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WASHINGTON, April 24, 2005—The World Bank today marked Africa Malaria Day with the launch of a new global approach to help developing countries make faster progress in their fight against malaria. An ancient killer throughout the centuries, malaria still kills more than a million people each year, mostly children under the age of five, causes millions more to become sick, and blunts economic growth in the most affected countries.
Drawing on the global knowledge base and recent successes in malaria control in Brazil, Eritrea, India, and Vietnam, the Bank said its new Global Strategy and Booster Program reflected ‘a need for decisive action on a large scale in order to achieve impact’ to counteract what it described asthe ‘inadequacy of global efforts to control malaria and the modesty of the Bank’s current efforts relative to its potential.’
The Bank says that judging from initial demand from countries for more help in fighting malaria, its working assumption is that a total commitment of US$500 million to US$1.0 billion is feasible over the next five years, including co-financing that the Bank anticipates from partners.
The Bank will mobilize financial and technical resources itself, as well as from the development community and private sector, to expand access to prevention (including integrated vector management) and treatment, and to improve the underlying systems for sustainability. These efforts will increase the availability of insecticide-treated bed nets, anti-malarial drugs, and other commodities; support countries to lower taxes and tariffs on such items; improve and maintain long-term malaria control by governments and civil society groups; and build public-private partnerships for program design, management and evaluation. In doing so, the Bank will deploy its comparative advantages in cross-sectoral work, policy analysis, medium- to long-term financing, convening power and program implementation to help countries achieve impact.
“For many countries, controlling malaria is crucial to reduce the staggering numbers of mothers and children who die every year from this preventable and curable disease,” says Jean-Louis Sarbib, Senior Vice President for Human Development at the World Bank. “With this global strategy, we are re-committing ourselves to a strong and sustained effort to control malaria. It is good for reducing human suffering and good for economic growth.”
Sarbib says that malaria erodes economic growth, for example, when adults, debilitated by the disease, cannot work, and lose income. Furthermore, the education system becomes disrupted when children are either too sick to attend school, or their teachers are absent because of malaria-related illnesses.
Sub-Saharan Africa most affected by malaria
While malaria affects more than 100 countries worldwide, Africa is the worst-affected region of all, with at least 85 percent of all deaths from malaria occurring there. This compares to 8 percent in Southeast Asia, 5 percent in the Eastern Mediterranean region, 1 percent in the Western Pacific, and 0.1 percent in the Americas. Globally, there are more than 500 million new cases of malaria a year, with one recent study putting the number of new cases from a particularly severe form of the malaria parasite called Plasmodium falciparum, at 515 million in 2002 alone.
"On the occasion of Africa Malaria Day, we hope that this new malaria strategy will prompt public and private sector donors to follow the Bank's example and join us to 'boost' their funding to better control malaria in Africa and beyond,” says Gobind Nankani, the World Bank’s Vice President for Africa and member of the Bank’s Steering Committee for the Booster Program. “If sufficient new partners would join us, along with those already active in the field, to increase funding for effective and performance-based malaria programs, we may well be able to close the large financing gap that most African countries still face in their efforts to bring down this terrible disease.”
The new Bank strategy notes that in Tanzania, for example, when the use of insecticide-treated bed nets for infants increased from 10 to more than 50 percent, child survival increased by 27 percent and anemia decreased by 63 percent. In Uganda, where no more than 15% of households have at least one mosquito net, there is a new sense of urgency about malaria control. In addition, there have been formal or informal expressions of need from many countries, including Benin Republic, Burkina Faso, Democratic Republic of Congo, Eritrea, Ghana, Kenya, Mali, Mozambique, Nigeria, Senegal, Sudan, Tanzania and Uganda. In response to country requests and in collaboration with institutions in the Roll Back Malaria (RBM) partnership, the Bank is preparing to increase its support to Benin, Democratic Republic of Congo, Eritrea and Zambia.
According to Nankani, African countries have made important headway fighting the scourge of malaria, along with agencies such as WHO, UNICEF, the Global Fund for AIDS, TB and Malaria and the Roll-Back-Malaria partnership (RBM), as well as several bilateral agencies and OECD countries, “but it is not enough by a long shot.”
Moreover, Nankani says that he hopes the Bank's enhanced effort will re-energize the international community to help provide African families with enough supplies of the right anti-malarial drugs, especially the new and effective ACT or Artemisinin-based Combination Therapy and also to invest in malaria research to ensure more effective prevention and treatment, including new drugs to which the malaria parasites will have no resistance and, hopefully, an effective malaria vaccine.
Drug-resistant malaria worrisome
The need for ACT drugs is reinforced by evidence that malaria has made a resurgence because of resistance to traditional first-line anti-malarial treatments, such as chloroquine (CQ) and sulfadoxine pyrimethamine (SP or Fansidar) by Plasmodium falciparum, the parasite that causes a severe form of malaria. Faced with increasing resistance to these first-line treatments, countries are revising their anti-malarial drug policies and exploring alternative treatment options.
Experience in some areas of Southeast Asia has shown that artemisinin-based combination therapy can be successful in treating and reversing the spread of drug-resistant malaria. However, as the US$1–2 per course of treatment, ACTs are 10–20 times as expensive as the failed or failing chloroquine. Recent reports have identified a potential bio-medical crisis. For example, since the artemisinin-based drugs are the only first-line anti-malarial drugs appropriate for widespread use that still work against chloroquine-resistant malaria parasites, malaria’s toll could rise even higher if resistance to artemisinin were allowed to spread. The challenge is thus twofold: to facilitate the widespread use of artemisinins where appropriate while, at the same time, preserving their effectiveness for as long as possible.
Malaria also a priority in South Asia
While African countries shoulder most of the global malaria burden, others in South Asia also suffer from the social and economic impact of the disease. According to the World Health Organization, Afghanistan in 2002 recorded three million new cases of malaria, with the heaviest pockets of disease in border areas where refugees have settled after political conflicts. Isolated groups in various South Asia countries, with little or no access to healthcare, also suffer disproportionately from the ravages of malaria.
India, on the other hand, has experienced more success in combating the disease. In 2002–2003, India achieved dramatic reductions in malaria morbidity in the states of Gujarat (58 percent), Maharashtra (98 percent), and Rajasthan (79 percent) through country efforts that included the World Bank-supported Malaria Control Project.
"One of the great success stories of the last 30 years is the 85 percent reduction in the incidence of malaria in South Asia," said Praful Patel, World Bank Vice President for the South Asia Region, and member of the Bank’s Steering Committee for the Booster Program. "But the burden of malaria remains oppressive and needs more attention. India, for example, suffered 1.7 million cases last year, almost half of which were the more deadly form of the disease. We are being challenged to expand our assistance across the region so that the progress of recent years can be accelerated."
Patel says that since 1997, the Bank has supported India's malaria control effort with a $165 million credit and is now planning a new vector borne diseases project for $200 million over the next five years. In other affected countries, particularly Pakistan, Bangladesh, Sri Lanka, and Afghanistan, assistance is provided through ongoing health operations but there too the challenge is one of scaling up and broadening success.
Learning from the Past
The new malaria strategy acknowledges that while the World Bank was a key contributor to recent successes in malaria control, including those in Brazil, Eritrea, parts of India, and Vietnam, and co-founded and supports the global Roll Back Malaria Partnership, the Bank’s activities were useful but not sufficient for success on a larger scale. Its efforts were severely hampered by under-staffing and under-funding. As the new approach now puts it, having digested the lessons of the last five years, the Bank realizes that “a different and more robust approach is needed for success.”
Strategy has wide support
The World Bank says its new malaria global approach has been extensively reviewed, and as a result is now widely supported. Many country officials, peer reviewers, colleagues in the RBM Partnership Secretariat and an External Consultative Group provided client perspectives, technical materials, critical reviews and helpful suggestions. The Roll Back Malaria Department of the World Health Organization provided data on malaria case notification and coverage with key interventions.
"The Bank’s new strategy and booster program are most welcome at a time when global momentum to roll back malaria is building fast," says Dr. Awa Coll-Seck, Executive Secretary of the Roll Back Malaria Partnership, and a former Minister of Health for Senegal. "The consultative approach was very good and consistent with the efforts of the Roll Back Malaria partnership. The world needs a World Bank actively engaged in malaria control. Together, we can make a big difference."
The Bank also benefited from consultations with partner agencies, some of which included, WHO, UNICEF, the MACEPA Project (funded by the Bill and Melinda Gates Foundation), Exxon Mobil Corporation, Medicines for Malaria Venture (MMV), the UN Foundation, bilateral agencies such as USAID, and NGOs. Going forward, the Bank will continue to work within and support the global framework of RBM, of which it is a founding member and financier.
To read the Bank’s global strategy online, visit:
Global Strategy and Booster Program
For more information on the Bank’s work in malaria and other communicable diseases, visit: http://www.worldbank.org/malaria