HIV/Aids, ebola, Marburg dampen gains made in fight against malaria

Saturday December 29 2012

A mother and child sleep under a mosquito net. The RTS,S vaccine reduced malaria by one-third in African children. Photo/FILE

A mother and child sleep under a mosquito net. The RTS,S vaccine reduced malaria by one-third in African children. Photo/FILE Nation Media Group

By Joint Report The EastAfrican

The region has experienced breakthroughs in the fight against malaria, but has also faced setbacks with HIV/Aids prevalence rates and ebola and Marburg outbreaks.

A breakthrough in the fight against malaria — Africa’s deadliest killer — appeared close, but as the year comes to a close, lack of funding clouds this milestone. Malaria kills up to 35,000 people, especially children under the age of five, every year.

In Uganda, HIV/Aids prevalence rates are on the rise, an alarming reality that needs to be addressed urgently. The 2011 Uganda Aids Indicator Survey released in mid 2012 shows the prevalence rate is at 7.3 per cent, up from 6.4 per cent in the 2004-05 survey.

In women, the prevalence rate is at 8.1 per cent. New infections are also on the rise at 145,000 in 2011, up from 128,000 in 2010 and 124,000 in 2009, which outstrips the annual enrolment in anti-retroviral treatment two-fold.

Vinand Nantulya, the chairman of the Uganda Aids Commission, foresees a bleak 2013 with new HIV/Aids infections reaching 165,000.

The country has also suffered ebola and Marburg outbreaks and the emergence of a mysterious “nodding disease” that affected children in the Acholi sub-region, in Northern Uganda.

Researchers are however positive that in 2013 they will have better knowledge about the immune response of the ebola/Marburg vaccine on humans.

Funding woes

The World Health Organisation (WHO) warns that in the past two years, funding has failed to reach required levels, frustrating the search for solutions to reduce malaria-related deaths.

This is despite recent positive sentiments following the trials of a vaccine conducted in seven African countries among them Kenya and Tanzania.

The trials saw one out of every three infants who were given RTS,S — the world’s first candidate malaria vaccine — develop immunity to malaria.

RTS,S reduces malaria by approximately one–third in African infants, according to the initial results of an ongoing large-scale Phase III trial, published in the New England Journal of Medicine.

“The trials we have conducted indicate that the vaccine as it is, can help to protect babies against malaria. More importantly, we observed that it provided this protection in addition to the widespread use of bed nets by the trial participants,” said Salim Abdulla, a principal investigator for the vaccine trial from the Ifakara Health Institute of Tanzania.

According to the World Malaria Report 2012 by WHO, although there was a concerted effort, in the past decade, to completely eradicate malaria in endemic countries, global funding for prevention and control levelled off between 2010 and 2012, and progress in the delivery of some life-saving commodities has slowed down.

This is despite donors and global malaria partners strengthening malaria control around the world.

A policy briefing released in mid December 2012 by the Institute of Security Studies, a pan-African think tank on human security issues, said efforts to realise a malaria-free sub-Saharan Africa would reduce malaria related deaths by 12 million, with the greatest absolute reduction occurring in Nigeria and the Democratic Republic of Congo.

It is expected that developing a malaria vaccine will cost $1 billion. In addition, WHO estimates that it will cost $5.1 billion annually from now until 2020 just to reach malaria control targets.

In 2010, $1.7 billion was committed to the cause, increasing to $2 billion in 2011. Funding for malaria, however, decreased in 2012, and is estimated to decrease by $1.5 billion every year by 2015.

An estimated $5.1 billion is needed every year between 2011 and 2020 to achieve universal access to malaria interventions in the 99 countries with on-going malaria transmission.

“While many countries have increased domestic financing for malaria control, the total available global funding remained at $2.3 billion in 2011 — less than half of what is needed. These developments are signs of a slowdown that could threaten to reverse the remarkable gains made recently in the fight against one of the world’s leading infectious killer,” said the report.

The number of long-lasting insecticidal nets delivered to endemic countries in sub-Saharan Africa dropped from a peak of 145 million in 2010 to an estimated 66 million in 2012.

“This means that many households will be unable to replace existing bed nets when required, exposing more people to the disease,” said the report.

The expansion of indoor residual spraying programmes also levelled off, with coverage levels in the WHO African Region staying at 11 per cent of the population at risk (77 million people) between 2010 and 2011.

Positive outlook

Kenya’s Director of Public Health Shahnaz Sharif sees no potential funding shortfalls in coming years.

“Our funding and the progress made in the fight against malaria is on course until 2014 because the prevalence rates for the disease have dropped significantly. Meanwhile, diarrhoea is now the number one killer in both children and adults,” said Dr Sharif.

Reported by Christabel Ligami, Edith Fortunate and Esther Nakkazi