The World Health Organization estimates that half the world’s population is exposed to a risk of malaria. In 2021, the disease—caused by a parasite transmitted by certain mosquitoes—claimed over 619,000 lives.
Although eradicating this pandemic remains the shared ambition of global health organizations, progress is currently hindered by several phenomena. These include a lack of growth in investment, the growing resistance to insecticides and antimalarial drugs, the reduced efficacy of rapid diagnostic tests (RDTs) due to the rise in mutations, the arrival of new mosquito species, and climate change. Despite a significant reduction in global malaria morbidity over the last two decades, the malaria pandemic remains very active, particularly in Africa.
We are fighting malaria on all fronts
Malaria poses significant challenges to the global community. L’Initiative helps respond to these challenges by providing technical and financial support to increase the impact of programs funded by the Global Fund. We are fighting malaria on all fronts: monitoring (supporting national laboratories to monitor therapeutic efficacy), prevention (promoting the use of repellent equipment, broadening access to diagnostic testing, access to chemoprevention), treatment (improving access to antimalarial drugs), operational research (funding innovative strategic and technical projects), and access to healthcare for vulnerable people (targeted support for pregnant women and children under the age of five).
L’Initiative plays a role in collective action to achieve the Global Technical Strategy for Malaria goals: to reduce the incidence of malaria and malaria-related deaths by at least 90% by 2030 compared with 2015.
Our comprehensive approach includes health and the environment
Climate change acts as a catalyst for epidemics, which obliges us to change our approach to combating malaria. An increase in average temperatures could lengthen the periods conducive to transmission of the disease by changing the behavior of mosquitoes and the areas they inhabit (see study published in The Lancet in 2022).
The climate crisis is one of many of the factors driving malaria, which we now take into account in our work and when allocating our investments.
Adopting the One Health approach
Applying the One Health approach to malaria means taking into account the complex interactions between human beings, animals, and mosquito vectors of disease and their parasites, as well as the ecosystem in which we all evolve. L’Initiative has integrated the One Health approach into its strategy, in line with the new EU Global Health Strategy. This approach gives us a better understanding of the factors affecting transmission of the disease by adopting an integrated, multi-disciplinary, and non-anthropocentric approach.
We are increasing our support for research
L’Initiative supports operational research programs and innovation relating to the prevention, diagnosis, and treatment of malaria. This investment is crucial, particularly to meet the growing challenges of drug-resistance among parasites and mosquitoes, to support innovative approaches to preventing the disease, and also to anticipate the consequences of climate change on the spread and evolution of the disease.
Since 2018, we have, therefore, issued a specific call for projects every year, dedicated to operational research. The 2023 call focuses on preventing malaria.
Improving the roll-out of effective treatments
After more than a decade of use, seasonal malaria chemoprevention (SMC) has contributed massively toward reducing the prevalence of the disease among infants and young children. The WHO recommends this combination of antimalarial drugs for people at high risk of serious malaria.
However, SMC is not yet used widely enough, so we support research projects that aim to accelerate its roll-out and optimize its use. One example is a project led by the Institut de Recherche en Sciences de la Santé (IRSS) in Burkina Faso, which aims to test and treat the close family (living under the same roof) of children taking preventive treatment.
The development of a malaria vaccine
In October 2022, the WHO announced its recommendation of RTS,S, the first “revolutionary” malaria vaccine for children at risk of malaria. Although groundbreaking, this vaccine has but relative efficacy (30% maximum protection) and requires four injections. Despite these constraints, the roll-out of RTS,S is promising, as seen in a recent study reporting a drastic reduction in malaria and malaria mortality when the vaccine is combined with seasonal chemoprevention.
This progress increases our determination to support the roll-out of these complementary therapeutic strategies.
Our work is resolutely focused on African countries
Africa bears the greatest burden of the malaria pandemic. Almost all (96%) of the 619,000 deaths attributed to this disease in 2021 were recorded in Africa. Eighty percent of these deaths were among children under the age of five. In addition to the human loss, the economic consequences of the pandemic are also severe. In 2013, the World Bank estimated that malaria could have a negative impact of up to 1.3 percentage points per year on growth in several African countries.
For this reason, L’Initiative focuses the majority of its work on fighting malaria on this region. In addition, since 2013, L’Initiative has loyally supported efforts to eliminate malaria in Southeast Asia, particularly because this involves preventing the spread of parasites, which are resistant to the most widely used antimalarial drugs.
Anopheles stephensi. Fear of a new vector in Africa
Originating in Asia, Anopheles stephensi is a species of mosquito that acts as a vector for malaria. It appeared in 2012 in the Horn of Africa, in Djibouti, which was at that point well on its way to eradicating malaria. From there, it spread across the continent and was recently reported in Nigeria. The spread of this mosquito is of great concern among experts since it can establish itself in urban environments, and transports two parasites responsible for serious malaria (P. falciparum and P. vivax). Its alarming resistance to the most powerful insecticides adds to the complexity of the situation.
L’Initiative supports the WHO’s regional response to fight this threat. Our support includes strengthening urban surveillance programs and improving the description of the behavior of this new species.
Protecting vulnerable populations
We pay particular attention to the most vulnerable populations and those who are at greatest risk of malaria, particularly in Africa. For example, we support several targeted programs, such as the evaluation conducted in Benin to better understand the barriers to malaria control strategies among pregnant women, the project to optimize the seasonal chemoprevention of malaria in young Burkinabe children, and the plan to reduce malaria among itinerant seasonal workers in Ethiopia.
