In commemoration of World Malaria Day 2021 (25 April), the ZERO Malaria 2030 Campaign (Management Office: Malaria No More Japan) held an online event on the evening of 16 April to discuss the impact of climate change on malaria and countermeasures.
As climate change becomes more pronounced, there are concerns about the increase in malaria prevalence and the expansion of the region. The movement of people between countries and regions has also become more active, and the possibility of a global epidemic has been pointed out. Japan is no stranger to malaria. Administrators, researchers, and politicians from both countries actively discussed what stance Japan and the United States, which have been leading international malaria control measures, should take in the future.
In Part 2 of the event report, it will focus on the transition of the international health framework, its achievements and challenges, and recommendations for measures to be taken in the future by experts in malaria control and Diet members who are familiar with health care policies.
International Health Framework on Malaria and Japan’s Comittement
Keizo Takemi, a member of the House of Councillors who has been involved in global health policy, reviewed the changes in international health policy regarding malaria and proposed measures to solve the problem.
Against the backdrop of the end of the Cold War and other factors, the concept of “human security” set forth in the UN report in 1994 has become widespread. Medical health policy was placed at the core of this concept, and infectious diseases, which had caused serious social problems in developing countries, came to be recognized as a prerequisite for sustainable development.
In 1998, WHO, the United Nations Children’s Fund (UNICEF) and other organizations launched the Roll Back Malaria Partnership, a global framework for malaria eradication, in which more than 500 public and private organizations are participating.
Against the backdrop of the AIDS epidemic, measures to combat infectious diseases were also positioned as a diplomatic issue. The “Okinawa Infectious Disease Initiative” was announced at the G8 Kyushu-Okinawa Summit in 2000, which Japan hosted, and this led to the establishment of the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund) in 2002, funded by major countries.
According to the Friends of Global Fund, Japan (FGFJ), the Global Fund mobilizes and invests approximately $4 billion per year for prevention, treatment, support for people affected by the diseases, and health system strengthening measures in over 100 low- and middle-income countries. It is the world’s largest funding source for malaria. From its creation to 2019, it is estimated that 38 million lives have been saved with the support of the Global Fund partnership.
Now, more than 90 research teams are working hard to develop a malaria vaccine to eradicate malaria. The GHIT Fund, an international public-private fund originating from Japan, is also providing funds for vaccine development. However, effective vaccines have yet to be brought to market due to the complexity of the malaria parasiteHowever, the world’s first malaria vaccine, RTS,S/AS01 continues to undergo pilot implementation with promising results.
Dr.Takemi said, “Japan has contributed to global health at milestones such as the holding of the summit. In addition, Japan has been successful in fostering human resources for policy making in Asian countries with high prevalence of infectious diseases and in providing funds through the Global Fund. We also need consistent support for the development of a malaria vaccine”.
Dr. Takemi added, “the boundary between disease-specific approaches and health systems development approaches is becoming lower, and there is a growing recognition that building a framework in which both approaches can coexist will lead to health maintenance. Low-income countries will be required to cooperate closely with their ministries of health and finance to fight malaria with their own resources”.
PMI and its initiatives
“I had malaria three times before I was nine. I was lucky. I survived. For too many other children and their families, this is not the case. Even today, a child dies of malaria every two minutes.”
Dr. Raj Panjabi, coordinator of the U.S. President’s Malaria Initiative (PMI), became a refugee during the civil war in his native Liberia and immigrated to the United States at the age of nine. When he returned to his home country as a doctor, he saw how relieved families were when their children recovered from malaria. “This happened because of the support of PMI and the Global Fund. When I was asked to become the coordinator for PMI, I couldn’t refuse”, he said. “I knew PMI was one of the most effective and efficient development programs in history.”
PMI was established in 2005 under the Bush administration and has been delivering medicines and supplies and strengthening health systems mainly in sub-Saharan Africa and the Mekong region of Southeast Asia, in cooperation with the Global Fund and other organizations. It has also trained millions of health workers, including nurses, midwives, pharmacists, and epidemiologists. As a result of this support, it is estimated that the death rate from malaria has been reduced by 60% in the areas where PMI works.
Dr. Panjabi introduced the example of El Salvador in Central America as a “hope” for malaria control. El Salvador has had zero reported cases of malaria since 2017, and in February 2021, the WHO recognized the country as having achieved zero malaria. Dr. Panjabi expressed his hope that PMI’s partners, Thailand and Cambodia, are also close to eliminating malaria.
He introduced examples of malaria resurgence. In India, due to the disruption of funding, the number of malaria cases jumped from less than 100,000 in the 1960s to more than 6 million in the 1970s. In Venezuela, due to the humanitarian crisis, the number of malaria cases quadrupled. A railroad under construction between China and Laos has also raised concerns about the potential for malaria to spread in the Mekong region. Problems with drug and insecticide resistance and outbreaks of other infectious diseases such as Ebola are also contributing to malaria surges.
In addition, COVID-19 and climate change are the two biggest threats to malaria elimination, according to Dr. Panjabi. “According to the WHO, between 2030 and 2050, global deaths from malnutrition, malaria, diarrhea and heat stress caused by climate change are expected to increase by 250,000 a year. It is also estimated that new costs in the health sector will be $2-4 billion per year. Mitigating and adapting to the effects of climate change is critical to maximizing the impact of malaria control”, he said.
What is Solidarity in the Age of COVID-19?
At the end of the event, a discussion titled “Climate Change and Infectious Disease Control in Japan and the U.S.: Solidarity in the Age of COVID-19” was held.
Dr. Takemi said, “the issue of insecurity (unstable state of society) has come up by the pandemic situation. I believe that the time has come to reexamine the interdisciplinary concept of human security in the current situation and to create a common framework for human society to solve the problem”. He went on to introduce the COVAX Facility as an actual example of this.
As of January 2021, 190 countries are participating in the COVAX Facility, an international framework created in response to the global outbreak of COVID-19. “If we can incorporate malaria vaccines into this new governance framework, I think it will be possible to strengthen the development of malaria vaccines and mobilize resources such as technicians”, Dr. Takemi said.
Osamu Kunii, Head of the Global Fund’s Strategy, Investment and Impact Division, emphasized the need for health services based on his experience as the Director of Health, Nutrition and Water Sanitation at the UNICEF Relief Center in Somalia. “Effective vaccines against COVID-19 have been developed, but vaccines are not a panacea. In Somalia, vaccinations for measles and other diseases were promoted, but children were still dying every year. It is necessary to provide not only vaccines but also health services. In Somalia, climate change has caused floods, droughts, and extreme temperature increases, which have also led to epidemics of malaria and cholera. These problems are being seen in many countries. We need to understand what is happening on the ground and unite and collaborate at the global level”.
Keiichi Hara, Deputy Director-General/Deputy Assistant Minister, International Cooperation Bureau, Ministry of Foreign Affairs, also mentioned the need for health systems. “Without a strong and sustainable health system that can provide basic services in the field, even if there are excellent vaccines and equipment available, they will not reach the people who need them. It is clear that building a strong basic health system in the community will be very useful in the fight against COVID-19. I think it is necessary to do the same for malaria”, he said.
Japan, having achieved zero malaria in the past, understands that the active participation by local residents is the key. “In the field of bilateral assistance, we would like to develop technical cooperation based on Japan’s experience and strengths while respecting the autonomy of the target countries” Mr. Hara also said.
Hein Mallee, Director, Future Earth Regional Centre for Asia and Deputy Director-General, Research Institute for Humanity and Nature said, “there are still shortages of medical resources and supply disruptions in COVID-19. In addition, climate change is bringing more widespread disruptions. We need to get malaria under control as quickly as possible before environmental problem becomes bigger”.