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“This costing is very conservative and assumes current levels [of elimination] would be maintained and that we would not have to change [disease control] methods,” Anthony Kiszewski, an epidemiologist at Bentley University, United States, tells SciDev.Net. He is an author of a paper that costs malaria elimination in the 34 countries published last month (31 December) in PLOS One.
“Things could go wrong. They are already going wrong in Africa with drug and insecticide resistance. The target is constantly changing, so we may have to re-cost malaria elimination in a few years’ time,” Kiszewski warns.
But without sustained efforts, even past gains could be reversed and malaria could resurge in areas of near-elimination. “Nature is adaptive,” says Kiszewski. “It is a race against time to achieve elimination.”
“Decreasing funding to countries may hurt their ability to maintain progress towards malaria elimination."
Brittany Zelman, Malaria Elimination Initiative
Under one, less-likely, scenario in the paper — involving greater use of long-lasting insecticidal bed nets — US$11.2 billion would be needed up to 2030 to get rid of the disease in the 34 countries with national goals to eliminate malaria. These include nations such as China and Thailand that have a high disease burden, but exclude Brazil, India and many African countries that are a long way from elimination.
The estimate comes at the start of a crucial period for malaria efforts. In May, the WHO is due to launch a global strategy for tackling the disease up to 2030. Discussions will also continue on including malaria elimination as a target of the proposed post-2015 Sustainable Development Goals (SDGs).
Since 2000, eight countries have eliminated malaria, according to the WHO.
The US$8.5 billion estimate assumes spending of around US$600 million a year for the next seven years, dropping thereafter, says another of the paper’s authors, Brittany Zelman, a policy analyst for the Malaria Elimination Initiative at the Global Health Group, University of California, San Francisco, United States.
Despite a more than 18-fold rise in financing to tackle malaria from 2000-2011, particularly from the Global Fund to Fight AIDS, Tuberculosis and Malaria, global aid for malaria has since levelled off, she tells SciDev.Net.
Zelman points to an uphill battle to sustain funding, noting a 20 per cent fall in funding for the 34 malaria targeting countries from the Global Fund as it shifted its focus to higher-burden, lower-income nations.
Almost two-thirds of the 34 malaria targeting countries will continue to qualify for Global Fund assistance. But this has still left a funding gap in several middle-income and lower-middle-income countries that are close to eliminating the disease, she says.
“Decreasing funding to countries — even middle-income countries where 40 per cent of people at risk of malaria live — may hurt their ability to maintain progress towards malaria elimination,” Zelman says.
But Nick Chapman, senior analyst at Policy Cures, which offers analysis on neglected tropical diseases, says the funding estimates for the 34 malaria targeting countries only relate to the costs of running programmes targeting malaria and exclude malaria-related research and development. Such R&D could dramatically change the outlook for elimination, for example if it led to an effective vaccine.
In 2013, Policy Cures estimated the overall funding needed for malaria elimination and eradication R&D at around US$335 million yearly, rising steadily to around US$450 million a year by the end of the decade, with slower growth after 2018.
“R&D benefits aren’t country-specific, so this goes beyond the eliminating countries,” he tells SciDev.Net.