Fifteen years ago, the pediatric ward at the national hospital in Kigali, Rwanda, overflowed with children suffering from malaria. The mosquito-transmitted disease was the leading cause of death and illness in the country, and pediatrician Dr. Lisine Tuyisenge remembers anemic babies being doubled up in beds.
“Now, the number has reduced considerably. Now we can see the ward is empty,” she says. “The future of the country is good for the new generation.”
Dr. Tuyisenge is not the only health provider in Africa with such a story. Back in 2005, malaria killed almost 1.2 million people worldwide. Last year, there were 405,000 malaria-related deaths.
What changed to make this reduction possible? George W. Bush’s launch of the U.S. President’s Malaria Initiative (PMI) on June 30, 2005, marked a turning point in the fight against a disease that has plagued humans for thousands of years. U.S. leadership through his and subsequent administrations brought new energy, resources, and a coordinated commitment from malaria-affected countries and donors. There was a new wave of optimism with the goal to save lives, give children the gift of a healthy childhood, and break the cycle of disease and poverty in places where malaria hits hardest.
Led by USAID and co-implemented with the U.S. Centers for Disease Control and Prevention, PMI now works in 24 partner countries in sub-Saharan Africa and three programs in the Greater Mekong Subregion in Southeast Asia — representing about 90 percent of the global malaria burden.
Here are 15 achievements and innovations in the fight against malaria.
1. Fewer people getting sick with malaria and fewer people dying from it.
Since PMI began operations in 2006, global efforts have supported a 27 percent decline in malaria case rates and a 60 percent decline in malaria death rates in partner countries.
2. A better chance of survival for children than at any other point in history.
Twenty-two PMI partner countries in sub-Saharan Africa have seen significant reductions in all-cause mortality rates in children under age 5, thanks in part to fewer malaria infections.
3. More countries on the path to being malaria-free.
PMI’s support has helped make malaria elimination a realistic goal, with nine partner countries now on track to not just control malaria transmission within their boundaries, but to stop it.
4. Culture of bed net use.
PMI spearheaded distribution of free insecticide-treated nets through campaigns and through pregnancy care and immunization programs at health clinics, and now more and more people are protected from malaria risk by sleeping under a net.
5. Simple, rapid malaria testing.
PMI drove the shift away from presumptive treatment by purchasing inexpensive rapid diagnostic tests (RDTs) and training health workers in villages and clinics to use them, allowing for better care and more efficient use of antimalarial medicines.
6. Better malaria medicines.
Together with the Global Fund, PMI helped communities move to more effective antimalarial drugs known as artemisinin combination therapy (ACTs) as first-line treatment, and made them more available in order to save more lives with these fast-acting treatments.
7. Improved data to guide decision making.
By ensuring malaria is addressed in national household surveys and building country capacity to collect and analyze data, PMI has helped malaria managers and clinic staff better track malaria outbreaks, seasonal variations in malaria, and how many drugs and tests they need.
8. Homes sprayed with insecticide.
PMI worked to build partner country capacity to implement and scale up indoor residual spraying (IRS) where malaria is particularly severe and preemptively rotate insecticides to prevent the spread of insecticide resistance.
9. More malaria-free pregnancies.
From procuring drugs to supporting studies on timing and frequency of dosing to training health workers, PMI has prevented malaria in pregnant women, thus protecting both mothers and their babies.
PMI’s support of operational research, ongoing procurement of drugs, and assistance with distribution campaigns have made it possible to protect almost all of the 20 million eligible children in West Africa.
PMI support for community health worker training and community-based diagnosis and treatment for children has made it so families can receive life-saving malaria care closer to home in villages and rural communities across Africa and parts of Asia.
12. Communities empowered to prevent and treat malaria.
PMI investments in more evidenced-based, data-driven behavior change interventions have helped millions of families take steps to prevent or recover from malaria.
13. Insecticide and drug resistance monitoring.
PMI has built partner country capacity to test and track effectiveness of insecticides and antimalarial treatments, in order to determine when a change in strategy or tools may be needed to combat resistance.
14. A strong pipeline of new drugs, insecticides, and other malaria control tools.
USAID investments and technical assistance to partners such as Medicines for Malaria Venture, Innovative Vector Control Consortium, and Malaria Vaccine Development Program have generated new tools to address insecticide and drug resistance.
15. A supply chain that ensures that the right supplies are in the right place at the right time.
Systems are now capable of buying and distributing millions of malaria commodities such as nets, tests, and medicines, and can even pinpoint stock imbalances down to the health facility level.
Our work is far from over. But as we celebrate PMI’s 15th anniversary, we reflect on the progress made possible through partnerships with host country governments, national malaria control programs, civil society, faith groups, the private sector, other donors, and multilateral organizations. We remain optimistic that together we can end malaria within a generation.
About the Author
Dr. Ken Staley is the U.S. Global Malaria Coordinator and Executive Director of the USAID COVID-19 Task Force.