The State of the Global Effort Against Malaria and the Cost-Effectiveness of Prevention Measures

Among the top 20 causes of death worldwide, malaria is a deadly disease that causes many economic and social burdens for the nations plagued by it. In 2016, it is estimated to have infected 216 million people and to have killed 445,000 people worldwide. 90% of these new cases and 91% of these deaths came from Africa, with the majority of these occurring in the Sub-Saharan region.

Below, we will discuss recent developments in the fight against malaria, the cost-effectiveness of malaria-prevention measures, and what nonprofits should do to better fight the disease.

Recent Developments in the Fight Against Malaria

During the last several years, new cases and deaths from malaria have decreased. Deaths have decreased from more than a million people per year in the 2000s to 445,000 in 2016. Likewise, new cases have decreased from 237 million cases in 2010 to 215 million in 2016.

These improvements have come from the increased deployment of insecticide-treated mosquito nets (ITNs), which continue to remain effective despite recent increases in resistance to the insecticides used in ITNs. Likewise, the decrease in death rates can be attributed to the increase in artemisinin-based combination therapy (ACT), which uses a combination of drugs to combat resistance to individual drugs.

However, the fight against malaria faces several challenges. In some settings, increasing levels of histidine-rich protein 2 genes (HRP2) deletions threaten the ability to diagnose people infected with certain types of malaria by causing false-negatives to appear in tests. Fortunately, however, HRP2 gene deletions in most high-transmission countries are infrequent.

The greatest obstacle in the fight against malaria, however, is a lack of funding. In 2016, about $2.7 billion was invested in combating malaria. Although this indicates that funding for the fight against malaria has remained stable since 2010, this is far from what is required ($6.5bn/yr.) to have at least a 40% decrease in global malaria incidences in comparison to 2015 levels. In fact, among the 41 high-burden countries, funding per person at risk of malaria is below $2.

Cost Effectiveness of Prevention Measures

Since a lack of funding is the greatest factor constraining the fight against malaria and less progress has been made in preventing malaria incidences than in preventing malaria-caused deaths, we believe that it is integral for nonprofits trying to combat malaria to look at the cost effectiveness of malaria prevention methods.

One common method of malaria control is spraying the chemical DDT indoors. A 2001 study shows that households that employed this method had about 37% of the malaria rates that households that did not use any preventative measures had.

Another method of malaria control is deploying ITNs. The same 2001 study shows that households that used ITNS had about 46% of the malaria rates that households that did not use any preventative measures had.

However, despite the ITNs’ lower reduction of malaria rates, the cost of malaria-prevention per person was only $1.54 (in 2001 USD) for ITNs, while DDT’s was $1.87. Thus, ITNs are more and more cost-effective prevention method.

Bottom Line

Nonprofits aiming to combat malaria should prioritize giving ITNs to at-risk communities, because the effort to stop new cases of malaria is lagging behind the effort to stop deaths from malaria, ITNs are the most cost-effective method of prevention, and the proportion of households with sufficient nets (one net for every two people) is still insufficient (only 43% in 2016).

Furthermore, although the HRP2 gene deletions in most high-transmission countries are low, nonprofits should also aid in efforts to monitor HRP2 gene deletions, as these can make knowing the true number of cases of malaria harder.