Dr Richard Nchabi Kamwi, Africa CDC Champion and Ambassador of Elimination 8
Increased domestic funding, better surveillance and a focus on operational research are among the solutions outlined in a new study about fighting malaria in African countries.
Dr Richard Kamwi is optimistic that a malaria-free Africa is a real possibility. “I remember the situation in Namibia, my own country, in 1990,” he says. “Out of a population of 1.5 million, over 7,000 died from the disease that year. Fast forward to 2012, and how many malaria cases did we have? Two hundred. How many people died from it? Four.”
Kamwi is emphatically not suggesting that there is a simple fix or solution. Indeed, evidence shows that prevalence of this terrible disease — which kills a child every two minutes — is increasing. “But we cannot lose hope,” he says, “that should not be an option”.
Why complacency is a solutions-killer
However, complacency is not an option either, he insists. Take the example of Namibia again. After those heartening statistics from 2012, cases of the disease increased in 2016 (more than 24,500 were recorded — although deaths remained relatively low). “Clearly,” says Kamwi, “this tells us that complacency can be a real problem.”
If anyone knows about the challenges of the disease it’s Kamwi, who is an expert in the field of malaria elimination. He served for 15 years as Deputy Minister and then Minister of Health in Namibia, and is currently Africa CDC Champion (Centres of Disease Control and Prevention) and Ambassador of Elimination 8 (E8), a platform for regional collaboration towards solutions and elimination in the Southern African Development Community (SADC) region. He is also co-chair of a newly published opinion research study entitled MalaFA (Malaria Futures for Africa), which captures the thoughts of 68 African malaria experts in 14 sub-Saharan African countries “in the face of increasing challenges.” The study was commissioned by Novartis, the healthcare company that launched fixed-dose artemisinin-based combination therapies (ACTs), the current gold standard treatment
Without donor funding, we can expect a rise in malaria
The study’s respondents make various messages loud and clear. One main concern is that current malaria programme funding models are inadequate, due to an imbalance between domestic and donor funding. Domestic financing must therefore increase substantially. “As much as I appreciate what donors do, some member states can become over-dependent on them,” says Kamwi.
“Funding is declining in countries categorised as ‘middle income’; donors pull out because they think these places are ‘rich’.”
Dr Richard Kamwi
Even so, no-one should underestimate the importance of donor funding, which is declining in some areas. “We see this happening in countries that are categorised as ‘middle income’,” says Kamwi. “Donors pull out because they think these places are ‘rich’ — but this is not the case. The MalaFA study makes quite clear to donors that, without them, we can expect a resurgence of malaria in Africa.”
Also, Kamwi cautions, surveillance of drug and insecticide resistance must be increased and strengthened. “Surveillance is a cornerstone part of finding solutions. Inadequate reporting and monitoring of the current tools makes it difficult to measure the real impact of the disease burden. And while we remain extremely grateful for the old tools that have worked in so many cases, we need to invest in research and development for new tools in the fight against malaria. This is because resistance is now a major threat.”
Counterfeit medicines and lack of political drive hinder elimination
The scourge of counterfeit medicines is another major issue highlighted by the study — one that can actually cause deaths in some cases. “Counterfeit medicines also potentially increase the risk of drug resistant strains developing,” says Kamwi. “We need to work together collectively — WHO, INTERPOL, Africa CDC, E8, etc — to fight against counterfeit medicines. It’s a real problem and we don’t need it.”
Worryingly, the study’s respondents had mixed feelings about the likelihood of 2030 malaria targets being met. Yet success in countries such as Botswana, Swaziland, and South Africa show that the push-back against malaria can be effective. “I am now seeing a political will to fight the disease like never before,” says Kamwi. “So let us be optimistic about the future.”