How to achieve Zero Malaria within our living times

Malaria is one of the oldest and deadliest diseases, stealing young futures and diminishing both national and individual potential. Fighting it has led to some of the greatest strides in global health in history and yet, today, a child still dies from malaria every minute, and more than half of the world’s population remains at risk from the disease.

The WHO’s latest World Malaria Report once again illustrated that Africa continues to shoulder a vastly disproportionate burden of malaria with 94.5 per cent of global malaria cases (234 million), and 95.9 per cent of all global malaria deaths (593,000). A new and innovative approach is needed if a Zero Malaria world is to become a reality within our lifetimes.

Tragically, pregnant women and infants represent the largest vulnerable group of those impacted by the disease, which poses substantial risks to both the mother and unborn child, including maternal anaemia, stillbirth, miscarriage, problems with child growth and cognitive development, and low birth weight.

Pregnancy-related malaria causes around 200,000 infant deaths every year and is responsible for 20 per cent of stillbirths and 11 per cent of all new-born deaths across the WHO’s Africa region. In 2021, in 38 moderate to high transmission countries, there were an estimated 40 million pregnancies, of which close to one in three were exposed to malaria infection. Although many malaria-endemic countries, donors, and other organisations have taken steps to increase delivery of life-saving interventions for malaria in pregnancy - Intermittent Preventive Treatment with quality-assured sulfadoxine-pyrimethamine (IPTp-SP) - more than two-thirds of eligible women still do not receive the full triple-dose course today, with access and coverage remaining precariously low across many areas of sub-Saharan Africa.

The Kenya National Malaria Strategy targets IPTp interventions to pregnant women living in malaria-endemic areas. Among these, 49 per cent in the Lake endemic zone and 46 per cent in the Coast endemic zone received triple doses of IPTp, whereas urban women and those from the most vulnerable households in these zones are least likely to receive the correct course of treatment. Women who only received one or two doses of IPTp were asked why they did not complete the treatment, with 41 per cent saying they were not offered, and more than a third unaware they had to take more.

This is where The RBM Partnership’s innovative Speed Up Scale Up campaign comes in to help ensure that every eligible pregnant woman and unborn child is protected against malaria by 2025.

Launched in 2020, the campaign is designed to deliver an urgent call to leaders and policymakers to scale up to at least three doses of IPTp-SP in pregnancy and commit to increasing their efforts to safeguard more pregnant women from malaria.

As well as being an effective, safe, and proven safeguard against malaria for pregnant women, IPTp-SP is also an excellent example of targeted delivery and improving supply chains on the continent. Medicines for Malaria Venture is currently leading a Unitaid-funded project to enable pharmaceutical companies in Kenya and Nigeria to manufacture quality SP, for both domestic use and other countries in Africa.

In fact, Universal Corporation Ltd in Kenya became the first ever African manufacturer to gain WHO prequalification of high-quality sulfadoxine-pyrimethamine (SP). This achievement directly feeds into the need for local production of quality medicines for use in Africa -a major gap that was critically highlighted when the Covid-19 left the continent with limited access to vital health products in 2020.

From IPTp-SP to next generation bed nets and malaria vaccine development, it is important to remember that a combination of tools to fight the disease is critical to saving millions of lives and unlocking the economic potential of endemic countries, helping us on the road towards malaria elimination and UHC.

Ending malaria and improving women and adolescent girls’ access to treatment is an unrealised opportunity for advancing gender equality in health and achieving crucial WHO malaria targets and SDG Goals. 

With public and political commitment, strong leadership, and increased investment in creative solutions, we can achieve Zero Malaria within our lifetimes and take back our futures.

By Rosemary Mburu and Dr Astrid Bonfield. Bonfield is the CEO of Malaria No More UK while Mburu is theExecutive Director of WACI Health, Kenya