The WHO Regional Office for South-East Asia is observing the World Malaria Day on 25 April 2017, to commemorate collective efforts being made by the global community to accelerate progress towards eliminating malaria. This year marks the tenth year of World Malaria Day, which was instituted by the World Health Assembly in 2007. The objective of the event is to highlight progress in defeating malaria as well as to take stock of challenges and the unfinished agenda.
This year, WHO is placing special emphasis on prevention as a critical strategy to reduce the global burden of malaria and to meet various targets. Closing gaps in ensuring access to proven malaria control tools has been identified as a priority area under WHO’s Global Malaria Programme. We believe closing the gaps in prevention is critical to ending malaria. The theme for the World Malaria Day, “End Malaria for Good” – which was also the theme in 2016 – truly represents aspirations as well as challenges.
This World Malaria Day, the world has much to cheer about. New malaria cases fell by 21% between 2010 and 2015 worldwide, while malaria death rates fell by 29% in the same period. Many regions have made impressive progress in reducing their malaria burden. The South-East Asia Region achieved all the targets for malaria set under the Millennium Development Goals (2000-2015) agenda. During the period 2010 to 2015, the estimated malaria case incidence in the Region was reduced by 54%, and mortality rate by 46%.
All eleven countries in the Region have reported significant declines in malaria incidence. I am happy to note that two countries in the Region have successfully eliminated the disease.
Maldives has been malaria-free since 1984 and was certified by WHO as malaria-free in 2015. Sri Lanka interrupted indigenous malaria transmission in October 2012 and was certified in September 2016. This has helped reduce the number of malaria endemic countries in the SEAR from 11 to 9. This represents a major step forward.
Remaining endemic countries in the Region too are making notable progress. Bhutan reported only 34 indigenous cases in 2015 and is targeting malaria elimination by 2018; incidence in Nepal has decreased to less than 2000 cases in 2015 and there are no reported malaria deaths since 2012; in Timor-Leste, the decline in cases has been steep to less than 100 and no malaria deaths were reported in 2015. India, having 89% of the region’s estimated malaria burden, has launched and started to roll out its national malaria elimination framework 2016-2030. In Indonesia, nearly half of the subnational malaria-endemic units have become malaria-free and malaria is among those diseases whose progress is regularly monitored at the highest political level. Myanmar halved reported malaria cases between 2014 and 2015.
As a result of the massive reduction in malaria burden in the Region, and the elimination success in some countries, all countries in the Region now have national strategies in place aiming to eliminate malaria by or before 2030. This perfectly matches with the target of ending the epidemics of AIDS, tuberculosis, malaria and neglected tropical diseases set under the framework of the Sustainable Development Goals (SDGs).
However, the road ahead is not an easy one in the Region which has the second highest malaria burden (after the African region). Despite significant progress, a number of important challenges remain. Domestic funding for malaria in the Region has shown a decline between 2010 and 2015. Another major challenge is the emerging threat posed by multi-drug resistance including to artemisinin-based combination therapies (ACT) in the countries of the Greater Mekong Subregion. Resistance of malaria-transmitting mosquitoes to insecticides is another area of concern. In most countries, high-burden areas exist close to low burden areas. This means different programmatic approaches are needed within countries with elimination approaches side by side with intensified high burden reduction. Special efforts are needed to keep malaria-free areas free of the disease.
If we have to end malaria for good, as enunciated in this year’s theme, then we will have to focus on scaling-up prevention, along with treatment. Prevention tools can prove to be lifesaving. Proven tools are available but many people in malaria-affected areas lack access to them. Prevention tools such as long-lasting insecticidal mosquito nets (LLINs) and indoor residual spraying (IRS) must reach people in malaria endemic areas. Malaria transmission often occurs in remote areas and affects disadvantaged, neglected, communities like tribal people, migrant or mobile populations. Reaching such areas and communities at risk with malaria interventions, and actively engaging them in the process of eliminating malaria should be given high priority in national programmes.
It is my earnest appeal to all countries in the Region to close the gap in access to tested and effective prevention measures, mainly LLINs and IRS. We have the necessary knowledge, drugs for treatment and proven prevention tools to defeat malaria. We need to make specific targeted efforts, find local solutions including engagement of other relevant sectors and people at risk, and make related investments to reach the unreached or difficult-to-reach. In parallel, WHO is calling for greater investment in the development and deployment of new malaria elimination tools.
Malaria is a preventable and treatable disease. We need strong political commitment and speedy and innovative implementation of strategies, including integrated strategies for ending the diseases targeted under the SDGs since they pose similar challenges and often affect difficult-to-reach communities. I thank all of you for your strong contribution to achieve our vision of a malaria-free South-East Asia Region by 2030.