Submission to the Foreign Affairs Committee Inquiry into Global Health Security (GHS0028)
Malaria No More UK
Introduction
Malaria No More UK welcomes the Foreign Affairs Committee’s Inquiry into Global Health Security.
As the second (to the US) largest international donor to the fight against malaria, the UK has been at the forefront of efforts that have helped to save 7.6 million lives and prevented 1.5 billion cases since 2000.
Despite remarkable progress, the global gains in combatting malaria have levelled off in recent years, and many high burden countries have been losing ground. In 2019, there were 229 million cases of malaria and 409,000 deaths.[1] Malaria continues to take a heavy toll on pregnant women and children, particularly in Africa. In 2020, the COVID-19 pandemic has emerged as a serious additional challenge to malaria responses worldwide.
In 2016, the UK Government made a five-year commitment to spend £500m per annum tackling malaria. Now, it has the opportunity to renew this commitment, in line with the Conservative Manifesto pledge in 2019: “Building on this Government’s existing efforts, we will end the preventable deaths of mothers, new-born babies and children by 2030, and lead the way in eradicating Ebola and malaria.”[2]
As the world continues to battle a global pandemic, the UK Government’s investment and leadership in global health, including health systems strengthening and global disease prevention, have never been more important. They are continuing to save hundreds of thousands of lives every year and helping to build the infrastructure that will protect us all from future pandemics. The decision to cut our overseas aid spending at this time of global crisis is of concern in terms of our ability to maintain these crucial programmes at their current scale – both in terms of the UK’s obligations to the most vulnerable in the world, and to protect citizens at home from future health threats.
However, it was encouraging to hear the Foreign Secretary speak in the House to the UK’s continued leadership on diseases such as HIV, TB, and malaria, as part of priority measures to promote wider international health security.[3]
In this submission, we set out evidence as to why investments in tackling global diseases like malaria should be considered a central pillar of efforts to build global health security and pandemic preparedness, and must be maintained for the years to come.
Malaria imposes a significant burden on health systems in endemic countries. For example, in Nigeria, the country with the largest burden of malaria in the world, malaria accounts for up to 60% of outpatient visits to hospitals.[4] Tackling malaria considerably de-burdens national health systems and communities to free up resources and the capacity to fight COVID-19 and other health challenges that may emerge. Investments in malaria over the last 2 decades kept almost 100 million malaria cases out of health clinics and hospitals in 2018.[5]
Maintaining these investments during the COVID-19 pandemic is essential for protecting the gains we have made against malaria, and preventing any resurgence of cases of the disease, which would put further strain on the most vulnerable health systems when they can least afford it. As fever is a key symptom of both malaria and COVID-19, preventing malaria also allows for more focused and effective diagnosis and response to COVID-19.
Investments in malaria have also created vital capacity and infrastructure, which many countries have been able to use and adapt to facilitate their response to COVID-19. For example:
Therefore, investing in malaria prevention during the COVD-19 crisis has mutual benefits, both in terms of reducing the strain on health systems and the confusion of managing fever cases, which could be COVID-19 or malaria. We encourage the government to remain committed to a quality COVID-19 response, whilst also maintaining investments in tackling malaria, to save lives and prevent additional strain on health systems during this global health crisis.
The malaria community has decades of experience and knowledge about how to prevent and treat fever diseases. In many countries, malaria programmes provide a platform for tackling emerging disease threats, as well as delivering key malaria interventions.
Over the last 2 decades, investments in tackling malaria have helped to:
Malaria prevention and treatment is deeply intertwined with the broader health system. A patient with acute febrile symptoms requires an integrated system of care that includes malaria diagnosis and treatment alongside other health services. The distribution of malaria tools and drugs requires resilient infrastructure to ensure they are available in the right place at the right time. Data and local intelligence are critical for adapting to constantly evolving local disease patterns, and for optimizing the choice and delivery of interventions. Health care workers are vital to malaria surveillance, particularly as countries approach elimination and timely diagnosis of cases becomes more and more critical.
Vital pillars of the malaria fight – including effective case management, data-informed decision-making, incentivised workforce and engaged communities – are also critical to broader global health security. Strengthening the synergies between malaria programming and health systems thus offers an opportunity to increase value for money through integrated service provision, and develop strategies that will not only help deal with ongoing threats like malaria, but also contribute to global health security and preparedness. It is also particularly important for the long-term sustainability of malaria prevention and control and an ultimate transition away from external donor support.
Investments and programmes that strengthen community health care can be a valuable entry point. Integrated community case management and the overall role of community health workers illustrate a clear intersection between malaria, the broader health system, and strengthened response to emerging infectious diseases. Strengthening the use of data and surveillance for effective malaria programming provides another critical interface between malaria programming and the wider health system and would help to lay the foundations for any future global pandemic early warning system.
In particular, the UK’s bilateral malaria programming can play a key role in unlocking key bottlenecks to broader progress and leveraging catalytic impact by showcasing innovation and good practice. By maintaining a considerable programme of bilateral financing, the UK government can work in partnership with others to establish a legacy of technical and strategic support and institutional capacity building, as well as fostering strong government-to-government relationships with endemic countries and providing clear visibility of the contributions the UK is making to efforts to combat malaria.
Finally, experts from the Lancet Commission on Malaria Eradication and WHO SAGME agree that malaria eradication will not be achieved without the development of new tools to prevent and treat the disease.[10] The UK has a long track record of world leading R&D on global health that stretches from Sir Ronald Ross’s Nobel Prize in 1902 to vital support for Product Development Partnerships such as Medicines for Malaria Venture and the Innovative Vector Control Consortium. Such investments serve to leverage the expertise and leadership of institutions and organisations across the country and beyond to accelerate the fight against malaria, and in doing so, build vital R&D infrastructure and capacity which can be used to tackle other existing and future health threats.
For example, the Jenner Institute – the same team behind the Oxford Covid-19 vaccine – has also been developing the ground-breaking new R21 malaria vaccine that has shown very promising efficacy rates after phase 2 trials.[11] This breakthrough could be a game-changer in the fight to end malaria and, alongside other great British scientific innovations like GSK’s RTS,S malaria vaccine, demonstrates the global importance of British scientific expertise that is leading the way in tackling global diseases and keeping us all safe from global health threats.
By investing in malaria R&D, the government has a real opportunity to make a game-changing contribution towards meeting its manifesto commitment to lead the way in eradicating malaria, and further strengthen the UK’s reputation as a science superpower – showcasing British scientific research into new tools and treatments, including world-leading malaria vaccine development, as one of the UK’s proudest international exports.
We encourage the government to strengthen the synergies between malaria, health systems strengthening and global health security, alongside continued bilateral investment in critical malaria services and ground-breaking science and innovation, to maximise impact and build preparedness for future pandemics.
The Global Fund to Fight AIDS, TB, and Malaria responded rapidly to COVID-19. In March, the Global Fund made available US$ 500 million in grant flexibilities. In April, it announced an additional US$ 500 million of funding to support direct COVID-19 responses, risk mitigation for HIV, TB and Malaria programmes, and critical health systems strengthening activities.
The Global Fund has been one of the only global health institutions able to respond at this speed by pivoting its proven systems and structures. The Global Fund has also become a founding partner of the Access to COVID-19 Tools Accelerator (ACT-A), a global collaboration to accelerate the development, production, and equitable access to COVID-19 tests, treatments, and vaccines. It has become clear that it is the systems that have been built up over decades to support the AIDS, TB and malaria responses that are now enabling the COVID-19 response to deliver.
In July, the Global Fund published a new report, which outlines its priorities for the next 12 months. It also details an additional US$6 billion funding need, to adapt HIV, TB, and malaria programmes, protect health workforces, strengthen critical health infrastructures, and enable the effective implementation of the ACT-A. The Global Fund has already been able to raise US$ 1 billion through cost savings and grant flexibilities referenced above, and both Germany and Italy have stepped up additional funds in recent months. However, there is still an urgent need to raise the additional funds.
The UK has a longstanding and effective relationship with the Global Fund. As a founding member of the public-private partnership and a voting board member since 2002, the UK has shaped the Global Fund’s strategies and policies to be as effective as possible and ensure alignment with UK strategies. In this time, the UK’s investments have helped the Global Fund save 32 million lives.
The Global Fund is a highly effective partner, which amplifies UK resources to achieve even greater results. It plays a catalytic role in spurring greater investment through leveraging private sector financing, stimulating significantly increased domestic investments in health, and reducing commodity costs through pooled procurement. The Fund invests about US$1 billion per year in strengthening health systems, making it the largest provider of grants to build health systems among the multilateral institutions.
A study of Global Fund activities in Kenya, Uganda and Vietnam found that approximately one third of the malaria-specific work completed by the Global Fund in these countries also supports health security[12].
Investments in the Global Fund are investments in Global Health Security. We encourage the government to protect the UK’s long-term commitment to the Global Fund and to distribute funds that have already been pledged as planned. We also encourage the government to use its global leadership to galvanise further support from other donors ahead of the 7th Replenishment in 2021 and to use its position on the board of the fund to promote continued international collaboration in response to COVID-19 and the global health security agenda.
The UK Government has a real and timely opportunity to reaffirm its leadership on malaria through a renewed multi-year commitment of £500 million per annum, outlining an approach that will position the UK as an ongoing global leader on malaria eradication and global health security.
The UK should leverage its unique strengths in science, business, diplomacy, and development to simultaneously drive progress on malaria eradication and strengthen global health security. To maximise impact, UK’s long-term leadership and investment should focus on:
The UK hosted G7 Summit and Commonwealth Heads of Government Meeting in Rwanda in 2021 present key opportunities for the government to galvanise action from other countries to continue the fight against existing deadly diseases like malaria, and whilst doing so, improve their defences against any future diseases which may emerge. We encourage the government to lead by example and commit to maintain our own vital investments in this field ahead of these global leadership moments.
Founded in 2009, Malaria No More UK is one of the leading UK organisations working to eradicate malaria worldwide. We work to unite policymakers, private sector actors and public audiences in this fight.
10th December 2020
[1] WHO World Malaria Report 2020
[2] Conservative Party Manifesto 2019
[3] Statement to the House on Overseas Development Assistance, 26th Nov 2020
[4] Dawaki et al. 2016. Is Nigeria winning the battle against malaria? Prevalence, risk factors and KAP assessment among Hausa communities in Kano State. Malar J. 2016; 15: 351
[5] WHO Malaria and COVID-19 – September 2020
[6] Callahan, S. (2020) ‘Opinion: How to simultaneously tackle malaria and COVID-19’. Devex.
[7] Flavia Mpanga. June 2020. Why escape COVID-19 only to die of malaria? UNICEF Andresen. June 2020. Frontline heroes battle disease in Rwanda
[8] Malaria Consortium. June 2020. Digital health at the forefront of the community response in Mozambique amidst COVID-19 pandemic
[9] MMV. June 2020. MMV launches the COVID Box to stimulate new drug research
[10] Richard G A Feachem et al (2019), “Malaria eradication within a generation: ambitious, achievable, and necessary”, The Lancet, Vol 394
[11] The Times view on the Oxford malaria vaccine: Another Breakthrough | Comment | The Times
[12] Boyce et al. March 2019. Mapping Global Fund to Fight AIDS, Tuberculosis and Malaria Activities to Health Security; A Study of Kenya, Uganda and Vietnam.