The Reuters agency shares a press release from the Global Fund that worries that, “The Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM) is facing a budget hole of about $3 billion as the recession dries up foreign aid.” This includes commitments to existing grants as well as new ones planned for the upcoming year.Â Through the end of 2008, GFATM “distributed 70 million insecticide-treated bed nets worldwide to prevent malaria infections,” but continued progress may be threatened.
The report notes that the US and Japan, who have respectively pledged $4.4 billion and $1 billion since GFATM started, are both facing a major credit crunch as well as commitments to domestic stimulus packages.Â This does not preclude the US from continuing its controbutions.Â In April the US Ambassador to the United Nations relayed that, “President Barack Obama is committed to making the United States a global leader in ending the nearly 1 million deaths annually from malaria by 2015.”
The problem may not even be a US one per se. The US is constrained by law to fund no more that 25% of GFATM activities.Â If other donors reduce their contributions, the US cannot make up the difference to the GFATM.Â Does this mean that the US would increase support to endemic countries through the US President’s Malaria Initiative and other USAID country projects (since PMI covers only 15 countries)? What about the G8 commitments made over the years?
We thus must revisit the question – a particularly difficult one in this harsh economic climate – when and to what extent will malaria endemic countries begin to take on more responsibility for eliminating the disease within their borders and in their regions?Â Since national health account studies in endemic countries show that the bulk of health expenditures often come from out-of-pocket expenditures by the same poor people who need protection from malaria, the idea of sustaining malaria control efforts for another 20-30 years to reach elimination is challenging to say the least.
In the US state and local governments annually spend millions of dollars on mosquito control.Â Will the US and other industrialized nations continue to direct greater sums of money to other parts of the world where mosquitoes lead to millions of malaria deaths?
PS – While we worry about the need to continue malaria control support in highly endemic countries, we must not forget support in low or formerly endemic areas if we are to reach goals of malaria elimination.Â A study of the Caribbean by Rawlins and colleagues is sobering:Â All the essential malaria transmission conditions–vector, imported malaria organism and susceptible human host–now exist in most CMCs (Caribbean Epidemiology Centre [CAREC] Member Countries). A call is now made for enhanced surveillance, vector control and anti-malaria skills to be established in CMCs, in particular in: Recognizing the possible impact of climate change on the spread of anopheles and malaria transmission. Improving vector control skills for anopheles in CMCs.