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Are we losing the battle against malaria?   Declaration for an accelerated reduction in malaria mortality in Africa
GFO issue 447

Are we losing the battle against malaria? Declaration for an accelerated reduction in malaria mortality in Africa

Author:

Christian Djoko

Article Type:
Analysis

Article Number: 7

The Yaoundé Declaration, signed on March 6, 2024 by health ministers from 11 high-prevalence African countries, marked a renewed commitment to eliminating malaria deaths on the continent. The declaration's bold ambition, encapsulated in the phrase "No one should die of malaria", prompted both optimism and critical reflection. This article dissects the Declaration's core principles, analyzing its potential and the challenges that lie ahead in achieving its ambitious goal.

The situation is critical and alarming

 

Meeting in Yaoundé on March 6, 2024, the health ministers of the African countries most affected by malaria made a crucial commitment to fight this deadly disease. The Declaration for Accelerated Reduction of Malaria Mortality in Africa: “No One Should Die of Malaria ” highlights the urgent need to step up efforts and put an end to malaria deaths.

 

The ministerial conference had four main objectives:

1) To take stock of progress and challenges in implementing the objectives of the WHO Global Malaria Strategy;

2) To explore mitigation strategies and financing mechanisms to intensify the fight against this disease;

3) Agree on strategic measures to accelerate the reduction of malaria mortality in Africa;

4) Develop a roadmap to strengthen political commitment and community participation in the fight against malaria, while establishing a clear accountability mechanism.

 

These objectives and the resultant Declaration are set against a backdrop in which Africa is still the region hardest hit by the disease. According to the World Health Organization’s (WHO) World Malaria Report 2023 (for a detailed exploration of this report, see our article at this address), the African continent bears the heaviest burden of malaria, with 94% of the disease’s global incidence (233 million cases) and 95% of its mortality (580,000 deaths) (Figure 1). This region is also home to 11 countries that account for around 70% of the global malaria burden: Burkina Faso, Cameroon, Democratic Republic of Congo, Ghana, Mali, Mozambique, Niger, Nigeria, Sudan, Tanzania and Uganda. In these African nations, no significant progress has been made since 2017. More broadly, the African region as a whole is not making favorable progress towards achieving the targets set by the Global Technical Strategy for 2025 in terms of morbidity or mortality, presenting respective deviations of 52% and 50% from the established targets.

 

This stagnation stems from a variety of factors, including humanitarian crises, difficulties in accessing health services and their inadequate quality, the impacts of climate change (see our article on the subject), gender-related obstacles, the growing threat of insecticide and drug resistance, and the repercussions of global economic crises. The fragility of local health systems and gaps in data and surveillance compound these challenges.

 

Figure 1: Malaria situation worldwide and in the Africa region in 2022

Source: WHO World Malaria Report 2023

 

What’s more, global funding for the fight against malaria remains insufficient. In 2022, only US$4.1 billion – just over half the required budget – was earmarked for this cause (Figure 2).

 

Figure 2: Global malaria funding landscape

 

Just another declaration?

 

The declaration adopted in Yaoundé is part of the “from high burden to high impact” approach, based on four fundamental principles:

a) Political commitment to reduce malaria deaths;

b) Strategic use of information to maximize impact;

c) Improved guidelines, policies and strategies;

d) Coordinated national response to malaria.

 

In the published declaration, these 4 principles are broken down into 7 major commitments:

1- Strengthen political will;

2- Ensure that information is used strategically;

3- Provide better technical guidance;

4- Strengthen coordination and multi-sectoral action;

5- Strengthen national health systems;

6- Establish collaborative partnerships for resource mobilization, research and innovation;

7- Ensure effective accountability for malaria.

 

Some of these promises deserve particular attention.

 

Political will

 

The declaration rightly emphasizes the strengthening of political will as the cornerstone of success. Decades of research have produced powerful tools – insecticide-treated nets, rapid diagnostic tests and effective antimalarial drugs. However, their consistent and equitable deployment requires sustained political commitment and increased national funding for national malaria control programs. Historical trends of weakening political commitment and stagnating funding in some countries raise concerns about the long-term sustainability of this renewed attention. By way of example, it is instructive to note that the budget allocated by Cameroon’s Ministry of Health to the fight against malaria has gradually decreased over the years. Indeed, it represented 2% for the years 2019 and 2020, but this share has dropped to just 1% in 2021. This budget reduction has had a direct impact on the ability to carry out certain crucial activities in the fight against malaria. Insufficient financial resources can lead to shortfalls in the supply of anti-malarial drugs, the deployment of insecticide-treated nets, the implementation of awareness-raising and screening programs, and the research and development of new control strategies. As a result, declining funding jeopardizes not only the progress made to date, but also future efforts to control and eliminate malaria.

 

Multi-sector collaboration

 

The emphasis placed on multi-sector collaboration is also a very interesting aspect. The 11 signatory states are committed to decentralizing malaria control coordination mechanisms to sub-national levels, involving various stakeholders such as public institutions, universities, NGOs, the private sector and civil society. They aim to rationalize resources and unify efforts to fight malaria. In addition, these states commit to leading multi-sectoral action to ensure that all sectors are involved in the planning, implementation and monitoring of malaria control, ensuring that all at-risk populations benefit from appropriate tools, including those in hard-to-reach areas and in situations of humanitarian conflict.

 

It is striking, even surprising, that the term “multisectoral” used by the signatories of this declaration does not explicitly take into account the need for collaboration that goes beyond the health sector alone. Indeed, factors such as poverty, environmental degradation and inadequate infrastructure all contribute to malaria transmission. An ambitious and truly multi-sectoral approach should not only recognize these interconnected realities, but also encourage a holistic response that addresses the underlying determinants of the disease.

 

The fight against malaria cannot be effectively led by the health sector alone. Interventions in areas such as education, economic development, land-use planning and environmental protection are also essential to reducing the prevalence of the disease.

 

Research and innovation

 

With regard to research and innovation, it is important to note that the development of new tools, such as next-generation insecticides, long-lasting nets and single-dose treatments, is of paramount importance in overcoming current challenges, including insecticide and drug resistance. However, translating research discoveries into real-world application requires robust health systems with strong product evaluation, deployment and monitoring capacity. The declaration’s call to strengthen antimalarial manufacturing in Africa could pave the way for improved accessibility and affordability. Will the commitments live up to the promise, or will they become nothing more than the umpteenth litany of good intentions with no end in sight? The question deserves to be asked. The long list of unfulfilled commitments invites skepticism. In a recent article, we asked similar questions against a backdrop of skepticism: What has become of the commitments made in the Abuja Declaration (2001), in which African states pledged to allocate at least 15% of their budgetary resources to health? What about the ALM Declaration (2019 ) and the Parliamentarians’ Working Group on Mobilizing Domestic Resources for Health in Africa, mentioned at the African Union summit in 2023? Political posturing is not a sign of health vitality. We are losing the battle against malaria. It’s high time we took real action. As Dr. Daniel Ngamije, WHO’s new Director of the Global Malaria Program, points out: “The signing of the Yaoundé Declaration was a crucial first step. Now, commitments must be translated into concrete actions and financial resources!” (Publication twitter/X, March 7, 2024) https://x.com/DrDanielNgamije/status/1765775275017568725

 

Responsibility and collaboration

 

Finally, the declaration recognizes accountability as a major key to success in the fight against malaria. Indeed, setting clear benchmarks, monitoring progress and holding stakeholders accountable for meeting their commitments are crucial. The digital platforms proposed to track progress offer a promising approach, but ensuring transparency, data quality and effective use of this information across diverse health systems remains a challenge.

 

Finally, it is imperative that major donors such as the Global Fund, PMI (President’s Malaria Initiative) and GAVI, particularly with the introduction of new vaccines, effectively coordinate their actions and align them with the existing roadmap, in order to maximize their impact. This coordination will avoid duplication, rationalize resources and ensure efficient use of available funds. In addition, close collaboration between these major players will reinforce synergies and optimize results in the fight against malaria.

 

Conclusion

 

The Yaoundé Declaration represents an interesting opportunity in the fight against malaria in Africa. Its emphasis on political will, data-driven strategies, multi-sectoral collaboration, research and innovation, and accountability, provides an ambitious framework for achieving the challenging goal of zero malaria deaths. However, translating this ambitious vision into reality requires tackling deep-rooted socio-economic challenges, addressing emerging threats such as drug resistance, fostering regional collaboration and ensuring the effective implementation of proposed interventions. The success of the Yaoundé Declaration depends on sustained political commitment, increased funding and a focus on equity to ensure that no one in Africa, regardless of place of residence or socio-economic status, dies from a preventable disease like malaria.

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