By Benedict David, Principal Health Adviser, AusAID
Malaria, like other communicable diseases, is not just a public health problem; it’s a development problem, and one that affects our region of the Asia-Pacific. It is a disease that kills mothers and children, and impacts on economic growth and business interests. It does not respect borders.
The World Health Organization (WHO) estimates that in 2010, there were 216 million cases of malaria worldwide which killed 655,000 people. The disease hits the most vulnerable, marginalised and migrant populations, pregnant women and the young. In 2010, 86 per cent of global malaria deaths were children under five years of age.
The costs to society are enormous, not just in terms of lives lost, but through illness and loss of productivity. One study estimates that in the countries most affected by malaria it results, on average, in an annual reduction of 1.3 per cent in economic growth.
While Africa bares the greatest burden, the Asia-Pacific had 30 million cases of malaria and around 42,000 deaths in 2010. The majority of these deaths were in India, Burma, Bangladesh, Indonesia and Papua New Guinea (PNG). In addition to heavy burden countries such as Burma and PNG, the region also faces some unique challenges. Plasmodium.Vivax, the stubborn strain of malaria, is widespread and is difficult to detect and treat.
I was recently in Western Province of PNG. At its closest point this is just 3.6 kilometres from the Australian Torres Strait island of Saibai. There I met Alice, a PNG public health director. When discussing malaria in her community Alice said, “We have both plasmodium falciparum (the most deadly form of malaria) and Plasmodium Vivax malaria, but we’ve seen progress. The use of insecticide treated bed nets, new treatment, educating communities and training our health workers is starting to make a real difference.”
Artemisinin is the latest and most effective malaria drug. However, resistance to artemisinin has been confirmed in the border regions of Burma, Thailand, Cambodia and Vietnam. Given the lack of alternatives, failure to contain this drug resistance could see an increase in malaria deaths and damage economic growth.
If this resistance spreads further into Asia and onwards to Africa, as has happened in the past with resistance to other antimalarials such as chloroquine, this would pose a major global public health threat.
The Asia-Pacific region has seen rapid economic growth and poverty reduced over the last decade, but the risk factors that drive malaria are linked to broader development challenges. Growing inequality means isolated, poor and marginalised communities are less likely to have access to malaria testing and treatment and basic commodities like insecticide treated bed nets.
This is particularly evident in rural border regions. In addition widespread use of “mono therapy”, instead of a combination of malaria drugs, along with low quality and counterfeit drugs, drives drug resistance.
Rapid economic growth is opening up new transport corridors and new infrastructure through high risk malaria regions. With new work opportunities comes population movement and the risk of malaria spreading is increased.
A further challenge arises in sustaining finance to fund malaria programs. The global economic crisis has put pressure on international development financing with almost a 3 per cent decline in overseas development assistance in 2011.
Despite these challenges, there have been successes across the Asia-Pacific region with consistent declines in confirmed malaria cases over the last decade. Country malaria programs which have increased coverage of insecticide treated bed nets, managed vector control such as indoor residual spraying, and increased access to testing and treatment with quality anti-malarials have played a major role.
Vanuatu and Solomon Islands, with AusAID support, have made great gains and progress towards their control and elimination targets. Since 2003, Solomon Islands and Vanuatu have achieved reductions in annual incidence rates for malaria of over 70 per cent (down from 199/1000 to less than 50/1000) and 85 per cent (down from 74/1000 to less than 26/1000) respectively. Malaria prevalence in Tafea Province in Vanuatu is now less than one per cent of the total population.
The region has also seen innovation. China has made one of the greatest contributions with the discovery of artemisinin, now used globally as the front line drug in combination with others to effectively treat malaria.
AusAID is playing its role through direct support to countries such as Burma, PNG, Solomon Islands and Vanuatu, and support to international agencies such as the Global Fund for AIDs, Tuberculosis and Malaria (GFATM), WHO and UNICEF. We also support research and analysis, and engage with our international partners on critical policy issues, such as emerging drug resistance.
The Asia-Pacific region is rapidly changing. It’s important that we maintain momentum, build on the successes and protect the gains made in tackling malaria. Maintaining political commitment is essential. Stronger national and regional malaria programs and more equitable national health systems are critical. However, the region also needs to address the broader development drivers of malaria such as poverty, and drive innovation in areas such as the private sector, financing and new technologies to address malaria.
Australia will be hosting an international conference later in the year to discuss
malaria in the Asia-Pacific region and the issues raised above with our regional and international partners.
About the author: Benedict David
Ben David is AusAID’s Principal Health Specialist, responsible for the technical oversight of the AusAID bilateral and multilateral health portfolio. Ben has a background in health policy, planning and financing; health sector reform; and aid effectiveness in health. He has experience in a range of country contexts across Africa, Europe and Asia-Pacific.