Some 627,000 people died of malaria and another 241 million were infected in 2020, according to the annual report of the World Health Organization (WHO). Olivia Ngou (Yaoundé, Cameroon, 37 years old) knows this well, having survived her several times. Ngou is the founder and CEO of Impact Santé Afrique (ISA), a Cameroon-based, women-led NGO that focuses on advancing parasitic disease through community engagement. “I believe that building resilient community systems, mobilizing local leaders and empowering communities are key to winning and sustaining the war on malaria. By working together with the global and local community, stronger and smarter, leaving no one behind, we can win it,” she declares. For this reason, from her ISA she co-founded and established the first Global Civil Society Network for Malaria Elimination (CS4ME), which now coordinates with more than 450 members from 43 countries.
After years of steady decline, malaria cases and related deaths are on the rise. According to the Global Fund to Fight AIDS, Tuberculosis and Malaria (The Global Fund), funding has stagnated and resistance to drugs and insecticides is on the rise. This accelerates the risk of a resurgence of this disease, caused by parasites that are transmitted to humans through the bite of a female mosquito of the genus Anopheles. The parasite multiplies in the liver and enters the bloodstream; if another stilt bites that person, the insect becomes infected, and so the cycle of spread continues. Although the annual number of deaths has fallen by almost half in the last two decades, the year 2020 closed with 69,000 deaths and 14 million more reported infections compared to 2019. Approximately two-thirds of these additional deaths were related to interruptions of covid-19.
Thus, malaria remains a serious public health problem in many regions, especially in Africa. In 2020, the continent concentrated 95% of malaria cases and 96% of deaths from this disease. Of all deaths from malaria recorded in the territory, 80% correspond to children under five years of age. “Growing up, it was a ubiquitous threat, with friends, family and even myself suffering from the tiny but deadly mosquito,” said Ngou, who has survived its onslaught several times. “In addition to the physical symptoms (fever, joint and headache pain, vomiting), it prevents children from going to school and families from earning a living, reducing the chances of communities to prosper,” she explains. “As long as malaria continues to advance in Africa, the continent will not be able to reach its true potential,” she denounces.
As long as malaria continues to advance in Africa, the continent will not be able to reach its true potential
So when it comes to malaria elimination, Ngou stresses, civil society organizations and communities really do matter. “It is the people on the ground, those who suffer it every day, who have the power to change the fight. We have seen time and time again that malaria programs and initiatives are most effective when working with local communities upwards,” she argues. “How do you do that?” asks Ngou. “Joining national and local health committees, increasing communications about prevention methods, advocating for more national funding…” she replies.
To give an example, it refers to CS4ME. “Through the network, civil society organizations have joined forces to develop charters and statements for leaders and have organized campaigns and meetings with high-level officials across Africa to demand accountability,” he recounts. In addition, she gives another example: Zero Malaria Starts With Me, an awareness campaign launched in 2014 by the Senegalese organization Speak Up Africa. “Since then, it has become a force across the continent. Building on Senegal’s success, the African Union heads of state and government endorsed it,” she explains.
Civil society, but also political commitments and financing
Although ISA has learned that “top-down government investment is not enough,” Ngou maintains, “political commitments and holding leaders accountable for increased funding are critical to continuing the mission.” Because many resources are still needed, and because they must reach everyone. “We need new tools, new more effective vaccines, new treatments, and we need to reach the most vulnerable and isolated populations.”
Over the past 20 years, the Global Fund partnership has invested more than US$53 billion (€51.906 million) helping to save 44 million lives and reduce the combined death rate from HIV, tuberculosis and malaria in more than half. Now, the campaign for the Seventh Replenishment of Resources is already underway and, for the period 2023-2025, the Global Fund intends to raise at least 18,000 million US dollars (17,628 million euros). “This is the minimum number necessary to end the three epidemics, build resilient and sustainable health systems, and strengthen preparation for and response to pandemics in order to achieve a more equitable and safer world in the face of future threats”, they point out from the organization. That capital would save 20 million lives, and would reduce the mortality rate from these diseases by 64%.
For the period 2023-2025, the Global Fund aims to raise at least 18,000 million US dollars (17,628 million euros)
The Global Fund is not the only funder. Other philanthropic organizations, governments, international organizations also contribute money… However, the amount invested in 2020 did not reach the 6,700 million euros that are estimated to be necessary, a gap that has widened drastically in recent years. During the 2010-2020 period, international sources provided 69% of total funding for malaria control and elimination, led by the United States, United Kingdom, and France. The governments of countries where malaria is endemic contributed almost a third of the total funds, with investments close to 1.1 billion euros.
What about the vaccine?
In Ngou’s opinion, the malaria vaccine, recommended for large-scale use by the WHO last year, is only “a new weapon, an additional tool that adds to the preventive and repellent treatments already present in the antimalarial arsenal.” ”. At the moment, only Ghana, Kenya and Malawi are injecting it, as part of the Pilot Implementation Program, which has reached more than a million children since 2019. Cameroon, not yet.
Given the partial efficacy of the RTS,S (Mosquirix) immunization, of 40%, this inoculation is not intended as a single remedy, but rather as a complementary tool to the existing ones that will help reduce infant mortality. In this sense, Ngou lists other means of prevention, such as mosquito nets, indoor residual spraying of insecticides, larvicides, water and sanitation, or chemoprophylaxis for children under five years of age, in endemic areas, for pregnant women, and for people who are not immune that travel to affected areas.
For Ngou, the most frustrating thing is that malaria is “preventable and curable”. However, it continues to kill thousands of people, most of them children. To eradicate it, he says, “people have to believe it’s possible.”
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