in Southern Africa points to the need to orient donors to the financial challenges of working toward and achieving malaria elimination. Establishing more focused and intense intervention in some of Botswana’s northern districts as well as epidemic outbreak detection in the eastern areas is not cheap.

WHO pointed out that, “The Government of Botswana is the major financier for malaria control, accounting for more than 90% of total expenditure.” There are unmet financial needs in the areas of surveillance, vector control and human resources. Is this the fate of Zanzibar as the islands become low prevalence areas like Botswana?

Fortunately Zanzibar has a 10 million Euro Global Fund Grant that will last through 2014 as well as PMI support, but not every low transmission area is as fortunate.

There are great expectations for achieving universal coverage of malaria interventions by 31 December 2010. Success at that point in time will be meaningless unless interventions are sustained and new interventions appropriate to achieving elimination some years hence are funded.

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