International goals to reduce malaria burdens not likely to be achieved

For malaria control goals to be achieved, we must in the future tie funding commitments closer to level of need, says new research by Bob Snow and colleagues from the Kenyan Medical Research Institute-Oxford University-Wellcome Trust Collaborative Programme.

Building on their Malaria Atlas Project, which created a global map of Plasmodium falciparum risk, Snow and colleagues conducted an audit of international malaria financing between 2002 and 2007. They compared funding commitments by major donors such as The Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM), the World Bank, the US President's initiative, and the Gates Foundation to objective assessments of national burdens of malaria. They find that almost US $1billion are distributed each year to the 1.4 billion people exposed to stable P. falciparum malaria risk, which amounts to less than US$1 per person per year at risk. Forty percent of international malaria financing comes from the GFATM.

The researchers report the distribution of funds to be broadly appropriate. More than three-quarters of GFATM funding, for example, has been targeted at the continent with the highest burden, Africa. But they also found areas of heavy need that received disproportionately little support for malaria control. Countries in the South East Asia and Western Pacific regions, for example, which represent 47% of the global population at risk, received just 17% of GFATM and 24% of non-GFATM support.

Snow and colleagues also found great variation in spending levels. While Myanmar (Burma) received an average of US$0.01 per capita-at-risk of malaria by the GFATM, the northern South American country Suriname was awarded US$147 per capita. Alarmingly, the 16 countries who received less than US$0.5 per capita-at-risk from all sources represent 50% of the global population at risk and include 7 of the poorest countries in Africa and two of the most densely populated stable malaria endemic countries in the world (India and Indonesia)

Given the gaps between funding support and level of stable P. falciparum risk, the authors conclude that the goal to halve the global burden of malaria by 2015 very likely will not be met with current commitments: "We estimate that there remains a 50%-450% shortfall of funding to achieve the scaling up of malaria control required worldwide," say the authors.

In a related Perspective, Anthony Kiszewski from Bentley College in Massachusetts, who was not involved in the study, says that estimates of need often undershoot actual needs, and so the deficit in funds needed to achieve basic international goals to reduce malaria burdens may be far greater.