AFM's take on UN General Assembly malaria resolution

21 Apr 2023
Africa Fighting Malaria In the run up to World Malaria Day on April 25, 2011, the 65th Session of the United Nations General Assembly adopted a malaria resolution. This long and encompassing resolution "Consolidating gains and accelerating efforts to control and eliminate malaria in developing countries, particularly in Africa, by 2015," sets the UN agenda against malaria. It is encouraging that the UN managed to get agreement on the language and raise the profile of malaria.

Strong leadership from the UN is important in the fight against malaria and while the resolution raises good points and calls for action on important areas, it falls short in some key areas. But there is a much bigger problem that the UN must deal with if it is going to achieve its malaria goals - and that is the UN itself. The UN can pass resolutions and make promises, but unless the UN Secretary General, Ban Ki-moon, stops the UN Environment Program (UNEP) from undermining WHO's Global Malaria Program, and unless he ensures the UN Development Program (UNDP) is open and transparent in the way it spends Global Fund monies, malaria will continue to ravage poor countries.

Here is AFM's take on the resolution.

First, the good:
• The resolution recognizes the problems of drug and insecticide resistance and also recognizes the challenges related to counterfeit and sub-standard medicines, and poor microscopy services.
• The resolution recognizes the problems of delays and bottlenecks in getting malaria commodities to those who need them, and commends those countries that have removed taxes and tariffs on malaria commodities.
• The GA resolution calls for comprehensive malaria control, to include indoor residual spraying (IRS), a highly effective method of disease control; this is a great step forward for the UN, which several years ago barely even mentioned IRS and based all malaria control on the use of insecticide-treated bednets alone.
• The resolution calls for investment in new medicines, insecticides and new technologies that will be required in the coming years.
• The resolution calls on banning oral artemisinin monotherapy tablets; this is welcomed as these monotherapies will undermine artemisinin-based combination therapies (ACTs) and could lead to resistance to our last best hope for malaria treatment.

Now, the not so good:
• While we are pleased that IRS is included in the resolution, the language on DDT, probably the most effective public health insecticide, is inadequate. The resolution refers to the Stockholm Convention, which regulates the use of DDT, but fails to point out that the Stockholm Convention Secretariat and the UNEP are putting continual pressure on countries to stop using DDT and to stop manufacturing it (see this Position Paper and the Report of the 2nd meeting of the interim steering committee). The Stockholm Convention Secretariat even has a flash cartoon on its website, pushing for the elimination of all production and use of DDT by 2020. For a UN Secretariat to reduce one of the most pressing and important public health issues for Africa to a childish cartoon is outrageous and should be roundly condemned by the GA.
• The resolution encourages the WHO and member states to continue to explore possible alternatives to DDT. That is all well and good; AFM strongly welcomes alternative insecticides that will strengthen malaria control programs. However, the GA seems to ignore the fact that so far the efforts under the Stockholm Convention have been farcical and that the WHO's Global Malaria Program appears to be frozen out of this effort by the WHO's Environmental Health Unit. Furthermore, as we explain here, these efforts have involved appalling instances of scientific malfeasance whereby the UNEP misled the public about the effectiveness of its non-insecticidal methods of malaria control.
• The GA should be aware of the fact that UNEP has explained that it seeks to 're-formulate' WHO's Global Malaria Program so that it is more focused on eliminating the use of insecticides. Insecticides form the basis of malaria control - as this is an insect-borne disease. The absurd position aggressively taken by UNEP would turn the clock back and allow malaria to rise once again.
• The resolution talks blithely about investment in new insecticides - but provides no guidance as to how this will be accomplished. Given the opposition to insecticides from within and without the UN, it is totally unacceptable to simply state that there should be investment without providing a strategy and a plan, along with necessary incentives and regulatory reforms, that will actually bring much needed new public health insecticides to market.
• The resolution is right to call for a halt to the production, marketing and use of oral artemisinin monotherapies, however the UN and WHO have made this call before. Some sanctions on countries that allow these drugs to be produced and sold, and on the companies that continue to produce these drugs, would be a step in the right direction - the UN must put some teeth into the resolutions otherwise they will never bite.
• Lastly, in light of recent media around the growing problem of substandard and counterfeit antimalarial drugs, the GA's call seems a bit weak. While they call on the international community to strengthen health systems, national pharmaceutical policies, and national drug regulatory authorities, these are enormous tasks. Much more guidance in this area is needed. For starters, the GA could insist that the UNDP be open and transparent with their spending of Global Fund grants - hundreds of millions of dollars are channeled through the UNDP in countries that lack capacity, but the UNDP refuses to share its audit reports with the Global Fund's Inspector General. This is a dreadful abuse of the Global Fund - the most open and transparent funder - and should stop. Support from the GA for the Global Fund in this regard would be a big boost.

So all in all, it is good that the GA has passed a resolution - but regrettably, one of the biggest stumbling blocks to reaching the UN goals on malaria control and elimination is the UN itself. Ban Ki-moon and WHO Director General, Margaret Chan, need to get serious about reform, otherwise UN malaria resolutions will simply be heaped onto the growing pile of meaningless, empty and unfulfilled UN promises.