What We Do

Malaria

Strategy Overview

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Lab technicians conducting mosquito research at Ifakara Health Institute in Tanzania.

Lab technicians conducting mosquito research at Ifakara Health Institute in Tanzania.

our goal:

a world free of malaria.

The Challenge

At A Glance

Malaria occurs in nearly 100 countries worldwide. According to the 2013 World Malaria Report, there were more than 200 million malaria cases in 2012. An estimated 627,000 people died from malaria in 2012, 90 percent of them in Sub-Saharan Africa. Most of those who die from malaria are children under age 5.

Between 2000 and 2012, major investments in diagnosis, treatment, and prevention contributed to a 25 percent decline in malaria incidence and a 42 percent decline in malaria deaths worldwide.

Despite significant progress, current tools and treatments are insufficient to eliminate malaria in many countries because of challenges such as growing insecticide and drug resistance and continued transmission by people who are infected but asymptomatic.

The only sustainable approach to addressing malaria is eradication of the parasite. Donor countries cannot maintain funding of several billion dollars a year in perpetuity, and a resurgence of malaria could threaten hard-won progress. Eradication of malaria is biologically and technically feasible, with sufficient global commitment and major investments in transformative new tools and delivery strategies.

Our Malaria strategy, updated in 2013, is led by Alan Magill, director, and is part of the foundation’s Global Health Division.

Malaria occurs in nearly 100 countries worldwide, exacting a huge toll on human health and imposing a heavy social and economic burden in developing countries, particularly in Sub-Saharan Africa and South Asia. An estimated 207 million people suffered from the disease in 2012, and about 627,000 died. About 90 percent of the deaths were in Sub-Saharan Africa, and 77 percent were among children under age 5.

Malaria is caused by parasites transmitted by mosquitoes. Even in relatively mild cases, it can cause high fever, chills, flu-like symptoms, and severe anemia. These symptoms can be especially dangerous for pregnant women and young children who are experiencing the disease for the first time. Severe malaria can cause lifelong intellectual disabilities in children, and malaria’s economic impact is estimated to cost billions of dollars in lost productivity every year.

In the past dozen years, malaria funding has increased nearly 10-fold and major gains have been made in controlling the disease in developing nations. The number of new cases has declined by 25 percent globally, and deaths from malaria have fallen by 42 percent. These gains have been made through a combination of interventions, including timely diagnosis and treatment using reliable diagnostic tests and effective drugs; indoor spraying with safe, long-lasting insecticides; and the use of bed nets treated with long-lasting insecticide to protect people from mosquito bites at night.

Current tools and treatments are insufficient, however, to achieve elimination in many countries. And the cost of maintaining these interventions has reached several billion dollars a year. The malaria parasite has begun to develop resistance to currently available insecticides and drugs, and these resistant strains will spread. Infected individuals who are asymptomatic—the majority of those infected—remain an ongoing source of transmission.

Given sufficient global commitment, major investments in research and development, and transformative new tools and delivery strategies, the ambitious goal of malaria eradication can be met. Without an immediate, coordinated worldwide effort to eradicate malaria, this window of opportunity could close indefinitely and the progress already achieved will remain at risk.

The Opportunity

Malaria is preventable and treatable, and history shows that it can be eliminated. Less than a century ago, it was prevalent across the world, including Europe and North America. Malaria was eliminated in most of Western Europe by the mid-1930s; the United States achieved elimination of the disease in 1951.

We have the opportunity to accelerate progress toward elimination in all countries by improving the delivery of existing interventions as well as developing new tools and new strategies that target not just malaria-transmitting mosquitoes but also the parasite itself, which can survive in humans for more than 10 years. By mobilizing the required commitment and resources, we can achieve global eradication and save many millions of lives.

Our Strategy

Malaria is a top priority of the Bill & Melinda Gates Foundation. Our new multi-year Malaria strategy, Accelerate to Zero, adopted in late 2013, addresses the areas in which we believe the foundation is best positioned, among a broad spectrum of partners, to develop groundbreaking approaches to reducing the burden of malaria and accelerating progress toward eradication of the disease.

Our Malaria strategy is based on a core set of foundational principles that support our evolving strategic choices.

  • Malaria eradication is defined as removing the parasites that cause human malaria from the human population. Simply interrupting transmission is not sufficient to achieve eradication.
  • Eradication can be accelerated by new drug regimens and strategies that lead to complete parasitologic cure of the individual. Current artemisinin-based regimens achieve only clinical cure of the individual and do not eliminate the forms of the parasites that are responsible for continued transmission.
  • The majority of malaria infections occur in asymptomatic people, who are a source of continued transmission. A successful and accelerated eradication effort will target asymptomatic infections through community-based efforts.
  • Emerging resistance to current drugs and insecticides is an immediate threat to recent gains and an obstacle to future progress. Use of current tools and development of new tools should be guided by this evolutionary imperative.
  • Malaria is biologically and ecologically different throughout the world. Malaria eradication will depend on strategies developed and implemented on a local or regional level.

We concentrate our resources in areas where we can identify significant leverage points, and we assume risks that are more challenging for others to take.

An entomologist examines dead mosquitoes extracted from a window trap in a village.

Potentially transformative measures that could accelerate malaria eradication include single-dose treatments that are safe and well tolerated, highly sensitive diagnostic tests, and vaccines that prevent infection or block transmission.

Because emerging resistance to insecticides and drugs is the most important biologic threat to the goal of eradication, we are investing in the development of new tools and strategies to prevent or delay resistance.

To date, we have committed nearly US$2 billion in grants to combat malaria. In addition, we have committed more than US$1.6 billion to the Global Fund to Fight AIDS, Tuberculosis and Malaria, which provides about 50 percent of international funding for malaria control worldwide. We also advocate for sustained and increased funding of malaria-related efforts by donor governments and endemic countries.

Areas of Focus

We concentrate our efforts on three main priorities:

Demonstrate an Accelerated Path to Elimination

A nurse dispenses a malaria drug to treat an infected child in Tanzania.

We are generating evidence that malaria can be eliminated in diverse geopolitical and transmission zones, including Southern Africa and the Greater Mekong Sub-region. We believe that current tools used more effectively or in novel ways, along with strong partnerships and government commitment, can bring malaria campaigns closer to the “last mile” of elimination. This includes improving the delivery of existing vector-control tools, diagnostics, and drugs; investigating the potential of existing drugs to achieve complete cure at the individual and population levels, including the asymptomatic reservoir; and refining strategies for reaching special populations, such as pregnant women and children under age 5.

Invest in New Interventions

Because current tools are not sufficient to achieve global eradication, we are investing in a range of new interventions that have greater impact. We are working to develop transmission-blocking vaccines as well as a single, fixed-dose combination drug for complete cure and prevention.

We invest in high-sensitivity diagnostic tools and real-time data transfer methods to better understand epidemiological patterns of infection. This can help lead to better surveillance strategies and more efficient and effective elimination campaigns.

We are exploring new vector-control tools that address increasing resistance to insecticides that kill mosquitoes or prevent them from biting people.

Rural residents of Pailin Province, Cambodia, attend a course on malaria prevention.

New and enhanced surveillance tools will be critical to moving from very low transmission to zero transmission and sustaining zero transmission, especially in remote areas and areas of conflict. In testing and implementing new surveillance tools and methods, we are learning from other eradication programs, such as those for smallpox and polio. We are also exploring new ways to measure progress and to document when elimination has been achieved.

Mobilize Support

We work to ensure that malaria has a prominent place on the global agenda and garners the political support and resources needed for eventual eradication. Our work in this area includes supporting countries in their efforts to lower the malaria burden and scale up successful interventions, providing evidence to support the use of effective new measures, and advocating for national and global policies and funding to support effective malaria programs.

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