World Malaria Day: April 25
CDC and Partners on the Road to “End Malaria for Good”
This year's theme for World Malaria Day is "End Malaria for Good," reflecting the increased interest in and commitment to breaking the transmission cycle of malaria and eliminating it once and for all. CDC was at the forefront of the original global public health push for malaria elimination, which resulted in eliminating local malaria transmission in the United States, across much of Europe, and in parts of the Middle East. Current malaria control initiatives led by the World Health Organization (WHO); the Roll Back Malaria Partnership; theGlobal Fund to Fight AIDS, Tuberculosis and Malaria; and the U.S. President's Malaria Initiative (PMI), working in partnership with endemic countries, have contributed to important reductions in malaria incidence and deaths over the last 15 years. Over the last 10 years, donors have collectively supported procuring and distributing more than a billion insecticide-treated bed nets and more than a billion artemisinin-based combination therapies (ACTs) globally. Since 2000, the estimated number of malaria deaths worldwide has declined from 839,000 to 438,000 in 2015, a 48% reduction. This accomplishment is estimated to have saved up to 6.2 million lives, mostly among children under the age of five. Between 2000 and 2015, WHO reported that the proportion of all child deaths due to malaria fell globally from 17% to 10%.
The map of where malaria is still a risk has also shrunk. Twenty countries that historically had seasonal malaria transmission are now categorized by WHO as having achieved "elimination" (no locally acquired malaria cases for at least three years) or "pre-elimination" status. Nine additional countries that have been malaria-free for more than three years are monitoring against reintroduction. Four countries have been certified as malaria-free since 2007. Progress on malaria control and elimination is also estimated to have helped countries save more than $900 million in healthcare costs between 2000 and 2015.
Despite this tremendous set of achievements, approximately 3.2 billion people still remain at risk of malaria, and over 200 million cases of the disease (and more than 400,000 deaths) are reported annually. Access to diagnostic testing and antimalarial drugs for children and pregnant women also remains too low in many parts of Africa, and concerns about insecticide and antimalarial drug resistance are as pressing as ever. There is still much work to be done to achieve the targets identified in WHO's Global Technical Malaria Strategy 2016–2030.
What CDC Is Doing
In support of the goal to end malaria, CDC is committed to expanding proven malaria control strategies worldwide, including the distribution of long-lasting insecticidal nets (LLINs), rapid diagnostics tests (RDTs), ACTs, and intermittent preventive treatment in pregnancy (IPTp) through PMI. By the end of 2015, PMI had procured and distributed more than 197 million LLINs, 229 million RDTs, 376 million ACT treatments, and 58 million IPTp treatments in 19 countries in sub-Saharan Africa, as well as countries in the Greater Mekong Region. Contributions by PMI and other donors have increased access to quality malaria diagnosis and appropriate antimalarial drugs in sub-Saharan Africa. In 2014, WHO reported more than 65% of all malaria cases identified in public sector healthcare facilities were diagnosed with a confirmed laboratory test result. This confirmed test result is an important step toward reducing the inappropriate use of ACTs, which contribute to drug resistance.
CDC also continues to invest in cutting-edge science[2.36 MB] in the fields of malaria surveillance, entomology and vector control, malaria diagnostics, and studies to identify and address emerging resistance to insecticides and antimalarial drugs as it has since its founding in 1946. In 2015, CDC scientists contributed to research on a diverse range of issues, including adapting a laboratory tool for detecting low-levels of malaria infection in resource-limited settings, a clinical trial on the effectiveness of an artemisinin drug combination (primaquine + dihydroartemisinin-piperaquine) to prevent onward transmission of malaria from infected humans to mosquitoes, and an evaluation of bed nets treated with a combination of insecticides to curb insecticide resistance. CDC staff have also been integral to the evaluation of the first malaria vaccine to reduce malaria in African children, the RTS,S/AS01 vaccine, which was recently recommended by WHO for pilot evaluation in in several African countries.
In 2015, CDC began leading a consortium of malaria partners aiming to eliminate indigenous cases of malaria on the island of Hispaniola by 2020. Made possible by an initial $29.9 million grant from the Bill & Melinda Gates Foundation, the consortium, called Malaria Zero, is working collectively with governments and organizations in Haiti and the Dominican Republic to implement an evidence-based plan to create a malaria-free zone across the Caribbean.
Malaria in the United States
While local transmission of malaria was eliminated from the United States in the early 1950s, CDC remains vigilant to detect, and to help clinicians respond to, cases of imported malaria each year. In 2013, CDC documented 1,727 cases of imported malaria reported by U.S. physicians, the third highest number recorded since CDC began tracking in 1973. Ten of those cases were fatal. Rapidly responding to these imported cases is critical to saving lives and to preventing reintroduction of locally transmitted malaria in the United States. CDC also provides guidance for the prevention of malaria in international travelers to areas where malaria still poses a risk.
Looking ahead, President Obama's recent call for additional investment in the global fight against this ancient disease is both an endorsement that optimism about the potential for malaria elimination is warranted, but also a reminder that the battle against malaria is not yet won.