Updating WHO’s global strategy for malaria

As reported in the most recent edition of the World malaria report, progress towards 2 of the strategy’s 2020 milestones is off course: reducing global mortality rates and case incidence by at least 40%. The 2 other milestones focused on country-level elimination and prevention of re-establishment of malaria will likely be reached.

Despite the remarkable gains seen in driving down malaria cases and deaths over the last 2 decades, progress in recent years has levelled off, and many high burden countries are losing ground. The emergence of the COVID-pandemic in 2020 has posed a serious additional challenge to malaria responses worldwide. Urgent and concerted action is needed to change the global trajectory of the disease.

Addressing participants in the webinar, Dr Tedros Adhanom Ghebreyesus, Director-General of WHO, noted that while meeting the strategy’s 2030 targets would be a challenge, malaria-endemic countries and partners must remain firm in their commitment to achieving them.

“None of these challenges are simple, but none are insurmountable,” said Dr Tedros. “Together, we have already overcome many difficulties in the fight against malaria. And together, we can rise to the challenges we face now, and realize our shared vision of a malaria-free world.”

Goals, milestones and targets for the Global technical strategy for malaria 2016-2030

Strategy refresh

The updated strategy is fully aligned with WHO’s 13th General Programme of Work (2019-2023) and Triple Billion targets, as well as with the Sustainable Development Goals and the global universal health coverage (UHC) agenda, a key driver of the Organization’s work worldwide. It calls better integration of malaria services into broader health delivery systems and the strengthened capacity of countries to generate, analyze and use malaria-related data.  The revised strategy also calls for the inclusion of malaria control in Health-in-All-Policies, with the aim of facilitating a multi-sector sectoral response.

The strategy’s 5 guiding principles will be reordered to place a greater emphasis on the critical role of country ownership.  A 6th principle will be added to reflect that successful malaria responses are underpinned by resilient health systems.  Other guiding principles focus on the need for strong surveillance systems, equity in access to health services, innovation in tools and approaches, and interventions that are tailored to local conditions.

“We are moving squarely away from a ‘one-size fits all’ strategy to a more tailored, data-driven approach,” said Dr Pedro Alonso, Director of the WHO Global Malaria Programme, as he presented the proposed updates. “It’s about identifying the people who suffer most and bear the brunt of the disease, and then making a purposeful effort to reach them with the services they need.” This approach will help maximize available resources by ensuring efficiency, effectiveness and equity in malaria responses, he added.

Feedback from the frontlines

Dr Alonso’s words echoed those of Dr Jimmy Opigo, Uganda’s national malaria programme manager, who described the “transformational” paradigm shift that he had witnessed among malaria stakeholders over the last 5 years. “The malaria world decided that instead of investing just for coverage, we need to invest for impact,” he said during the webinar. “We need to optimize. We need to target. We need to stratify. And to do this, data has become very important.”

The webinar also included the voices of health care workers on the frontlines, such as Ms Luseshelo Simwinga, a midwife based in Malawi who described the obstacles many pregnant women face in obtaining preventive malaria treatment. “Most of the time, people fail to visit health facilities because they feel that they are not treated with respect,” she said. “Local communities should claim their right to be treated equally, with respect and dignity, and to be provided with quality health services,” she added.

Stock-outs of essential medicines at health facilities was another key barrier to accessing treatment, noted Ms Simwinga. “I want the government to prioritize the health of vulnerable populations like pregnant women and children by making sure that essential drugs and supplies for the management of malaria are always available in the health facilities,” she said.

Reflections from global partners

Dr Abdourahmane Diallo, CEO of the RBM Partnership to End Malaria, underscored the importance of meeting the strategy’s funding goals. “Now is not the moment to lower the level of our ambition on the achievement of global malaria targets. However, any strategy is only as good as its funding level allows. We must double down on advocacy and resource mobilization efforts for malaria elimination, which will bring outsized returns on investment,” said Dr Diallo. In 2019, global resources for malaria control and elimination totaled US$ 3 billion, falling far short of the estimated US$ 5.6 billion needed to fully implement the strategy.

Dr Dyann Wirth, Chair of the WHO Malaria Policy Advisory Group (MPAG), said the malaria community can draw lessons from the response to COVID-19.  “Endemic countries, WHO and their partners stepped up to ensure malaria prevention and treatment were not disrupted,” she said. “The current crisis forced innovation and emergency measures, the need for rapid response, the need for real-time data, a switch to community care, and protection of frontline workers from other infections.