Despite the many successes across Asia and the Pacific in reducing the incidence of malaria, the disease continues to be a heavy burden for many countries, with an estimated 2.2 billion people at risk in the region. Growing resistance to simple-to-use, effective malaria drugs and sub-optimal delivery of malaria treatment, in particular for mobile and migrant populations, are both widespread throughout the Greater Mekong Subregion (GMS). Lack of timely and comprehensive disease surveillance and inadequate cross-border and multi-sectoral cooperation are also serious obstacles to malaria elimination. Together, they threaten to undo all the progress to date toward elimination of this public health menace. Any serious effort to tackle malaria and other communicable diseases must thus start from this understanding: these diseases thrive in the face of weak health systems, and they do not respect national boundaries. Malaria has long been on ADB’s radar as a threat to regional prosperity and security, and our efforts to support countries striving to eliminate malaria received a significant boost when the Regional Malaria and Other Communicable Diseases Threats Trust Fund (RMTF) was set up in December 2013 to support developing member countries create multi-country, cross-border and multi-sector responses. To date, the RMTF has pooled over $28 million in resources from multiple donors, among them Australia, Canada, and the United Kingdom. Over $19.5 million in technical assistance has already been approved, including support to countries to reduce the risk of drug-resistant malaria and work toward elimination of the disease; malaria and dengue risk mapping in the GMS; and support for the Asia-Pacific Leaders Malaria Alliance. Expectations of solid results by the end of 2017—when the first round of financing expires—are high, with ambitious targets set for each of its six components: strengthened regional leadership; increased financing for malaria; better access to drugs and commodities; better use of surveillance technologies; improved capacity to detect drug resistant malaria and other disease threats; and inclusion of malaria and communicable disease prevention in large commercial and development projects. The focus of the RMTF tells us that five changes to the business-as-usual approach are needed if we are to get serious about malaria control and elimination:
- More sustainable financing.
- Cooperation to ensure supplies of affordable and effective malaria drugs and commodities.
- Improved data for evidence-based decision-making.
- Stronger national malaria programs.
- Expansion of leadership that looks beyond the health sector.
Under the RMTF, ADB is busy leveraging financing by mobilizing co-financing from other donors, and linking with ADB’s ongoing and planned loan and grant portfolio on communicable diseases control in the GMS. We are acting as both a catalyst and financing body for innovation, bringing together centers of excellence such as the the Harvard School of Public Health, Oxford University, the Mahidol Oxford Tropical Medicine Research Unit and the University of Tokyo to help GMS countries better manage their malaria and dengue surveillance and response planning through call data record and geographical information systems. The benefits of the RMTF stretch beyond malaria and will feed into broader health systems strengthening, so we are working with the World Health Organization and the Asia eHealth Information Network to improve the regional evidence base for elimination of malaria and control of other communicable disease threats through better data collection, and analysis including accurate data on the costs involved. And since accurate surveillance of malaria relies on being able to identify, track and treat people with the disease, ADB and UNICEF are supporting national efforts on civil registration and vital statistics systems, based on unique identifiers for every member of the population. Finally, we are also teaming up with Singapore’s Center of Regulatory Excellence and other partners to improve regulatory convergence of pharmaceuticals to improve availability of high-quality communicable disease and anti-malaria pharmaceuticals and commodities. For ADB, malaria elimination is an obvious public-health best buy, not just because of the reduction in human suffering that it offers, but also because it can bring substantial economic gains: annual per capita GDP growth in malaria-affected countries is 0.25–1.3% lower than in countries without the disease. Investments in malaria now will yield savings in the longer term through reduced health care costs, more robust and sustainable health systems, increased worker productivity, improved educational outcomes, and a more vibrant tourism sector. Success depends on countries, agencies and sectors working together, being as innovative as possible, and putting our developing member countries in the driving seat.