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Malaria is a common parasitic disease, caused by a parasite transmitted from human to human via a mosquito. Three billion people are at risk of malaria. It was responsible for nearly 800,000 deaths worldwide in 2010. The WHO estimates that around €4 billion is necessary in order to tackle malaria during the year 2015.
• €2.7 billion must be raised for prevention (preventive treatment for pregnant women, and insecticide-treated nets and insecticide for indoor residual spraying)

Author / translator Michael Creek

Malaria is a common parasitic disease, caused by a parasite transmitted from human to human via a mosquito. Three billion people are at risk of malaria. It was responsible for nearly 800,000 deaths worldwide in 2010. The WHO estimates that around €4 billion is necessary in order to tackle malaria during the year 2015. • €2.7 billion must be raised for prevention (preventive treatment for pregnant women, and insecticide-treated nets and insecticide for indoor residual spraying) • €0.4 billion must be raised for treatment and diagnosis (anti-malarial drugs and severe case management, and rapid diagnostic tests) • €0.6 billion must be raised for programmes (reinforcing healthcare systems, training and pay for medical staff in countries affected and educating citizens) • €0.6 billion must be raised for research (developing a vaccine and new drugs, and improving diagnostics, treatment and prevention) Policymakers and NGOs must make efforts to ensure all these targets are met. But if only €3.5 billion of the necessary €4 billion is raised, how should the spending be distributed?

Aims of the game

- Clarify what your opinions are - Work towards a shared group vision - Let your voice be heard in Europe - Enjoy discussing! Photo credits 1 & 6: Gates Foundation, Flickr. 2: Babasteve, Flickr. 3: IITA Image Library, Flickr. 4: ReSurge International, Flickr. 5: Yuen-Ping aka YP, Flickr. 7: Daltoris, Flickr. 8: zz77, Flickr. 9: C+H, Flickr. 10: Matt Floreen, Flickr.

Created 28 December 2011
Last edited 17 May 2018
Topics Health

Policy positions

Policy position 1

Spend €0.5 billion less across prevention, treatment and diagnosis, programmes and research, split proportionally according to the amounts suggested by the World Health Organisation.

Policy position 2

Spend €0.5 billion less across prevention, programmes and research, split proportionally according to the amounts suggested by the World Health Organisation, but safeguard the budget for treatment and diagnosis.

Policy position 3

Spend €0.5 billion less across treatment and diagnosis, programmes and research, split proportionally according to the amounts suggested by the World Health Organisation, but safeguard the budget for prevention.

Policy position 4

Spend €0.5 billion less across prevention, treatment and diagnosis and programmes, split proportionally according to the amounts suggested by the World Health Organisation, but safeguard the budget for research.

Policy position 5

Spend €0.5 billion less across prevention, treatment and diagnosis, programmes and research, but cut the budget by region according to the level of poverty in the region. Regions with lower levels of poverty will have their budget cut more.

Story cards

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I’m a nurse in Tanzania. I think the main reason malaria is so widespread here is that most people just don’t know very much about how to prevent malaria. I see people who think any fever must be malaria, or who think that if they show symptoms of malaria, they can stay at home and take paracetamol. Some arrive at hospital at the late stages of the disease. Or they get treatment, but don’t finish the doses. Many go to witch doctors or use traditional medicine like papaya leaves. I’d like to be able to educate people better, but I have enough to do just working with my patients.

Francis, Tanzania
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I work for the Ministry of Health in Ethiopia. Malaria is one of our top health priorities here, along with HIV, tuberculosis and maternal and child health. We have recently been able to train more than 30,000 health workers on new guidelines to diagnose and treat malaria. We have seen very encouraging results already. We also managed to distribute 20 million insecticide-treated nets in three years. We couldn’t do this without the support of global partnerships and financing. But we still have around 9 million new cases of malaria every year, in a population of 77 million Ethiopians.

Emebet, Ethiopia
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I am a research physician from Ghana, where malaria is the major cause of death in children under five. I think we need a wide array of tools to fight malaria. No single tool will win the fight, even if antimalarial drugs, insecticide-treated nets, and indoor spraying with insecticides are all effective methods. But to me the possibility of a vaccine against malaria is the greatest opportunity we have of finally eradicating this disease. It gives me hope that I could see malaria eliminated in Ghana in my lifetime, although I am sure it will still need to be used together with the other control measures, as it will not protect 100%.

Ruth, Ghana
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I’m a doctor in Labangi, a village in the east of India. Our hospital has a programme to treat all patients with fever as if they had malaria until confirmed otherwise. This strategy is not recommended by the World Health Organisation (WHO) any more. But I think it’s been very effective. The WHO is concerned about malaria parasites becoming resistant to the drugs, but for us, this treatment is much cheaper. If we followed WHO guidelines and performed a rapid diagnostic test to all patients with fever to treat only positive cases, we would spend three times the amount we currently spend on malaria treatment. We just don’t have that kind of money.

Milu, India
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I’m 26, I’m a farmer and I have six children. I’ve had malaria three times in recent years. The symptoms are mainly headaches and fever. You get a temperature. And you feel really tired, with pains all over. With severe forms of it, my children run very high temperatures. Every time I get ill, I can’t work and I don’t have enough money to feed my family. I often don’t go for treatment because there is no money – if I can’t feed my family, I can’t afford medication. But if I am ill for a long period of time, who will provide for my family then?

Ketsholikei, Botswana
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I’m a young mum to five children, and we live a long way from the nearest town. Getting to a hospital is really difficult for us. My daughter Becri is one year old, and I’m especially worried about her getting ill. I am HIV+, which means that I am also more at risk from malaria. Once a community health worker came to give advice on how to prevent malaria, and gave us nets, to sleep under and sprays for free. But now the government funding for indoor residual spraying was cut and residents in our area have not received sprays, mosquito nets or window screens. There is always a chance we can get ill, and with the hospital so far away, I’m not sure how easily I could get treatment.

Marta, Namibia
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My son is six months old now. When I got pregnant I was really worried, because a few of my friends have got malaria during their pregnancy. But my aunt gave me a mosquito net to sleep under while I was pregnant, and the hospital gave me some pills to prevent me from getting malaria. My son is healthy for now, but I’m always worried, he could get severely ill at any time. I noticed that the net we sleep under is not keeping the mosquitoes away like it used to, but I can’t afford a new one. It’s certainly going to be difficult to afford any more treatment, if he does get ill.

Doreen, The Gambia
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I’m a nurse in a hospital in a town in the east of India. We only have limited facilities, so normally pregnant women or babies with symptoms of malaria might have to share beds or sleep on the floor if they are with us longer than 48 hours. Babies born to mothers with malaria are often very underweight, so we try to keep them warm.
We used to use a drug called chloroquine to protect people from malaria. But now it has been withdrawn because the parasite that causes the disease became resistant to chloroquine. So now nets treated with insecticides are our main method of preventing malaria infection.

Mamta, India
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I work in drug development for a pharmaceutical company. We offer our malaria treatments for adults and children at the lowest cost possible. As pharmaceutical companies are private, for profit organisations it is important to incentivise them by various means to invest in research and development for malaria. Public-private partnerships have worked very well to achieve this. Governments can also help by speeding up the reviews of new drug applications, for example.
For our company, malaria treatments are part of a strategy for sustainable growth and our corporate social responsibility. Last year alone, our access to medicine programme reached 74 million patients and was valued at over €1 billion or 3% of our sales.

Tilmann, Germany
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I’m a teacher in the Mangochi district in Malawi. A few years ago, I had training to treat malaria in school using a Pupil Treatment Kit. I was trained to recognise symptoms and give the treatment safely. I could then treat students that got ill, and if their condition didn’t improve, I sent them to the hospital. The kits cost €50 for the school every year, and we had to ask parents and communities to cover most of the cost. Now the government has withdrawn the kits, saying there is a new treatment which we cannot administer. I have to admit I feel more comfortable sending the children to hospital to be treated properly, although it’s true that they miss a lot of school because of malaria.

Thocco, Malawi

INFO CARDSISSUE CARDS

Economic effects of malaria

Malaria affects mainly pregnant women and children, which has significant impacts not only on families, but on economic development. Resources are diverted from productive economic activity to nursing sick children. Malaria is an important cause of school absenteeism, because children suffer malaria or because they have to take time off school or work to look after relatives with malaria.

Malaria and social justice

Malaria usually affects the poorest, most vulnerable and least powerful people in society. Care must therefore be taken to ensure that malaria programmes really reach those in the most need.

Vaccine cost and availability

To have a real impact, a vaccine must be cheap (it can be expensive but subsidised) and available to the most needed. If a vaccine is produced, funding must be put in place to ensure countries make it available. Otherwise, it would remain a luxury for rich people.

Are nets the solution?

Nets treated with insecticide are cheap and relatively easily distributed. In an area where nets are used, even people without nets may be less likely to become infected. But nets rarely eliminate the possibility of infection altogether, as mosquitos do not only bite while people are sleeping. Over time, mosquitoes can also acquire resistance to the insecticides in the nets.

Getting the message across

It is not always easy for citizens in malaria-hit countries to find out about malaria prevention and treatment. Programmes to educate them have to be funded.

Spraying insecticides: for and against

Spraying houses may be as effective as nets in limiting malaria. But it uses more insecticide, which can be toxic to humans when breathed in or swallowed. More insecticide means more cost and a greater chance that mosquitoes develop resistance.

Difficulties of prevention using drugs

Travellers to endemic countries can take antimalarial drugs as prevention against contracting malaria. But continuous use of drugs to prevent infection is not feasible for most people who live in malaria endemic areas – mainly due to problems of cost, availability and drug resistance.

Old and new antimalarial drugs

In some regions, the parasite that transmits malaria has become resistant to older types of antimalarial drugs. Developing newer treatments can be expensive.

Treatment strategy

In a population where funding is limited, how do you decide who to treat? Those most in need? The poorest? Those with the most acute conditions? Those who have the least access to hospitals?

Malaria and poverty

Malaria is more likely to affect poor people as they have poor living conditions, poor general health and little access to malaria prevention tools. Malaria also makes people poorer – they have to pay for treatment and lose money from time off work. Wiping out poverty is part of the battle against malaria.

What is needed for elimination?

Elimination of malaria from an area requires significant investment and coordination. If eradication efforts are not carried through systematically, then there is a risk that the parasite transmitting malaria can become resistant to the insecticides, or to the drugs used to prevent infection.

Getting consent from participants for research

Researchers need participants from countries with malaria in order to test new treatments, for example. It is difficult to ensure these participants are informed and really agree to the tests, for reasons to do with language, cultural diversity, or relative lack of knowledge of medical practice and scientific research.

Why do participants sign up for research?

People in malaria-hit countries may take part in clinical trials to get the benefit of new drugs which they could not otherwise afford to pay for.

How much is spent on malaria compared to public health issues elsewhere?

€4 billion was spent on malaria in 2009, a disease which can potentially affect 3 billion of the poorest people in the world. Governments spent €59 billion tackling obesity in 2006 in the EU alone.

Where should research be focused?

Not all research money is spent directly on developing new treatments and methods of prevention. Some is also spent to better understand the biology of the parasite and how immunity is acquired, for example.

Prevention or treatment?

It is more cost-effective to spend money on preventing malaria transmission, rather than treating existing cases of malaria. But from an ethical perspective, we cannot leave people untreated, when there is a treatment available.

Individual treatment getting cheaper

Treating malaria patients can only become cheaper. As funding programmes increase, there is greater demand and so drug companies have to make their prices more competitive.

Eradication: mission impossible?

Scientists generally agree that with currently available tools, malaria can be better controlled and eliminated in some areas, but not eradicated worldwide, unless new tools are developed.

Should we rely on DDT?

DDT is an insecticide used in some African and South-East Asian countries against mosquitoes. It is banned in most of the world for its harmful effects on health and the environment. As DDT accumulates in the soil, health impacts begin to appear in fish, other marine animals, birds, and even humans and other mammals.

Patent protection

The most effective malaria treatments are relatively expensive since they rely on patented medications – treatments that have been “copyrighted” by drug companies, to prevent generic versions of a new drug being copied and circulated more cheaply. But if governments drop this patent protection, drug companies will not invest in anti-malarial drugs because the research is so expensive.

The social impact of elimination

Eliminating malaria often means draining wetlands to prevent mosquitoes breeding. But this can lead to loss of jobs or homes for those who live and work in wetlands.

Resistance to combination therapy

There is already evidence of parasites becoming resistant to the new ACT combination therapy used to treat malaria in some countries of South East Asia. This can be partly because the individual drugs in the combination therapy were commonly distributed, before the combination therapy became the recommended treatment.

How much should be spent on malaria?

Countries where malaria is endemic often have other serious public health and development problems such as poverty, hunger and HIV. How can we determine where to spend aid money?

Preferred channels for education

People in Tanzania with low access to information on malaria were surveyed to find out how they would like to be informed. 74% said radio, 41% by their doctor, 38% by friends and family and 29% by TV.

Genetic protection against malaria

One third of the population in sub-Saharan Africa possess a form of genetic protection against malaria. They are born with one copy of the gene for Sickle Cell Anaemia or Thalassaemia, which confers certain protection against severe malaria.

Acquired immunity to malaria

In areas where malaria is endemic, people develop a natural acquired immunity to malaria. If children survive the first years of life after repeated exposure to the malaria parasite, they become semi-immune, which means malaria infection will show no symptoms or only mild symptoms.

Malaria and pregnancy

During pregnancy, women are more at risk of severe diseases like malaria. Malaria infection can also cross the placenta and affect the foetus.

Development of a malaria vaccine

A new vaccine, called RTS,S and produced by GlaxoSmithKline, has shown to be partially effective against infection and clinical malaria in babies and children up to 5. A clinical trial is ongoing with thousands of children in Africa. If successful, it will become the first malaria vaccine to be licensed. However, it will only be effective in about 50% of children.

Insecticides and malaria prevention

To prevent malaria, one very successful method is to spray the walls of houses with insecticidal sprays, and to distribute nets treated with insecticides, to sleep under. Insecticide-treated nets require regular re-treatment.

Preventing malaria in pregnant women (IPTp)

A strategy called Intermittent Preventive Treatment for pregnant women (IPTp), which means taking an antimalarial drug 2 or 3 times during pregnancy, is now recommended in endemic areas. It is recommended that pregnant women sleep under insecticide-treated nets.

Intermittent preventive treatment in infants (IPTi)

The WHO recommends IPTi for infants in endemic areas. This is a full course of antimalarial drugs given to infants at the same time as routine vaccinations - usually at 3, 4 and 9 months of age. It is also recommended that infants and young children sleep under insecticide-treated nets.

Eliminating malaria

Malaria has been successfully eliminated from several parts of the world, through a combination of medical and environmental strategies, including drainage of habitats where mosquitos breed, use of antimalarial drugs and use of insecticides.

Malaria and the economy

In Africa, malaria is thought to be responsible for 12 billion US dollars every year in public and private spending, resulting in a loss of 1.3% of gross domestic product per year.

Who gets malaria?

Around 90% of the cases in Africa occur in children under 5 and pregnant women. Older children and non-pregnant adults are semi-immune and protected from severe disease.

Where is most affected by malaria?

Around 91% of all malaria cases occurred in the African region during 2010, mostly in sub-Saharan Africa. Asia, Latin America, and to a lesser extent the Middle East and parts of Europe are also affected.

The scale of insecticide use

In Africa, 75 million people (around 10% of those at risk of malaria) were protected by having their household walls sprayed with insecticide in 2009.

Treatment for malaria

Malaria can be treated and cured. Nowadays artemisinin-combination treatments (ACTs) are recommended, which combine several antimalarial drugs. ACTs are part of the national policy for treatment in 90% of countries where malaria is endemic.

RDT: A new method of diagnosis

The Rapid Diagnostic Test is a new device that detects the presence of the parasite in the blood without the need of a microscope. This technique is ideal for remote areas where there is no microscope, microscopist or electricity. About 30 million RDTs were delivered by ministries of health in 2009.

How widespread is preventive treatment in pregnancy?

33 out of the 43 countries in Africa where malaria is endemic adopted intermittent preventive treatment for pregnant women as national policy by the end of 2009.

Aiming to eradicate malaria

In 2008, the Roll Back Malaria initiative, after a call from the Bill and Melinda Gates Foundation, declared that eradication was a moral obligation for the international community and suggested that it should be the final goal. The Global Malaria Action Plan was launched, and is ongoing.

Coverage of insecticide-treated nets

Between 2008 and 2010, around 289 million insecticide-treated nets were distributed around the world, covering around 76% of people at risk. This was still below the 80% target set by the Roll Back Malaria partnership.

What do we mean by “endemic”?

An infection is said to be endemic in a population when, if nothing changes, the number of people infected will neither increase nor decrease, but remain at a steady state. Malaria is endemic in 106 countries.

Malaria and conflict

In many low-income countries, civil war and international conflicts have led to the breakdown of malaria control programmes. Incidence of malaria has increased since these conflicts. Money is needed to rebuild the national programmes.

Malaria and education

In areas where malaria is endemic, 20% to 50% of African schoolchildren suffer from malaria each year. Malaria is a leading cause of illness and absenteeism among students and teachers and impairs attendance and learning.

Malaria and children

One in five of all childhood deaths in Africa are due to malaria. It is estimated that an African child has on average between 1.6 and 5.4 episodes of malaria fever each year. Every 30 seconds a child dies from malaria in Africa.

Malaria and childbirth

Pregnant women are at high risk not only of dying from the complications of severe malaria, but also of spontaneous abortion, premature delivery or stillbirth. Malaria is also a cause of severe maternal anaemia and is responsible for about one third of preventable low birth weight babies.

Cost to households

The average African household spends 10% of its yearly income on prevention and treatment of malaria.

Cost to governments

In some countries, malaria accounts for up to 40% of public health expenditures; 30% to 50% of inpatient hospital admissions; and up to 60% of outpatient health clinic visits.

Capacity building

Countries affected by malaria often do not have strong enough healthcare programmes to cope. Part of the global fund to fight malaria is spent on improving these systems, training staff, communicating to the public and monitoring implementation of malaria programmes.

Resistance to antimalarial drugs

The parasite that infects people with malaria can become resistant to antimalarial drugs over time, depending on the drug and the location. A parasite can be resistant to a drug in one country and not in another, for example. Antimalarial drugs are not suitable for continuous use in endemic areas, as the parasite can soon become resistant and potentially interfere with acquired natural immunity.

Where has malaria been eliminated?

The Maldives, Tunisia, and most recently Morocco, Syria and the United Arab Emirates are some of the countries which have eliminated malaria from within their borders. In the past, many countries in Europe, North America and Australasia also had malaria transmission.

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