The US Senate's Resolution on World Malaria Day - a nice gesture ... but more is needed

25 Apr 2023
Africa Fighting Malaria
We commend the US Senators from both political parties for introducing a World Malaria Day Resolution. The Senate is right to highlight the importance of fighting malaria, especially during such a pivotal time when progress against the disease is being made, but global budgets for malaria control appear to be shrinking. The Resolution correctly highlights the benefits of malaria control funding and the successes achieved in recent years, thanks in large part to US-funded initiatives. The Resolution also states that if progress is to be sustained, both bilateral and multilateral efforts will be critically important. But the story of malaria isn't just one of ongoing successes and raising and spending more money. The Resolution could have noted that much of the success against malaria has come about thanks to improved oversight of malaria spending by the US Congress. US efforts against this disease have been successful because of an insistence on measurement, accountability, targets and results.

Notwithstanding the successes, there are still many challenges that lie ahead and they must be addressed. For instance:

• The Resolution fails to mention the twin threats of drug resistance and insecticide resistance. These two problems could undo some of the progress that has been made and are exacerbated by the use of substandard and fake medicines, and potentially the use of poor quality insecticides.
• The Senators also fail to mention that as a result of decades of anti-insecticide activism from activists, government agencies and the UN, there are few options for alternative insecticides to control for resistance.
• On this same topic, the Resolution supports research and development for more effective and affordable tools for malaria diagnosis, treatment, and vaccinations, but does not mention tools for prevention, such as new and more effective public health insecticides. There is great scope for Senators and Congressmen to show some leadership and help to create the kinds of incentives needed to bring new public health insecticides to market. See Michael Miller and Richard Tren's newly-published article on the topic here.
• Lastly, there is a possible internal conflict within the Resolution in that it supports both the Lantos/Hyde Act and the President's Global Health Initiative (GHI). With the GHI's seeming focus on health systems strengthening it is possible that over time there will be a shift away from disease-specific interventions to more general funding. The only reason that we have had the successes we've had is because of the laser-like focus on malaria by organizations such as the US President's Malaria Initiative, and their insistence on openness, measurement, accountability, targets and results. These critical factors are most likely to be absent with a move to broader health systems strengthening. For starters few people can actually agree what health systems strengthening actually entails, let alone how to measure whether or not spending on it has been worthwhile. So in some respects supporting both Lantos/Hyde and the GHI is mutually exclusive. Perhaps the Senate should start speaking out against this and for funding only programs that we know we can measure and which hold individuals and agencies accountable.