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# Fight against malaria slowed in 2012 as funding fell

BMJ 2012; 345 (Published 18 December 2012) Cite this as: BMJ 2012;345:e8569
1. Anne Gulland
1. 1London

Recent gains in combating malaria are being threatened by a shortfall in funding, a report by the World Health Organization has warned.

New funding is urgently needed, it says, because the largest source of money to fight the disease, the Global Fund to Fight Aids, Tuberculosis and Malaria, has dried up over the past few years, says the World Malaria Report 2012.1 In 2009 the Global Fund disbursed $1bn (£0.6bn; €0.8bn), but this fell to just over$500m in 2011. Its funding is projected to increase over the next few years.

Total funding for malaria control (domestic and international) is projected to remain at less than $2.7bn between 2013 and 2015, substantially below the$5.1bn needed to achieve universal coverage of antimalarial interventions. However, international funding for malaria control has increased sharply over the past decade, from less than $100m in 2000 to$1.84bn in 2012.

The report also found that the proportion of households in sub-Saharan Africa with at least one insecticide treated bed net rose from 3% in 2000 to 53% in 2011, although this figure did not change in 2012. The report warns that the number of bed nets procured in 2012 (66 million) was far lower than that in 2011 (92 million) and 2012 (145 million). With the average useful life of treated bed nets estimated to be 2-3 years, effective coverage will decrease if these nets are not replaced soon, says the report.

Indoor residual spraying is also seen as a powerful vector control, but in 2011 only 5% of the world’s people at risk from malaria were protected in this way. In Africa the proportion of the at-risk population that was protected by spraying rose from less than 5% in 2005 to 11% in 2010 but remained at that level in 2011.

The report found that the numbers of rapid diagnostic tests and artemisinin based combination treatments were increasing. The reported rate of diagnostic testing in the public sector in Africa rose from 20% in 2005 to 47% in 2011. However, the report could not provide information on how many people used rapid diagnostic testing in the private sector, which received an estimated 40% of people who suspected that they had malaria.

Fifty countries are on track to reduce their malaria case incidence rates by 75% by 2015, the report says, in line with targets of the World Health Assembly and the Roll Back Malaria campaign. However, these 50 represent only 3%, or seven million, of malaria cases that were estimated to have occurred in 2000, the benchmark against which progress is measured.

Robert Newman, director of WHO’s global malaria programme, said that progress in tackling malaria had to be accelerated in the countries with the highest burden of the disease. “These countries are in a precarious situation, and most of them need urgent financial assistance to procure and distribute lifesaving commodities,” he said.

The burden is concentrated in 14 countries where malaria is endemic, which together account for an estimated 80% of deaths from the disease. Nigeria and the Democratic Republic of the Congo are the most affected countries in sub-Saharan Africa, while India is the most affected country in Asia.

Fatoumata Nafo-Traoré, executive director of the Roll Back Malaria Partnership, said that the world needed “fresh ideas” on raising funds.

“We are exploring many options—financial transaction taxes, airline ticket taxes together with UNITAID [the international funding facility for drugs for HIV, malaria, and tuberculosis that is financed by airline ticket sales], and a ‘malaria bond,’ among others,” she said. A bond would raise money for malaria control from private investors and provide them with a return according to the degree of success of a malaria control programme.

## Notes

Cite this as: BMJ 2012;345:e8569

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