Eradicating Malaria: Which International Strategies?

 

At the start of 2024, Cameroon launched a systematic vaccination campaign against malaria. This is an international first, given that by 2022 malaria had killed 608,000 people worldwide, including 508,000 on the African continent. What does Cameroon’s decision mean? Is it possible to eradicate malaria? If so, what resources should be deployed? An update from Anne Sénéquier, researcher at IRIS and co-director of the IRIS Global Health Observatory.

Cameroon has become the first country in the world to include malaria vaccine in its vaccination schedule. Why Cameroon? How does Cameroon’s decision represent a turning point for Africa and beyond?

There are several reasons why Cameroon was the first country in the world to include malaria vaccination in its immunisation schedule.

Firstly, it is one of the 11 countries most affected by malaria in the world, with more than 3 million cases and 3,800 deaths by 2021. The RTS,S/AS01 malaria vaccine will initially be deployed in sub-Saharan Africa, where the incidence of Plasmodium falciparum malaria is moderate to high.

Vaccination also requires comprehensive systems to be put in place at national level to make it feasible. This involves adapting public policies, drawing up an operational deployment plan, training healthcare staff (on vaccination, but also on « how to manage misinformation about vaccination »), investing in infrastructure, increasing technical capacity and vaccine storage (which must remain between 2 and 8°C). But we also need to work on community involvement and popular support.

Cameroon has long made malaria one of its health priorities. This has enabled it to launch the first vaccinations on January 22nd this year. Burkina Faso followed suit, launching its vaccination campaign on 5 February. Benin, Liberia and Sierra Leone are also finalising their deployment plans.

Malaria is a real burden on the African continent, hampering its human and economic development. Africa accounts for 94% of malaria cases worldwide. The number of cases has soared in recent years, rising from 232 million cases in 2019 to 249 million in 2022… As many cases of school absenteeism that can hamper schooling, and fewer working days (often informal) that can quickly jeopardise the family budget.

It also means a loss of human capital, with 608,000 deaths, almost 500,000 of which involve children under the age of 5.

It is easy to understand the major turning point that malaria vaccination could represent for the African continent, not only in human terms, but also in terms of economic development. This vaccine is a major step towards achieving goal 3 of the Sustainable Development Goals (SDGs): the UN hopes to put an end to the malaria epidemic by 2030…

With the development of this new vaccine and scientific progress, is it conceivable that malaria could eventually be eradicated?

Ending the malaria epidemic by 2030 is one of the targets of MDG 3 on « good health and well-being ». This vaccine adds a fundamental element to this long-term battle. However, like any vaccine, the RTS,S malaria vaccine is not 100% effective (it reduces the risk of serious infection in children) and must be used in conjunction with other tools, i.e. prevention measures such as sleeping under mosquito nets, combating stagnant water (vector control), improving access to healthcare for the population and combating misinformation.

Furthermore, the current vaccine « only » protects against Plasmodium falciparum malaria, whereas there are four forms of malaria linked to different parasites throughout the world. And let’s not forget climate change, which means that as climatic conditions change on the ground, the malaria-carrying mosquito also « travels » to new regions…

Eradicating malaria is technically feasible, provided there is a genuine political will at national and international level, and the necessary funds are made available. The World Health Organisation’s (WHO) « Global Technical Strategy for Malaria Control 2016-2030 » estimates that 7.3 billion dollars in funding is needed to eradicate malaria. However, there was already a shortfall of 2.6 billion dollars in 2019 and 3.8 billion dollars in 2021. What’s more, the current economic climate makes funding for health even more complicated.

What overview can you give of the current major pandemics and the strategies put in place to eradicate them?

There is, of course, HIV, which remains a major problem worldwide. 630,000 people will have died of AIDS-related illnesses by 2022. 39 million people are living with HIV, but only 30 million have access to antiretroviral therapy. In addition to this lack of access to care, there is a problem of misinformation among the general public. Some people believe that since HIV is no longer a « fatal disease », it is not important to protect themselves. Furthermore, the criminalisation of sex workers and drug use is still a major source of new cases. The same applies to conflict zones and the use of rape as a weapon of war.

Today, the strategy for combating HIV is multi-sectoral and broadly based: working towards universal health coverage and access to medicines, lobbying for the decriminalisation of homosexuality, drug use and the sex trade, etc. Laws that prevent people from seeking care. Working at community and city level with the Fast-Track Cities network, which supports more than 300 cities around the world in their efforts to reduce the HIV epidemic…

The Covid-19 pandemic that we experienced at the start of this decade may have become more discreet, but it is still a cause for concern. It is gradually falling into line with what are known as « seasonal » viruses. The notable difference is that Covid-19 is able to shed its seasonal aspect and is capable of producing clusters in both winter and summer. The strategy at national level is based on preventive measures: vaccination. At international level, the Covid-19 pandemic has led to a number of protocols being updated, including the International Health Regulations (IHR). A « global agreement on pandemic prevention, preparedness and response » is also being drawn up by WHO member states. This preliminary work will be presented at the next World Health Assembly in May 2024. In particular, there is talk of global preparedness and response mechanisms to respond more effectively and rapidly to future pandemics, securing sustainable funding and building governance for epidemiological surveillance.

The last pandemic, but perhaps the most important, is the non-communicable disease (NCD) pandemic. We are experiencing the first non-communicable disease pandemic in human history. NCDs include cardiovascular diseases, cancers, chronic respiratory diseases and metabolic disorders (diabetes, etc.). NCDs are multifactorial: genetic, behavioural, political and sociological… a complexity that makes the link between our living environment and the impact it has on our health invisible. Yet by 2021, NCDs will account for 74% of deaths worldwide. What’s more, our inability to unite around this emergency has meant that this figure has been rising steadily since 1990, when data collection for the Global Burden of Disease (GBD) began. This is the cross-cutting pandemic par excellence.

Yet public health policies on these issues still focus on making individuals more responsible: « Eat 5 fruit and vegetables a day », « Walk for short distances ». What can we do when ultra-processed products invade supermarkets and are cheaper than fresh produce? What can we do when there is no safe infrastructure for walking or cycling to school? Even though the United Nations put the prevention and control of non-communicable diseases on the agenda of its General Assembly in 2011, governments are struggling to develop policies that will have a real impact on this invisible pandemic. To really work on NCDs is to face up to the lobbies of cigarettes, alcohol, the food industry, the car industry, fossil fuels, etc.

Because of these NCDs, it is already predicted that the sustainable development objective relating to health will not be achieved in 2030 or 2040…

 

Translated by Deepl.