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A worker looks for holes in mosquito netting at A to Z Textile Mills in Arusha, Tanzania.

Checking for holes in mosquito netting at a textiles factory in Arusha, Tanzania.Credit: Jim Young/Reuters/Alamy

More than US$4 billion of new funding has been pledged by African countries, international donors and pharmaceutical companies at an international summit held in Rwanda to end malaria and neglected tropical diseases.

The commitments were announced at the Kigali Summit on Malaria and Neglected Tropical Diseases held on 23 June in Kigali, Rwanda. Neglected tropical diseases (NTDs) are a group of 20 diseases including dengue, leprosy, yaws and trypanosomiasis, which affect mostly the poorest people, including women and children. According to the World Health Organization (WHO), at least 1.7 billion people worldwide are infected with at least one NTD each year. Until now, these diseases have received relatively little attention from funders.

Before the summit, total funding for malaria control and elimination stood at $3.3 billion. This is just under half of the $6.8 billion that the WHO said it needed to reach a target of reducing malaria cases by 90% by 2032.

Rising cases

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Malaria, tuberculosis, HIV and NTDs have been on the rise in the past few years, largely from disruptions in diagnosis and treatment caused by the COVID pandemic. In 2020, there were an estimated 241 million cases of malaria and 627,000 deaths. African countries accounted for an overwhelming 95% of these cases. This was 14 million more cases and 69,000 more deaths compared with 2019. Around two-thirds of the additional deaths in 2020 (47,000) were caused by COVID-related disruptions to malaria diagnosis and treatment, according to the 2021 World Malaria Report.

At the same time, there was some encouraging news. “Even during the COVID pandemic, Bhutan and Sri Lanka remained malaria-free and several countries in southeast Asia remained on track towards malaria elimination,” Poonam Singh, WHO’s regional director for southeast Asia, told the summit.

Malaria caused by Plasmodium falciparum is the most severe form, according to the WHO. It is present across sub-Saharan Africa, and is responsible for more than 90% of global malaria cases and deaths. The most common treatment is artemisinin-based combination therapies.

Some 500 delegates attended the summit, which was organized by Rwanda and the international public-health groups RBM Partnership to End Malaria and Uniting to Combat NTDs. The new funding is intended so that countries can get back on track by significantly reducing new cases of malaria by the end of the decade. Since 2015, the WHO has certified nine countries as malaria-free, bringing the total to 40.

“The R&D pipeline is in the best shape than it has ever been,” with new drugs for [malaria] resistance and new vaccine technologies, Philip Welkhoff, director of malaria at the Bill & Melinda Gates Foundation based in Seattle, Washington, told the summit.

Representatives of some 65 African countries were at the conference and together they pledged $2.2 billion towards ending malaria and NTDs. The remainder has been pledged by high-income countries, philanthropic organizations and pharmaceutical companies.

For big pharma, London-based GSK has pledged research and development (R&D) investments worth $1.23 billion over ten years for malaria, tuberculosis, HIV, NTDs and antimicrobial resistance. Novartis, based in Basel, Switzerland, announced $250 million over the next five years for research on new treatments for malaria and NTDs; and Pfizer, based in New York City, has pledged $1 billion to the International Trachoma Initiative, which fights the blinding bacterial infection trachoma.

Among the philanthropies and charities, the Bill & Melinda Gates Foundation has announced $140 million to support African institutions’ research on malaria and NTDs; Wellcome, based in London, will provide $80 million for R&D in snakebite treatments and additional NTD research; and the UK-based charity Sight Savers, which works on preventable blindness caused by infections, has pledged $25 million over the next four years.

Some progress has already been made. Benin, Rwanda and Uganda have eliminated some forms of trypanosomiasis, and many other countries have eliminated yaws, Guinea worm and onchocerciasis (river blindness).

Lessons learnt

The conference heard how some countries have applied lessons learnt from handling the COVID-19 pandemic to controlling other infections. “COVID-19 taught us resilience and new ways to manoeuvre through the pandemic”, along with how to use existing health systems to tackle infections, said Russel Tamata, director general at the ministry of health in Vanuatu.

Nigeria leveraged the switch to virtual consultations and digital technology to connect caregivers with doctors during the pandemic to control malaria and NTDs, the country’s health minister Osagie Ehanire said. Despite restrictions due to the pandemic, the country distributed 17 million insecticide-treated bed nets and scaled up preventive chemotherapy for NTDs to 23 million children, Nigeria’s president Muhammadu Buhari told the summit. Rwanda is attempting to combine malaria treatment with optical and dental-care services, the conference heard.

Corine Karema, who heads the RBM Partnership to End Malaria, told Nature that if malaria and NTDs are not stopped in their tracks, “billions of people worldwide will continue to suffer or die from these diseases”. This will “cause greater strain on health systems”, which, in turn will impede their ability to respond to current and future health threats.



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