U.S. Response to the Global Threat of Malaria:
Basic Facts
Alexandra E. Kendall
Analyst in Global Health
February 22, 2011
Congressional Research Service
7-5700
www.crs.gov
R41644
CRS Report for Congress
P
repared for Members and Committees of Congress
U.S. Response to the Global Threat of Malaria: Basic Facts
Summary
In 2009, malaria infected an estimated 225 million people and killed 781,000 people, most of
whom were children under the age of five in sub-Saharan Africa. Despite the current burden of
disease, malaria is preventable and treatable. Congress has increasingly recognized malaria as an
important foreign policy issue, and the United States has become a major player in the global
response to the disease. The 112th Congress will likely debate the appropriate funding levels and
optimum strategy for addressing the continued challenge of global malaria.
Congress has enacted several key pieces of legislation related to global malaria control. These
include the Assistance for International Malaria Control Act of 2000 (P.L. 106-570); the U.S.
Leadership Against HIV/AIDS, Tuberculosis, and Malaria Act of 2003 (P.L. 108-25); and the
Tom Lantos and Henry J. Hyde United States Global Leadership Against HIV/AIDS,
Tuberculosis, and Malaria Reauthorization Act of 2008 (P.L. 110-293). These acts have
authorized funds to be used in the fights against malaria and have shaped the ways in which U.S.
malaria programs are coordinated and managed, including through the creation of the U.S. Global
Malaria Coordinator at the United States Agency for International Development (USAID).
In 2005, in response to growing international calls for global malaria control and to the success of
the President’s Emergency Plan for AIDS Relief (PEPFAR), President George W. Bush launched
the President’s Malaria Initiative (PMI), which aims to halve the burden of malaria morbidity and
mortality in 70% of at-risk populations in sub-Saharan Africa by 2014. PMI brought significant
new attention and funding to U.S. malaria programs and made the United States one of the largest
donors for malaria efforts. While U.S. funding for global malaria programs has increased each
fiscal year since FY2004, support for malaria interventions increased most precipitously
beginning in FY2007 as PMI has expanded into new countries. President Obama has continued to
support PMI and has called for greater spending on malaria programs in each of his budget
requests. The President’s FY2012 budget requests $691 million for global malaria efforts.
There is evidence that the growing international response to malaria has had some success in
controlling the epidemic. Since 2000, 11 African countries have experienced at least a 50%
reduction in either confirmed malaria cases or malaria admissions and deaths. The decreases in
each of these African countries are associated with intense malaria control activities. Despite
these successes, several key issues pose challenges to effective scale-up of the response to
malaria. First, increasing reports of drug-resistant malaria in Asia and insecticide-resistant
mosquitoes in Africa threaten the success of malaria control programs. Second, weak health
systems, including shortages in health care personnel and inadequate supply chain networks, have
limited the delivery of essential commodities for malaria control. There is also debate within the
global health community over whether malaria efforts should increasingly target areas where
malaria elimination is possible or whether efforts should remain concentrated on malaria control.
This report outlines basic facts related to global malaria, including characteristics of the epidemic
and U.S. legislation, programs, funding, and partnerships related to the global response to
malaria. The report will be updated as events warrant.
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U.S. Response to the Global Threat of Malaria: Basic Facts
Contents
Introduction ................................................................................................................................ 1
Description of Malaria ................................................................................................................ 1
Global Malaria Statistics ............................................................................................................. 1
Regional Distribution of Malaria ................................................................................................. 1
Malaria Prevention and Treatment ...............................................................................................2
Key U.S. Legislation on Global Malaria ...................................................................................... 3
U.S. Global Malaria Programs..................................................................................................... 3
Implementing U.S. Agencies ....................................................................................................... 5
U.S. Global Malaria Assistance Funds......................................................................................... 6
Key Partners in the Response to Global Malaria .......................................................................... 8
Key Issues in Global Malaria ...................................................................................................... 9
Figures
Figure 1. Malaria, Countries or Areas at Risk of Transmission, 2009 ........................................... 2
Figure 2. U.S. Bilateral Malaria Programs ................................................................................... 4
Figure 3. U.S. Bilateral Funding for Malaria in Constant Dollars: FY2004-FY2010..................... 7
Figure 4. Disbursements to Malaria Endemic Countries from External Donors, 2004-2009.......... 8
Tables
Table 1. PMI Focus Countries ..................................................................................................... 4
Table 2. U.S. Bilateral Funding for Malaria: FY2004-FY2012..................................................... 6
Table 3. U.S. Appropriations for the Global Fund: FY2004-FY2012............................................ 7
Contacts
Author Contact Information ...................................................................................................... 10
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U.S. Response to the Global Threat of Malaria: Basic Facts
Introduction
The United States has supported anti-malaria programs since the 1950s. Global malaria received
greater attention in 2005 when President Bush launched the President’s Malaria Initiative (PMI),
a five-year plan to expand U.S. malaria efforts. In FY2008, Congress significantly increased its
funding for global malaria and authorized the creation of the U.S. Global Malaria Coordinator at
the United States Agency for International Development (USAID) to oversee all U.S. malaria
efforts. President Barack Obama has emphasized combating malaria in his Global Health
Initiative (GHI) and has called for increasing funding for these efforts. This report provides
background information on malaria and explains the key components of the U.S. response.
Description of Malaria
Malaria is an infectious disease that is transmitted to people through the bite of infected
mosquitoes. The disease infects red blood cells, causing a range of symptoms that include fever,
headache, and vomiting. Although malaria is preventable and curable, if left untreated, it can be
fatal. Young children, pregnant women, and individuals with HIV/AIDS are particularly
vulnerable to malaria due to their weakened immune systems.
Global Malaria Statistics1
Malaria Cases: The World Health Organization (WHO) estimates that half of the world’s
population is at risk of malaria infection. Malaria is prevalent in 106 countries, referred to as
malaria-endemic countries. In 2009, there were approximately 225 million cases of malaria
worldwide, down from approximately 233 cases in 2000. Since 2000, 32 countries outside of
Africa have experienced more than a 50% reduction in reported malaria cases, and 11 African
countries have experienced at least a 50% reduction in either confirmed malaria cases or malaria
admissions and deaths.
Malaria Deaths: The malaria death toll declined from 985,000 in 2000 to 781,000 people in
2009. Roughly 85% of 2009 malaria-related deaths occurred among children younger than five.
Regional Distribution of Malaria2
Malaria occurs worldwide, though it is heavily concentrated in what are categorized by WHO as
the African, South-East Asian, and the Eastern Mediterranean regions (Figure 1).3
1 All data in this section is from World Health Organization (WHO), Global Malaria Program, World Malaria Report,
2010, http://whqlibdoc.who.int/publications/2010/9789241564106_eng.pdf.
2 All data in this section is from WHO, Global Malaria Program, World Malaria Report, 2010.
3 For an explanation of the countries included in each WHO Region, see “WHO Regional Offices,”
http://www.who.int/about/regions/en/index.html.
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• In 2009, about 78% of all malaria cases and 91% of all malaria-related deaths
occurred in the WHO Africa region. There are 43 malaria-endemic countries in
the Africa region.
• The WHO South-East Asia region was home to 15% of all malaria cases and 6%
of malaria-related deaths in 2009. Of the 10 malaria-endemic countries in the
South-East Asia region, India, Bangladesh, Indonesia, and Myanmar (Burma)
make up 97% of all malaria cases.
• The WHO Eastern Mediterranean region was home to 5% of all malaria cases
and 2% of malaria-related deaths in 2009. Of the region’s 12 malaria-endemic
countries, Afghanistan, Pakistan, Somalia, and Sudan make up 90% of malaria
cases.
Figure 1. Malaria, Countries or Areas at Risk of Transmission, 2009
Source: WHO, Global Health Observatory, Map Gallery, http://gamapserver.who.int/mapLibrary/.
Notes: Countries or areas in dark blue are where malaria transmission occurs. Countries or areas in light blue
are those with limited risk of malaria transmission.
Malaria Prevention and Treatment
The international community applies four strategies for combating malaria:
Treatment: Anti-malarial treatments include chloroquine, primaquine, and artesmisinin-based
combination therapy (ACT). ACT is the preferred treatment in areas with particularly deadly
forms of malaria or with drug resistance to earlier generations of anti-malarials. Multi-drug
resistant malaria is found worldwide, and there is evidence that ACT resistance is occurring in
Asia.
Intermittent Preventive Treatment in Pregnancy (IPTp): In areas with high concentrations of
malaria, physicians give pregnant women an anti-malarial drug to prevent them from transmitting
the disease to their infants.
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Insecticide-Treated Bed Nets (ITNs): Insecticides used to treat bed nets kill and repel
mosquitoes. ITNs are used as personal protection against mosquito bites, but evidence suggests
that high community coverage of ITNs can lower the number of mosquitoes in a general area and
reduce the life span of mosquitoes that remain. ITNs retain effective levels of insecticide for up to
six months. Newly developed long-lasting insecticide-treated nets (LLINs) last for at least three
years.
Indoor Residual Spraying (IRS): IRS involves covering household walls with an insecticide to
kill any mosquito that comes into contact with the surfaces for several months. To be effective,
IRS must be applied to a high percentage (80%) of household surfaces. Resistance to insecticides
is a growing concern.
While there is presently no malaria vaccine, research is ongoing. There are currently over a dozen
vaccine candidates in clinical development, and one, produced by GlaxoSmithKline, is in clinical
trials.
Key U.S. Legislation on Global Malaria
• On December 27, 2000, President Bill Clinton signed into law the Assistance for
International Malaria Control Act (P.L. 106-570). The act authorized $50 million
per year for FY2001 and FY2002 for anti-malaria activities in countries with
high malaria prevalence.
• On May 27, 2003, President George W. Bush signed into law the United States
Leadership Against HIV/AIDS, Tuberculosis, and Malaria Act of 2003
(Leadership Act, P.L. 108-25). The act authorized $15 billion for global
HIV/AIDS, TB, and malaria programs from FY2004 through FY2008. The act
recognized malaria control as a major foreign policy objective, though it did not
specify an amount for bilateral malaria programs.
The act also prohibited U.S. contributions to the Global Fund to Fight AIDS,
Tuberculosis and Malaria (Global Fund) (See “Key Partners in the Response to Global
Malaria”) from exceeding 33% of funds contributed from all sources.
• On July 24, 2008, President Bush signed into law the Tom Lantos and Henry J.
Hyde U.S. Global Leadership Against HIV/AIDS, Tuberculosis, and Malaria
Reauthorization Act of 2008 (Lantos-Hyde Act, P.L. 110-293). The act authorized
$48 billion for global HIV/AIDS, TB, and malaria programs from FY2008
through FY2013, including $5 billion for malaria programs over five years.
The act also created the position of U.S. Global Malaria Coordinator at USAID. The
Malaria Coordinator is charged with overseeing all U.S. anti-malaria efforts, submitting
an annual report to Congress describing U.S. malaria programs, and developing a five-
year strategic plan for U.S. efforts to combat malaria.
U.S. Global Malaria Programs
The United States has supported global malaria control efforts since the 1950s. Efforts to expand
U.S. malaria programs and improve their coordination increased following the announcement of
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the President’s Malaria Initiative (PMI) in 2005. PMI represented a growing acknowledgement of
the efficacy of malaria prevention and treatment strategies and built on the success of the
President’s Emergency Plan for AIDS Relief (PEPFAR) in harnessing resources to combat a
disease. PMI was initially created as a five-year, $1.2 billion effort to increase U.S. engagement
in global malaria control and reduce malaria-related deaths by 50% in 15 high-burden focus
countries. Focus countries were selected according to several criteria, including high malaria
burden, capacity to implement anti-malaria programs, and willingness to partner with the United
States. PMI has since expanded into two other malaria-endemic countries in Africa (Table 1).
Table 1. PMI Focus Countries
The PMI Focus Countries have been added over the course of several fiscal years:
FY2006: Angola, Tanzania, Uganda
FY2007: Malawi, Mozambique, Rwanda, Senegal
FY2008: Benin, Ethiopia, Ghana, Kenya, Liberia, Madagascar, Mali, Zambia
FY2011: Nigeria, Democratic Republic of the Congo
Note: PMI countries selected in FY2006, FY2007, and FY2008 represent the original 15 PMI focus countries.
PMI is an interagency initiative run by USAID and jointly implemented by USAID and the
Centers for Disease Control and Prevention (CDC). The U.S. Global Malaria Coordinator at
USAID coordinates malaria efforts across a number of agencies and departments, including CDC,
the Department of Defense (DOD), and the National Institutes of Health (NIH). Oversight duties
are shared with an Interagency Steering Group composed of representatives from USAID,
CDC/the Department of Health and Human Services (HHS), the Department of State, DOD, the
National Security Council, and the Office of Management and Budget. USAID and CDC also
provide bilateral malaria assistance to a handful of countries not designated as PMI focus
countries. Figure 2 depicts all countries that receive U.S. bilateral malaria assistance.
Figure 2. U.S. Bilateral Malaria Programs
Source: Kaiser Family Foundation, September 2010, http://facts.kff.org/chart.aspx?ch=876.
Notes: Countries in blue are those selected to receive U.S. bilateral support for malaria according to the
Department of State FY2011 Foreign Operations Congressional Budget Justification. Countries in yel ow do not
receive U.S. bilateral support for malaria.
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President Obama has indicated support for an expanded U.S. malaria program. On May 5, 2009,
the President announced the six-year, $63 billion Global Health Initiative (GHI), a new effort to
develop a comprehensive U.S. global health strategy. Malaria is one of the GHI’s six priority
areas, and PMI is considered a key component of the GHI, reflecting the Administration’s belief
that scaled-up malaria interventions can help maximize health impact per dollar spent. The GHI
calls for a more integrated U.S. response to global health issues, including better coordination
between malaria and maternal and child health programs. The GHI also calls for a shift in U.S.
global health strategy from one focused on specific diseases to a more comprehensive approach to
health, including a focus on health system strengthening.
In April 2010, in response to congressional reporting requirements to develop a coordinated
approach to global malaria, USAID, HHS (including CDC), and the Department of State released
a joint “Lantos-Hyde United States Government Malaria Strategy.”4 The strategy explains how
U.S. malaria programs will advance the goals of the GHI and outlines key targets for the U.S.
malaria program from 2009 to 2014. Key goals include the following:
• halve the burden of malaria (morbidity and mortality) in 70% of at-risk
populations in sub-Saharan Africa;
• limit the spread of anti-malarial multi-drug resistance in Southeast Asia and the
Americas;
• assist host countries to revise and update their National Malaria Control
Strategies and Plans to reflect the declining burden of malaria; and
• link U.S. malaria efforts with host country malaria plans.
Implementing U.S. Agencies
U.S. agencies supporting global malaria control efforts include the following:
• United States Agency for International Development: USAID manages PMI
programs in the PMI focus countries. USAID also supports malaria control
programs in several other countries and facilitates efforts to identify and contain
anti-malarial drug resistance through two regional programs in the Amazon Basin
and the Mekong Delta. USAID’s malaria programs focus on five key areas: IRS,
ITNs, IPTp, diagnosis and treatment, and pesticide management.
• Centers for Disease Control and Prevention: CDC jointly implements PMI
with USAID. CDC’s malaria efforts focus on monitoring and evaluation, disease
surveillance, and capacity development for national malaria control programs.
CDC also undertakes global malaria research to improve prevention and
treatment efforts with an emphasis on LLINs, IRS, and IPTp, and the elimination
of malaria.
• Department of Defense: DOD supports malaria research, including anti-malaria
treatment and vaccine development. Research is conducted at the U.S. Military
4 USAID, HHS, CDC, and Department of State, Lantos-Hyde United States Government Malaria Strategy: 2009-2014,
April 25, 2010, http://www.fightingmalaria.gov/resources/reports/usg_strategy2009-2014.pdf.
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Malaria Vaccine Program at the Walter Reed Army Institute of Research and the
Malaria Research Department at the Navy Medical Research Center.
• National Institutes of Health: The National Institute of Allergy and Infectious
Diseases (NIAID) of the NIH is the lead U.S. agency supporting malaria
research. NIAID works on developing tools for malaria prevention, treatment and
control, and enhancing research infrastructure in malaria-endemic countries.
U.S. Global Malaria Assistance Funds
Congress designates funds for malaria to USAID, through State-Foreign Operations
appropriations, and to CDC, through Labor, Health and Human Services, and Education
appropriations. Congressional appropriations for malaria have consistently increased since
FY2004. In response to growing calls within the international community for global malaria
control, funding for malaria interventions have increased most precipitously since FY2007 (Table
2 and Figure 3) in support of PMI expansion into new countries. President Obama has continued
to support PMI and has called for greater spending on malaria programs in each of his budget
requests. The President’s FY2012 budget requests $691 million for global malaria efforts.
Table 2. U.S. Bilateral Funding for Malaria: FY2004-FY2012
($ millions, current)
FY2004-
FY2004 FY2005 FY2006 FY2007 FY2008 FY2009
FY2010
FY2010
FY2011
FY2012
Program/Agency
Actual
Actual
Actual
Actual
Actual
Actual
Estimate TOTAL Request Request
USAID
Malaria
79.9 90.8 102.0 248.0 349.6 382.5 585.0 1,837.8 680.0 691
Of which, PMI
n/a
4.2
65.5
197.0
295.8
299.9
500.0
1,362.4
600.0
n/s
CDC
Malaria
9.2 9.1 9.0 8.9 8.7 9.4 9.4 63.7 9.2 n/sa
Malaria
Total
89.1 99.9 111.0 256.9 358.3 391.9 594.4 1,901.5 689.2 691
Source: Compiled by CRS from Congressional Budget Justifications, appropriations legislation, and PMI reports.
Notes: “n/a” stands for “not applicable.” PMI was established in 2005 and therefore did not receive funding in
FY2004. FY2011 Funding is currently provided under a continuing resolution at FY2010-enacted levels until
March 4, 2011.
a. The FY2012 budget request includes $19.6 million for parasitic diseases and malaria. It does not specify an
amount for malaria alone, as has been done in previous fiscal years.
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Figure 3. U.S. Bilateral Funding for Malaria in Constant Dollars: FY2004-FY2010
($ millions, constant)
600
)
500
illions 400
m
300
200
. Funding ( 100
.S
U
0
2004
2005
2006
2007
2008
2009
2010
Fiscal Year
Source: Compiled by CRS from Congressional Budget Justifications.
The United States also supports global malaria programs through contributions to the Global
Fund, an international financing mechanism for the response to HIV/AIDS, TB, and malaria. U.S.
contributions to the Global Fund support grants for HIV/AIDS, TB, and malaria. The Global
Fund has historically directed approximately 25% of its funds for malaria efforts. The United
States is the single largest donor to the Global Fund. Table 3 details actual and proposed U.S.
contributions to the Global Fund from FY2004 to FY2012.
Table 3. U.S. Appropriations for the Global Fund: FY2004-FY2012
($ millions, current)
FY
FY2004 FY2005 FY2006 FY2007 FY2008 FY2009
FY2010
2011
FY2012
Program/Agency
Actual
Actual
Actual
Actual
Actual
Actual
Estimate Request Request
USAID
397.6 248.0 247.5 247.5 0.0 100.0
0.0
0.0
0.0
FY2004
Carryover -87.8 87.8 n/a n/a n/a n/a n/a n/a n/a
State
0.0 0.0 198.0 377.5 545.5 600.0 750.0 700.0 1,000.0
HHS
149.1 99.2 99.0 99.0 294.8 300.0 300.0 300.0 300.0
Total
458.9 435.0 544.5 724.0 840.3
1,000.0 1,050.0 1,000.0 1,300.0
Source: Compiled by CRS from appropriations legislation.
Notes: In the “FY2004 Carryover” row, “n/a” is used to reflect requirements in the U.S. Leadership Act, which
stipulates that U.S. contributions to the Fund not exceed 33% of Fund contributions from al sources. FY2005
Consolidated Appropriations (P.L. 108-447) added this amount to the 2005 contribution, subject to the same
33% limitation.
The majority of total global funding for malaria control comes from three sources: external donor
assistance, national government spending, and household expenditures. According to WHO, of
the total malaria spending in 2007, donor assistance accounted for 47%, national government
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spending accounted for 34%, and household expenditures accounted for 19%.5 External donor
assistance comes primarily from three sources: PMI, the Global Fund, and the World Bank
(Figure 4). The Global Fund is the single largest donor for malaria efforts. According to the
Global Fund, it accounted for 57% of all external financing for malaria in 2008.6
Figure 4. Disbursements to Malaria Endemic Countries from External Donors,
2004-2009
Source: WHO, World Malaria Report, 2010, p. 12.
Key Partners in the Response to Global Malaria
The United States works with a range of partners to combat malaria, including other national
governments, multilateral organizations, non-governmental organizations (NGOs), and the private
sector. Key partners include the following:
• The Global Fund: The Global Fund was established in 2002 as a public-private
partnership to provide significant financial support for the global response to
HIV/AIDS, TB, and malaria. The United States contributes more to the Global
Fund than any other donor. By the end of 2009, the Global Fund had committed
to provide $5.3 billion toward malaria proposals in 83 countries.7
• The World Bank: In 2005, the World Bank launched the World Bank Booster
Program for Malaria Control in Africa. The Booster Program is implemented in
18 countries and supports the rapid scale-up of preexisting malaria control
interventions and works to strengthen in-country procurement and supply-chain
capacity, monitoring and evaluation, and health planning. Funding by the World
Bank on malaria control has increased eightfold since 2005.
5 WHO, World Malaria Report, 2009, p. 57, http://whqlibdoc.who.int/publications/2009/9789241563901_eng.pdf.
6 Global Fund to Fight for AIDS, Tuberculosis, and Malaria, Global Fund 2010 Innovation and Impact, Progress
Report 2010, p. 4.
7 Ibid.
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• World Health Organization: WHO is the authority for health within the United
Nations system. It is responsible for shaping the global health research agenda,
setting norms and standards, articulating evidence-based policy options,
providing technical support to countries, and monitoring global health trends.
WHO’s Global Malaria Program (GMP) promotes global malaria policies and
intervention guidelines, provides technical assistance to malaria programs, and
supports research and development of anti-malarial drugs and insecticides.
• Roll Back Malaria (RBM) Partnership: The RBM Partnership was created in
1998 by WHO, United Nations Children’s Fund (UNICEF), United Nations
Development Program (UNDP), and the World Bank to facilitate coordination of
malaria activities and optimal use of resources. The RBM Partnership has 500
partners, including malaria-endemic countries, Organization for Economic Co-
operation and Development (OECD) donor governments, multilateral
organizations, the private sector, NGOs, foundations, research institutions, and
ex-officio members. The Coordinator of PMI currently sits on the RBM
Partnership Board.
• United Nations Children’s Fund (UNICEF): UNICEF supports malaria
programs through its work on child survival and development. UNICEF assists in
developing national malaria plans and policies; monitoring and evaluation; and
supplying, procuring, and distributing malaria commodities. According to
UNICEF, it is the world’s largest procurer and deliverer of ITNs.8 UNICEF and
USAID have a “Malaria Control Partnership” to support malaria programming
and commodity procurement, supply, and distribution.
• American Red Cross: The American Red Cross malaria programs support
distribution of ITNs, community education on the threat of malaria and the
proper use of ITNs, and operational research on the effectiveness of ITNs.
• Bill and Melinda Gates Foundation: The Gates Foundation advocates
increased support for malaria and funds the development of new tools to treat,
diagnose, and prevent malaria. The foundation hopes to have supported the
development of a malaria vaccine by 2025.9
Key Issues in Global Malaria
The 112th Congress will likely be faced with a number of issues regarding the U.S. response to
global malaria, including how much assistance to provide and how to best apportion global
malaria funds. As Congress debates the role of the U.S. in global malaria control, it might
consider the following issues:
• Insecticide and drug resistance: Growing instances of drug-resistant malaria
and insecticide-resistant mosquitoes threaten global malaria control, particularly
in Africa. There are currently no alternatives to available forms of insecticides
and treatments. Some health experts argue that anti-malaria resources should
8 UNICEF website, “UNICEF in Action: Malaria,” http://www.unicef.org/health/index_malaria.html.
9 Bill and Melinda Gates Foundation website, “Malaria: Our Approach,” http://www.gatesfoundation.org/topics/Pages/
malaria.aspx#.
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prioritize drug and insecticide resistance, including efforts to improve drug
quality control, resistance monitoring and surveillance, and research and
development of new forms of malaria drugs.
• Health System Strengthening: Weak health systems have been a major
impediment to successful malaria prevention and treatment. In particular,
shortages in health care personnel and weak supply chain networks have limited
the delivery of essential commodities for malaria control. There is some
disagreement within the global health community about whether PMI has had a
beneficial or detrimental impact on the broader functioning of health systems.
• Control vs. elimination: There is debate within the global health community
over the degree to which the international community should commit itself to
malaria control (reducing the disease burden to a level at which it is no longer a
public health problem) or malaria elimination (reducing incidence of infection to
zero in a defined geographic). While the majority of international funding for
malaria efforts in the past decade have been focused on control efforts, a number
of experts have argued that efforts should increasingly focus on elimination of
the disease. Key issues affecting the debate over control versus elimination
include whether countries have the capacity to support more ambitious programs,
whether donor assistance is predictable enough to support elimination efforts, and
how the international community can avoid any potentially detrimental
consequences of an elimination campaign, such as increased insecticide and drug
resistance.
Author Contact Information
Alexandra E. Kendall
Analyst in Global Health
akendall@crs.loc.gov, 7-7314
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