Director-General commemorates World Malaria Day
Dr Margaret Chan
Director-General of the World Health Organization
Excellencies, distinguished guests, colleagues in public health, ladies and gentlemen,
World Malaria Day is an occasion to think about the burden of this disease, assess the current situation, and look to the future. Let me do so briefly.
Two decades ago, the only positive thing people could say about malaria was this: The situation is stable. It could hardly get any worse. My how things have changed.
The past decade has seen unprecedented progress in malaria control. Cases and deaths have declined dramatically worldwide, but most especially so here in sub-Saharan Africa, the heartland of malaria.
This progress comes following a massive increase in the use of mosquito nets, the expansion of programmes to spray the insides of buildings with insecticides, and improvements in the rapid detection and treatment of cases.
Since 2000, the number of malaria cases has been reduced by half in more than 43 countries. Namibia is one of those countries.
And Namibia is a star among those countries. Since 2000, deaths from malaria in Namibia have decreased by well over 80%. I am proud to be here today.
Worldwide, progress is fragile and not yet good enough. Ninety-nine countries still have ongoing malaria transmission. The disease remains a major killer, claiming more than 650,000 lives in 2010, mostly of young African children.
The two surveillance manuals WHO is launching today boost our ability to sustain recent gains and make further inroads. They support the achievement of international malaria targets and improve our ability to measure progress towards the health-related Millennium Development Goals.
The manuals will help countries and their development partners see how far they have come in efforts to shrink the malaria map and, in some cases, free entire countries and geographical areas from the burden of this disease. They can help turn the page on a very old, tenacious, and complex killer.
This is how far we have come, against an ancient foe, in a very short time.
As the malaria burden goes down, new challenges arise, including the need to step up surveillance for cases. To fight malaria to the finish, you need to know exactly where transmission is still occurring, especially as the disease gets pushed back to localized foci, as is happening here in Namibia.
Fortunately, new opportunities for better surveillance have recently opened up. Rapid and reliable diagnostic tests are now available. They are so quick and simple that they can be used right down to the community level. This is especially important for a disease like malaria that tends to flourish in remote rural areas.
The availability of these tests prompted WHO, two years ago, to issue strong recommendations that every suspected case of malaria be diagnosed before treatment is given.
This policy marks a radical departure from the past. In the “old days” in highly endemic countries, cases were so common that every child with fever was presumed to have malaria and, if lucky, was treated as such.
This practice carries a number of risks. It overestimates the number of cases and masks the true dimensions of the malaria problem. It causes health care staff to miss other deadly diseases, like childhood pneumonia, that can be effectively treated if detected quick enough.
It increases pressure on the parasite to develop resistance to precious and fragile medicines, in fact, our last line of effective medicines for treating malaria. It wastes money, and it wastes lives.
When a country moves towards the elimination goal, the game changes in significant ways. Malaria can kill within 24 hours. As deaths from malaria drop within a community, the level of alert and alarm goes down as well.
Mothers no longer rush their children to a clinic at the first signs of illness. In such settings, passive surveillance, that is, counting patients who present at health facilities, is no longer good enough.
Countries seeking to eliminate the disease altogether must ensure that every individual case of malaria is investigated, and that nearby cases are identified through active searches. Epidemiologists must be ready to move in like fire fighters to put out any sparks that could ignite a flare-up of transmission.
The surveillance manuals represent the third pillar in a new initiative that WHO is also launching today. This initiative, known as “T3: Test. Treat. Track.”, calls on malaria-endemic countries to ensure universal access to diagnostic testing and antimalarial treatment, and to build robust malaria surveillance systems. I urge the international health community and donors to support countries in this effort.
Let me close by saying how pleased I am to be launching this new initiative in Namibia. This country is a regional leader in malaria control and elimination.
Namibia’s Minister of Health and Social Services is an expert on malaria and on ways to control the mosquitoes that spread this disease. He is passionate in his desire to defeat a disease that kills so many of Africa’s children and stunts the continent’s prospects for development.
Under his guidance, Namibia is spearheading an initiative of 8 SADC countries, known as the Elimination 8, that are pulling together to eliminate malaria. The initiative has very smart plans, including intensified and targeted surveillance, and very good prospects of success.
Once again, I am proud to be here in Namibia.
This is a perfect place to celebrate World Malaria Day and consolidate our optimism about the prospects of freeing this world from an old and tenacious killer.