AT the recent East Asia Summit (EAS) in Malaysia, Asia Pacific leaders took an important step towards ridding the region of a disease which threatens more than two billion people and kills nearly 50,000 people annually, with the endorsement of a detailed plan to eliminate malaria in the Asia Pacific region by 2030.

The APLMA Malaria Elimination Roadmap, which has been developed through extensive consultation with experts from across the region, aligns with global malaria strategies such as; the WHO Global Technical Strategy for Malaria 2016–2030, the RBM Action and Investment to Defeat Malaria, and the Sustainable Development Goals.

The elimination roadmap identifies six priorities, which Asia Pacific leaders are now committed to supporting, to eradicate malaria throughout the region by 2030. The six priorities are; 1) unite national efforts and regional actions, 2) map, prevent, test and treat the disease everywhere, 3) ensure high quality malaria services, tests, medicines, nets and insecticides, 4) improve targeting and efficiency to maximize impact, 5) mobilize domestic financing and leverage external support, and 6) innovate for elimination.

Malaria has proven to be an extremely robust disease and in regions where the disease was thought to have been contained there is a history of resurgence after funding and resources are scaled back. There is now a consensus between malaria experts that the battle against the deadly disease must focus on elimination rather containment. The urgency with which this is now sought has increased following the detection, in the Greater Mekong sub-region, of a new strain with resistance to the most common first-line treatment of malaria, artemisinin-based combination therapies (ACTs). Artemisinin was first discovered as a treatment for malaria by this year’s Nobel Prize winner Dr Tu Youyou during the 1960s. ACTs are currently the most widely used treatment for malaria and the spread of artemisinin-resistant malaria is a global health threat. Resistance to chloroquine, the previous first-line malaria treatment, was also first discovered in the Greater Mekong Sub-region. When chloroquine-resistant malaria spread into Africa during the 1980s, it contributed to an 80% increase in child mortality from the mosquito-borne disease. The spread of artemisinin-resistant malaria from the Mekong region to sub-Saharan Africa would be equally catastrophic, as Dr Nafsiah Mboi explains: “Asia Pacific is facing a silent malaria emergency – one that could have a disastrous impact on the region as a whole, as well as on global health security, “Having halved deaths from malaria in just 15 years, the failure of the most effective antimalarial drugs in the Greater Mekong Sub region threatens much of that hard-won progress.” The indicative cost of eliminating malaria in the Asia Pacific region has been calculated by the APLMA Secretariat at just over US$1 billion per year during the first five years. In subsequent phases the costs have been estimated at just under US$2 billion per year. Financing this will be a challenge that requires a genuine commitment from Asia Pacific leaders but the costs of inaction are far higher. Malaria elimination is both a humanitarian and an economic investment which according to APLMA will, ‘strengthen regional economic prosperity by saving more than a million lives and creating cost savings and social benefits of almost US$300 billion’. Furthermore, failure to act now could allow the spread of artemisinin-resistant malaria to undermine the global investment of US$41 billion which has been made towards reducing malaria since 2000 and destroy the enormous gains made during the past decade. The investment required to eliminate malaria in the Mekong in the short term is far outweighed by the positive long-term impact.

 

The APLMA Malaria Elimination Roadmap proposes the development of innovative financing to meet the necessary costs. Suggestions for Asia Pacific leaders to consider include; introducing and expanding hypothecated taxes (such as alcohol, tobacco taxes, tourism and airline levies), leveraging national lotteries and earmarked financing for elimination, investigating ways to increase private sector involvement in malaria elimination, consider expanding debt financing mechanisms such as malaria bonds.

In recent months there have been highly encouraging developments in the fight against malaria, with the elimination targets included in the Sustainable Development Goals, and now the elimination roadmap endorsed by leaders across the Asia Pacific region. The next step is the elimination of artemisinin-resistant malaria in the Mekong region and then full commitment to ridding the entire Asia Pacific region of this deadly disease. Malaria elimination will save countless lives and greatly improve living conditions throughout the region, and it must remain a priority until its ultimate achievement.

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Daniel is an English Literature graduate from the University of London who has spent the past 20 years living and working in Southeast Asia. Passionate about education, health care, sustainable development, equality and human rights, Daniel is a regular contributor to Asian Correspondent, Ajarn, The Educator and Bangkok Post.

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