Just weeks ago, the World Health Organisation had cautioned that an unrealistic target for global malaria eradication was fraught with the risk of failure, frustration and waste of money. It projected that by 2050, there would still be 11 million cases of malaria in Africa. But now the Lancet Commission on Malaria Eradication, comprising academics from across the world, has challenged the WHO’s notion. It has released a new report stating that the near-complete eradication of malaria by 2050 is achievable and a worthwhile target. It further adds that a commitment to this “audacious goal” would “catalyse enthusiasm and financial support”. It points towards the progress made between 2000 and 2016, when spending had increased from $1.5 billion to $4.3 billion, and annual incidence rate dropped by 36% and annual death rate by 60%. The report lays out a roadmap to achieve its stated goal, which includes an increase in spending by at least $2 billion annually, accelerating research, closer collaboration between the main agencies involved, and accountability at the country, regional and global levels.
For India, there are urgent lessons in the report. In 2017, at 9.6 million cases, it had reported the fourth highest number of malaria cases worldwide. The report says India may struggle to meet elimination goals. While malaria is largely a rural disease, India was found to be a “major exception”. For instance, in 2017, 71% of the cases in Tamil Nadu occurred in Chennai. Urban malaria requires a different strategy, and in particular, the improvement of the municipal water supply infrastructure, thereby reducing the need for rooftop storage of water. The report is particularly scathing about India’s unregulated private healthcare sector, which leads to poor diagnosis, treatment, and reporting of malaria cases. Also, out-of-pocket spending contributes to some 60% of healthcare finance in India, further discouraging patients from seeking treatment. The Commission emphasises that a commitment by the leadership is crucial to the success of malaria eradication. A failure could lead to resurgence of cases in nearby countries such as Sri Lanka and Malaysia that that have been successful in eliminating malaria.