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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

According to the 2018 World Malaria Report, there were more than 200 million malaria cases in 2017. An estimated 435,000 people died from malaria in 2017, mostly children under age 5, and more than 90 percent of them in Africa.

Since the early 2000s, major investments in diagnosis, treatment, and prevention helped reduce malaria cases by more than 40 percent and reduce deaths by more than 60 percent worldwide.

Despite significant historic progress, we’ve now plateaued. Headwinds such as insecticide and drug resistance and stagnant funding put future progress in question without concerted action by donors and affected countries.

The only sustainable approach to addressing malaria is eradication of the parasite. Eradication is biologically and technically feasible, with commitment and collaboration from global partners and affected countries, and ongoing investment in transformative new tools and strategies.

Malaria exacts a massive toll on human health and imposes a heavy social and economic burden in low- and middle-income countries, particularly in Sub-Saharan Africa and South Asia. An estimated 219 million people suffered from the disease in 2017 and about 435,000 died. More than 90 percent of the deaths were in Africa, and over 60 percent were among children under 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.

Since 2000, deaths from malaria have been reduced by half. A combination of interventions and a rise in funding helped drive this progress, including the timely use of 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.

In recent years malaria cases in many high-burden countries have increased. Overall funding for malaria control has plateaued. The malaria parasite has also begun to develop resistance to currently available drugs, and insecticide resistance is becoming a challenge in key Anopheline species. These headwinds require new commitment and new approaches to malaria control.

Given sufficient global commitment, scaling up proven strategies using data, and continued investments in research and development to innovate transformative new tools and delivery strategies, the ambitious goal of malaria eradication can be met. Along the way, we can save millions more lives by addressing the high-burden countries, in partnership with affected countries, donors and technical partners.

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 in 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 can drive down burden in the short- to medium-term, resulting in fewer deaths on the path to eradication. This involves improving the delivery of existing interventions, using improved data systems to optimize where we use those interventions, developing new tools and strategies, and supporting the leadership of malaria affected countries.

Our Strategy

Malaria is a top priority of the Bill & Melinda Gates Foundation. Our malaria strategy, updated in 2018, addresses the areas in which we believe the foundation is best positioned, among a broad spectrum of partners, to be catalytic in reducing the burden of malaria and accelerating progress toward eradication of the disease. We intend to pursue a Pathway to Eradication that minimizes deaths due to malaria between now and the end of malaria.

The update of the malaria strategy can be summarized in a series of pivots that will drive our investments and work. In summary, they are:

  • Increasingly, work in high burden countries to rapidly reduce deaths through improved data-driven decisions and to build systems that will shorten the endgame. This is wholly aligned with the High Burden to High Impact initiative launched in November 2018 with the leadership of WHO and the RBM Partnership to End Malaria
  • Deepen our partnerships and collaboration with PMI, Global Fund, DfID, other leading donors and WHO to produce more coordinated support in service of affected country governments
  • Establish platforms to support next-generation surveillance and data use, with an emphasis on scaling genetic epidemiology to inform decision-making at every level and to determine how to get more out of tools and limited resources
  • Optimize coverage of chemoprevention through existing channels to save lives now using existing, proven tools
  • Test models that can scale access to – and quality of – care and medicines across public and private sector channels
  • Accelerate the number and pace of R&D for transformational endgame tools, acknowledging that what we have today won’t get us to eradication

We concentrate our resources in areas where our efforts can make an impact and save lives, and we assume risks that are more challenging for others to take.

We recognize that we are just one small part of a broader, global fight. That’s why we work closely with partners to maximize the impact of our aggregate efforts. To date, we have committed more than US$2.9 billion in grants to combat malaria. In addition, we have committed US$2 billion to the Global Fund to Fight AIDS, Tuberculosis and Malaria. We also advocate for sustained and increased funding of malaria-related efforts by donor governments and affected countries.

Areas of Focus

Three strategy goals define our pathway to eradication:

Drive Down Burden

In the short- and medium-term, scale surveillance and data-driven sub-national optimization, chemoprevention and case management in high-burden settings to reduce deaths and cases. Many of the tools needed to fight malaria – from vector-control tools, to diagnostics and drugs – already exist, yet cases continue to rise in many high-burden countries. We are working closely with partners to ensure life-saving tools are made available to the people who need them most, where they are most effective. Alongside strong partnerships and government commitments, finding ways to do more with the tools we already have can save lives and bring us closer to ending malaria.

Shorten the Endgame

Create an enabling environment for winning the endgame in high-endemic Sub-Saharan Africa by investing in next-generation surveillance systems, elimination in regions where drug-resistant malaria has emerged, and accelerating endgame research and development efforts today. Elimination is facilitated by having sufficient prevention of transmission and access to care, guided by timely and accurate surveillance data. These are also approaches that will help drive down burden in the short term, creating a strategic link between the first two goals.

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 document when elimination has been achieved.

Get Ahead of Resistance

Mitigate the emergence of drug and insecticide resistance by eliminating falciparum malaria in the Greater Mekong Subregion, developing a robust pipeline of active ingredients and analyzing entomological and genetic epidemiological data to quickly respond to threats.

Ultimately, ending malaria will require transformative innovations. And the current challenges of rising drug and insecticide resistance threatens the efficacy of existing tools. That’s why we are investing in the development of new tools and strategies to help finish the fight.

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