A woman waits outside a clinic in Malawi to be injected with the world's first vaccine against malaria.
The Delay
China and El Salvador have been declared free of Malaria.
The new annual report on malaria issued on Monday by the World Health Organization is encouraging. Despite progress in some countries, this disease took a bigger toll in 2020 than in the past.
The number of deaths and cases increased in 2020. The number of cases increased from 229 million in the year of 2020 to 241 million in the year of 2019. The number of deaths went from 558,000 to 627,000.
It's not just that the pandemic takes some of the responsibility.
Pedro Alonso is the director of the Global Malaria Programme at the World Health Organization and has been for nearly four decades.
The situation remains precarious according to the report. We talked to Dr. Alonso about the future of Malaria, the effect of COVID-19, and the potential impact of a new vaccine approved just this year.
When COVID-19 hit, what happened to malaria control?
In March 2020, we wondered what was happening here. The biggest threat was that people weren't going to health facilities because of the lack of commodities. It was like going back to the days when there was no control of the disease.
In 2020 alone, we could potentially double the number of deaths due to malaria. Many countries made a huge effort to keep on using bed nets and drugs to prevent Malaria, even though they didn't plan on it. It was not as large as could have been. An extra 47,000 people died of Malaria because of COVID-19 disruptions.
Were you surprised that things weren't worse?
Yes, to be honest. I've lived in Africa for a long time. I was imagining what would happen if there was a lack of provisions in a lock down. It could be a disaster. I'm happy.
What would the situation have been if there had been no epidemic?
The picture we get if we remove the COVID-19 impact is pretty much what we have been getting over the last three or four years. We're not making any more progress.
Some countries are reducing cases and deaths, others are not, and 39 other countries either went backward or did not make any progress in the last five years.
Why do you think things have gotten worse in some places even without COVID's impact?
We became a little bit too confident. We thought that we had the tools, all we needed to do was put some money in and everything would be fine. The creation of the President's Malaria Initiative and the establishment of the Global Fund to Fight AIDS has had a huge impact on the control of Malaria in Africa. Prevention and treatment tools could be used.
We're stuck for four or five years. I think the limits of what can be achieved with those resources are what we are seeing. Do we need more money? Yes. Do we need more robust health systems? Yes. Do we need a revision of our financing mechanisms? Yes. Do we need new tools? Absolutely, yes. It is urgent. That's the significance of the vaccine. What worked for the last 15 years isn't necessarily what will work in the future.
What can be done to get back on track?
This is not just a matter of an unfinished agenda. The world needs to step up its efforts in order to fight the Malaria crisis. I'm told that doing the same thing over and over again and expecting a different result is insanity. 2020 needs to be seen as a wake-up call.
What changes would you like to see?
The countries need to be in the driver's seat. They know how to address their problems. WHO and other partners can help them improve on their planning, but once they say this is what we want to do, financing mechanisms should be about supporting them, not about revising whether they're right or wrong. The countries themselves have to increase their financial commitment, and we need to shift away from a donor dependent effort in which the countries take the leadership. What has worked up to now is one of the best global health success stories, but what we're going to need to move forward in the next 10 years is not what has brought us here.
The World Health Organization recommends the use of a new vaccine for children in areas where there's lots of infections. That sounds low. Can this vaccine make a difference?
The vaccine was received well. It shows the power of science and I attach a lot of importance to it. This vaccine is not the first against Malaria. It's the first vaccine against a human parasites which is biologically orders of magnitude different than a virus. The fact that we have a vaccine that can save lives is huge.
Our estimate is that the vaccine could save between 40,000 and 80,000 lives a year. I think that is significant. Is this vaccine a tool for eradication? No. It will help save lives.
Will there ever be an end to Malaria?
When I arrived at the WHO as director of the Malaria program, the mood was that we would continue to make extraordinary progress over the next five years and that we would design a new eradication program. I don't think we're there in seven years. We might be too naive to think that by 2020 we'll be in a position to say we're on a trajectory that leads to eradication.
We need to acknowledge that this is a very hard enemy and that it's probably been the biggest killer of mankind. We need to design a new plan to acknowledge the challenges of inadequate health systems that are associated with poverty. We need to get the best minds and the best efforts to push forward.
You have been working on malaria for more than half your life. It seems like there's a long way to go. Are you angry?
I am happy. I can't afford to be frustrated. Malaria has killed 10 million people in the first 20 years of this century. That is a huge success. 10 million more people have been given the chance to live a healthy, productive life. We need to save lives. I think we can defeat Malaria, but we should not be too naive. We need to go on fostering research and development and come up with the tools that will allow us to say, "You know what?" We are ready for eradication.
A former health policy correspondent for NPR, Silberner is now a journalist. Since the outbreak of HIV, she has covered global health issues.
