Global Trends: Malaria
March 25, 2019
Global Trends: Malaria
The United States has supported global malaria control
Malaria Prevention and Treatment
efforts since the 1950s, including through the President’s
The four strategies commonly thought to be most effective
Malaria Initiative (PMI) since 2005.
to combat malaria are listed below.
Global Trends
1. Treatment with antimalarial drugs may include
According to the World Health Organization (WHO),
chloroquine, primaquine, and artesmisinin-based
roughly half of the world population (3.2 billion people) is
combination therapy (ACT). ACT is preferred for treating
at risk of contracting malaria, a life-threatening disease
particularly deadly forms of malaria, or in areas with
caused by parasites transmitted through bites of infected
resistance to earlier generations of antimalarial drugs.
mosquitoes. Malaria is preventable and curable, though in
some regions malaria parasites are developing resistance to
2. Intermittent Preventive Treatment in Pregnancy
drug treatments and pesticides. From 2000 to 2016, WHO
(IPTp) involves routinely administering antimalarial
recorded significant progress in combatting malaria in
treatments to pregnant women to prevent transmission of
endemic areas. However, data from the 2018 WHO World
the disease to their infants. Coverage and treatment
Malaria Report showed that progress in reducing global
adherence are a problem; currently, 22% of pregnant
malaria cases has stalled in recent years.
women in 33 Sub-Saharan countries receive all three
necessary antimalarial doses.
Malaria: Disease Burden and Global Trends
3. Insecticide-treated bed nets, if used in high volume in a
In 2017:
community, can reduce malaria transmission. Mass bed net
Malaria cases numbered 219 mil ion, up from 217 mil ion
distribution is the most commonly used preventive
in 2016.
intervention globally, with 220 million nets distributed in
435,000 people died from malaria, of which 61% were
2017, up from 144 million in 2010.
children younger than five years old.
4. Indoor residual spraying covers household walls with
Africa had 92% of global malaria cases (201 mil ion cases).
an insecticide to kill mosquitos that come into contact with
Southeast Asia accounted for 5% of global cases (about
them. Maximum efficacy is achieved when at least 80% of
11 mil ion cases), 80% of which occurred in India (8.8
walls within a dwelling are sprayed. The WHO estimates
mil ion cases).
that resistance to the four commonly used insecticides is
Increased transmission rates in Brazil, Nicaragua, and
widespread in all malaria endemic countries, and it
Venezuela heightened the number of new malaria cases in
identifies insecticide resistance management strategies as a
South and Central America.
necessary component of country-level malaria control
programs.
80% of children with malaria also tested positive for
anemia, which is a risk factor for malaria.
Recent Developments
From 2010 to 2017:
The WHO estimates that global malaria control efforts have
The absolute number of malaria deaths worldwide
helped reduce malaria deaths by more than 60%, saving
decreased by 172,000.
almost 7 million lives and preventing more than 1 billion
The incidence rate of malaria cases in the WHO
malaria cases between 2000 and 2015. Factors likely to
Southeast Asia region decreased by 59%.
affect future malaria developments are discussed below.
Source: WHO World Malaria Report, 2018, https://www.who.int/
Research & Development (R&D)
malaria/publications/world-malaria-report-2018/en/.
Scientists are researching the development of an effective
malaria vaccine. The most promising vaccine is being
Malaria is concentrated in the poorest regions of the world,
developed through a partnership between GlaxoSmithKline
where individuals in malaria-prone rural areas often live in
(GSK) and the Malaria Vaccine Initiative (MVI); late stage
informal dwellings that have few barriers against
clinical trials are underway in Ghana, Kenya, and Malawi.
mosquitoes. Some experts contend that, because malaria
The trials are being implemented in 2019 by the WHO, in
has severe effects on a person’s body—such as fatigue,
partnership with relevant ministries of health, and GSK.
diarrhea, vomiting, and nausea—serious socioeconomic
During the trial, the vaccine halved the number of malaria
impacts can follow, contributing to slowed economic
cases among children. The vaccine has halved the number
growth and development, thereby perpetuating poverty
of malaria cases among children. Widespread use of the
cycles.
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vaccine is limited, however, by its short-term effectiveness
President’s Malaria Initiative (PMI). In 2005, the George
and the need to administer several injections.
W. Bush Administration launched PMI, committing to
halve malaria-related mortality in 15 high-burden countries
International Coordination
within five years. The Tom Lantos and Henry J. Hyde
Multilateral and U.N.-aided efforts to counter malaria are
United States Global Leadership Against HIV/AIDS,
guided by the WHO Global Technical Strategy for Malaria
Tuberculosis, and Malaria Reauthorization Act of 2008
2016-2030. In 2018, the WHO launched a substrategy that
(P.L. 110-293) reauthorized a budget expansion of up to $5
seeks to intensify response efforts in the highest burden
billion over five years to fund PMI, and expanded U.S.
countries. Roughly 44% of donor funding for malaria is
programs to counter malaria. The Lantos-Hyde Act also
provided by the multilateral Global Fund to Fight AIDS,
called for a comprehensive U.S. Global Malaria Strategy
Tuberculosis and Malaria, to which the United States is the
and mandated the establishment of a U.S. Global Malaria
lead donor. Other actors working to counter malaria include
Coordinator to lead PMI. PMI has released two malaria
the World Bank and the public-private Roll Back Malaria
strategies since then (the first for 2009-2014, and the
Partnership.
second for 2015-2020) and has expanded its activities to
include 24 countries in Sub-Saharan Africa and the Greater
Funding Levels
Mekong Subregion in Asia. For example, in 2017, PMI-
The WHO estimates that, in order to meet the 2030 targets
funded spraying protected over 21 million people. The
of the Global Technical Strategy, $6.6 billion of annual
latest strategy accounted for progress made under the
global funding is needed over the next decade (more than
previous strategies and aligned PMI goals with the vision of
double the 2017 amount of global funding). In 2017, 28%
ending preventable child and maternal deaths, as well as
of funding for antimalaria activities came from malaria-
extreme poverty. It set several targets for the 24 PMI-
endemic countries. The WHO states that domestic financing
supported countries, including
is necessary to the global response but does not specify an
33% reduction in malaria mortality from 2015 levels,
amount that malaria-endemic countries should contribute to
antimalaria efforts.
at least 80% reduction in malaria cases compared to
2000 baseline levels, and
U.S. Government Response
The U.S. government is the largest single donor to
40% reduction in malaria morbidity from 2015 levels.
antimalaria activities worldwide. Through bilateral
programs and contributions to the Global Fund and other
The U.S. Global Malaria Coordinator leads PMI from the
stakeholders, the United States provided 39% ($1.4 billion)
U.S. Agency for International Development (USAID). An
of the $3.1 billion spent on malaria control in 2017.
Interagency Advisory Group, which includes
representatives from USAID, CDC, the State Department,
Congress funds global malaria efforts primarily through the
the National Security Council (NSC), and the Office of
Global Health Programs Account in annual State and
Management and Budget (OMB), provides technical
Foreign Operations Appropriations. Malaria research efforts
guidance to the PMI Coordinator.
by other U.S. agencies and departments, including the
Centers for Disease Control and Prevention (CDC),
Through PMI, the United States supports the
Department of Defense (DOD), and National Institutes of
aforementioned malaria prevention and control efforts and
Health (NIH), also complement PMI efforts. PMI funding
provides technical assistance in case management and
displayed in Table 1 does not include these other funds.
surveillance. Improved monitoring and surveillance have
reportedly been used to successfully advocate for increased
Table 1. President’s Malaria Initiative (PMI)
national malaria budgets in some endemic countries. The
Appropriations, FY2009-FY2019
data have also reportedly increased the effectiveness of
(current U.S. $ millions)
malaria programs by facilitating strategic application of
malaria interventions.
Appropriated
Fiscal Year
Amount
Considerations for Congress
FY2009
$300
In the 116th Congress, congressional attention may focus on
FY2010
$500
funding issues related to the U.S. role in global antimalaria
FY2011
$578
efforts. For example, in addition to setting funding levels,
FY2012
$604
Congress may consider how funding to improve access to
FY2013
$608
and uptake of lifesaving malaria interventions and tools
FY2014
$619
could also address health systems strengthening efforts to
FY2015
$619
improve early diagnosis and treatment in PMI target
countries. Expanded R&D efforts to combat multidrug
FY2016
$621
resistance could be another related global health priority.
FY2017
$723
FY2018
$755
Sara M. Tharakan, Analyst in Global Health and
FY2019
$755
International Development
Source: CRS table created from pmi.gov data, and the Consolidated
Appropriations Act 2019, P.L. 116-6. Figures in current U.S. dol ars.
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Global Trends: Malaria
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