‘We feel like we are the big winners,’ says Godofredo Menez Cruz, head of spraying unit at El Salvador’s Ministry of Health. In February 2021, the World Health Organization (WHO) has announced that El Salvador has become the first Central American nation to be declared malaria free. How did a tiny country with high rates of poverty manage to beat one of the world’s most lethal infectious diseases and how does Germany contribute to such efforts?

The answer lies in a long chain of cooperation, starting from village activists right through to international partners, including Germany, who help fund efforts to end the suffering caused by malaria.

COVID-19 slows down the struggle to end malaria

Global malaria death rates have dropped by 60% since 2000 – a decrease which has saved millions of lives. But although the incidence rate of malaria declined globally between 2010 and 2018, after 2014 this slowed down, according to the World Health Organization. Now with global attention and resources dominated by COVID-19, the struggle to end malaria has been adversely affected.

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According to a recent Global Fund report, surveillance activities monitoring the spread of cases, malaria diagnosis and malaria treatment have all fallen in 2020 compared to 2019. In surveyed facilities in seven countries across Asia, for example, malaria diagnoses fell by 56%, and malaria treatment services plummeted by 59%. ‘Of grave and immediate concern is the impact on malaria diagnosis and treatment, which has significant consequences especially for children, as the vast majority of malaria deaths occur in children under 5,’ the report states. 

What can be learned from El Salvador?

With the exception of one outbreak in 1996, El Salvador has steadily reduced its malaria caseload over the last three decades. ‘One of key measures that led to ending malaria was attacking the malaria-transmitting mosquito through herbicides, fumigation and also by testing and tracing migrant workers on our borders,’ says Esmeralda Sorto Villatoro, member of the network of malaria volunteers in El Salvador. ‘Another important aspect was the epidemiological surveillance through the blood testing conducted throughout the country. The lesson that can be learned from El Salvador’s successful experience is to always be vigilant, use epidemiological methods, and  involve civil society because working together we can achieve more.’

‘The work was done jointly with people at the local level,’ says Norma Ortiz, president of a local community development organization and herself a malaria health volunteer. ‘As volunteers, we fumigated larvae, fumigated homes, collected garbage. It was work well done and we achieved our goal thanks to support of the Global Fund,’ she adds. 

How does Germany contribute?

German support in the fight against malaria aims at broadly strengthening health systems through which access to medicines and materials to fight and prevent the disease can be ensured in the long-term. One of its most important partners in this endeavour is the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM). Germany takes a proactive role in the Fund’s Governance.

GFATM is the world’s biggest financier of AIDS, TB, and malaria prevention, treatment, and care programmes – activities closely linked to the sustainable development goal SDG 3 (‘Ensure healthy lives and promote well-being for all at all ages’), and in particular the sub goal 3.3, ‘By 2030, end the epidemics of AIDS, tuberculosis, malaria and neglected tropical diseases and combat hepatitis, water-borne diseases and other communicable diseases‘. It funds education about malaria symptoms, as well as means of malaria prevention and treament. It supplies rapid diagnostic tests to community health workers and helps to curb the spread of the disease through the distribution of mosquito nets, insecticide spraying and preventative treatment for children and pregnant women.

Today, Germany is the fourth largest government contributor to the GFATM. It is part of the Global Fund Board, and also a member of the Strategy Committee. In these positions and together with other partners it is playing a pivotal role in shaping Global Fund priorities, notably on building resilient and sustainable systems for health, on improving the governance of national coordination mechanisms and on ensuring the correct use of funds through risk management. From 2002 to April 2021, Germany has disbursed around €3.5 billion to the GFATM. For 2020-2022, Germany has increased its pledge by 55.4% to a total of €1.29 billion (including €290 million for the COVID-19 response). Of the current $ 12.71 billion in country allocations for 2020-2022, approximately 32% is spent on malaria. 

Developing an anti-malaria vaccine and new anti-malarial drugs

A malaria vaccine has been a major challenge for decades. Since 2006, Germany has been supporting the Gavi the Vaccine Alliance, a funding mechanism that helps give children in low-income countries access to vaccines and comprehensive immunisation. Germany is the fourth largest government donor to Gavi with a commitment of EUR 600 million in 2016-2020. In 2019, Gavi and other partners helped to finance the trials of the first malaria vaccine in Kenya, Malawi, and Ghana.

Germany also supports the work of researching an anti-malaria vaccine by the PATH initiative, an international nonprofit organisation that drives transformative innovation to save lives and improve health, especially among women and children. Through the KfW, Germany’s Federal Ministry of Education and Research is funding the Medicines for Malaria Venture – a not-for-profit partnership with a mission to reduce the burden of malaria in disease-endemic countries by discovering, developing and facilitating the delivery of new, effective and affordable antimalarial drugs.

Efforts to eradicate Malaria must continue full steam

Back in El Salvador, the end of malaria spells bright hopesfor the country’s economic, political and social development, says Roberto Lemus Herrera, an entomologist. ‘Imagine all those areas which in the past were super endemic to malaria, with lakes, lagoons, beautiful beaches – these can now bring more tourism to the country. Hotel zones are now going to grow. This also means economic opportunities, more employment and more investment.’

The coronavirus crisis has put population health prominently on every country’s political agenda. And this is where this topic ought to be, not just for the duration of the current pandemic. On Malaria Day, it is important to recognise and appreciate global efforts to eradicate malaria which need to continue at full steam. 

‘I want to encourage everyone to continue working, to maintain malaria elmination and to keep this contagion away from the population,’ says El Salvador’s Godofredo Mendez Cruz – a message relevant to everyone around the world striving to end this disease once and for all.

Inna Lazareva, April 2021