By Michael Adekunle Charles
Today it’s me, it’s someone else.
It’s me and you, we’ve got to stand up and fight.
Ugandan musician Philly Bongoley Lutaya sang in 1998, his soulful voice defying the tribulations that came his way as one of the first public figures in the East African country to publicly disclose he was HIV positive. This was at a time when HIV was spoken about in hushed tones and stigma thrived in the face of fear and lack of information.
Take the message, and cross the frontiers.
Break the barriers, we’ll fight together.
The song, Alone and frightened, goes on as it enumerates the power of accurate information in the fight against HIV which is, under the Strategic Development Goals, enlisted among the epidemics that we must end – alongside malaria and TB.
Philly Bongole’s words could as easily be applied to the fight against malaria.
Today it’s me, tomorrow someone else
The lines remind me of my time as a medical practitioner in Nigeria. During the malaria season, one patient always meant more would flock in. The World Malaria Report released this week shows there were 263 million cases of malaria cases in 2023, and 11 million rise from 249 million people in 2022. The report further shows that deaths have stagnated at about 600,000, with nearly all deaths from malaria occurring in Africa.
Malaria is linked to the climate, with infections peaking during the rainy season, typically from August to mid-October in Nigeria. This is usually when mosquitoes breed. Like dangerous killer jets, they move from home to home, oblivious to the fences separating households, the lines dividing regions, and, certainly, the borders separating countries.
Community and national malaria control interventions have their own set of challenges. And when countries that have active malaria transmission and share a border do not collaborate, the result is a vicious cycle of malaria in all the countries involved. One of the reasons many countries, especially in Africa where 94 percent of cases and 95 percent of deaths occur, are unable to eliminate malaria is the presence of cross-border transmission. In Africa, borders are often fictitious entities, with the same communities and ethnicities living with and across each side.
Cross-border malaria flourishes because borders create ideal conditions for mosquitoes to locate new hosts for the malaria parasite. These areas often experience significant movement of people, especially in the face of unrest or conflict. This leaves people vulnerable as they may lack access to healthcare while seeking safety. Consequently, displaced people might encounter malaria for the first time or be exposed to different strains of the disease, heightening their risk of illness and death. The risk is even higher for pregnant women and children under five. The communities most severely impacted by malaria are also those suffering the most from conflict.
Despite the high number of people at borders, many times, there is no clear responsibility for the area, and border areas sometimes suffer neglect and underdevelopment, further exacerbating the risks of malaria. At border points, other development problems such as food insecurity and lack of proper shelter combine to undermine the malaria response. Cross-border malaria therefore continues to stand in the way of malaria elimination even for countries that have made remarkable progress.
We know that in the run to Global Fund replenishment, resources for malaria are already strained and if cut further, could lead to an estimated 137.2 million additional malaria cases and up to 337,000 additional malaria deaths between 2027 and 2029. We have only invested $3.5 billion – less than half of the $7.3 billion that we need to eliminate malaria by 2030.
Essential lifesaving services for malaria are not being maintained at current funding levels, with a gap of over 200 million Insecticide Treated Nets to sustain coverage at 2023 levels, and even bigger gaps to get back on track and address biological resistance. Countries in Africa are facing a $1.5 billion budget shortfall by 2026 to sustain the current, yet inadequate, coverage of essential malaria interventions. National malaria control programmes are struggling and there is little left for cross-border interventions.
Today it’s me, tomorrow someone else
Despite challenges, there are regions that have taken the mantra to heart – with remarkable progress. Take for example the Sahel Malaria Elimination (SaME) Initiative that was formed under the Dakar Declaration in 2018.
Operating under the principle that more can be achieved by operating together in the fight against malaria, SaME brings together eight countries – Burkina Faso, Cabo Verde, Chad, Mali, Mauritania, Niger, Senegal, and The Gambia – to accelerate malaria elimination by sharing data, improving technology, scaling up the best practices and jointly mobilizing resources.
While three countries, Burkina Faso, Mali, and Niger were among the 11 High Burden High Impact countries that were responsible for 70 percent of all malaria deaths globally in 2022, The Gambia and Senegal have reduced the prevalence of malaria over the years through close collaboration, surveillance, data sharing and joint use of resources. Cabo Verde was declared malaria-free in January and continues to provide lessons to neighbours through the SaME exchange platform.
The challenges posed by malaria are becoming increasingly complex. Issues such as antimalarial drug resistance, insecticide resistance, and the impacts of climate change – conditions under which malaria flourishes – require us to break down barriers and collaborate to eradicate this disease. It is essential to allocate more resources towards cross-border initiatives, as we have witnessed their effectiveness. Just as mosquitoes do not recognize borders, neither should our efforts to combat malaria.
Michael Adekunle Charles is the CEO at RBM Partnership to End Malaria and a Global Health Advocate.
