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Richard Allan, CEO, The MENTOR Initiative

The world has fooled itself into believing that the fight against malaria can be won using the same old approach. The truth is we have to shake things up in order to save lives.

What must be done?

In some places, malaria-related deaths have increased by 100%. These three critical things now have to change:

1) Investment in malaria control must increase…

2) humanitarian organisations must partner with companies that have developed effective tools, with effective active ingredients that kill mosquitoes, and which are designed to suit to settings in the most malaria-prone countries…

3) and delivery of those tools has to be efficient, which means, for example, working with emergency agencies that are used to working in conflict zones.

Perhaps Dr Tedros Adhanom Ghebreyesus, Director General of the World Health Organization, summed it up best in the World Malaria Report 2017: “If we continue with a ‘business as usual’ approach — employing the same level of resources and the same interventions — we will face near-certain increases in malaria cases and deaths,” he wrote.

“It is our hope that countries and the global health community choose another approach, resulting in a boost in funding for malaria programmes, expanded access to effective interventions and greater investment in the research and development of new tools.”

Change is too slow

Allan wholeheartedly agrees with that assessment. Unfortunately, he says, altering the course of the institutions and bodies responsible for malaria prevention is like turning a supertanker.

“There is an entire administrative procurement system and policy setting system that takes years to change,” he says. “It has tuned itself to favour bulk procurement of the cheapest nets and is squeezing the good quality manufacturers out of the market.” A constant desire to get more for less can have lethal downsides he warns. Take net durability, for instance. If a net becomes damaged, its effectiveness against mosquitoes is reduced — or even eliminated. The cheaper the net, the less durable the netting material.

Allan is confident that things can change, because the active ingredients and tools to make a difference to malaria prevention already exist. Unfortunately, getting these through the required regulatory processes is another painstaking story.

“It took the World Health Organization almost 10 years to make insecticide-treated nets global policy after the evidence was published that they would dramatically reduce mortality,” he says. “So I am confident these changes will happen. I’m also confident, sadly, that they will happen too late for many.”