Global targets for combating the disease under threat as rate of increase in funding levels off, says WHO report

The remarkable gains made in the treatment of malaria over the past decade are under threat because of insufficient increases in funding over the past two years, according to an annual progress report by the World Health Organisation.

Mosquito nets have been key to bringing down the death toll from the disease but, according to the World Malaria Report 2012, these are no longer getting to the families that need them in sufficient quantities.

There was a rapid and substantial expansion in funding for malaria control between 2004 and 2009, but between 2010 and 2012 the rate of increase levelled off. Last year, $2.3bn (£1.4bn) was made available, but that is less than half the $5.1bn (£3.2bn) estimated to be needed to control malaria every year.

As a result, says the report, the number of long-lasting insecticide-impregnated nets delivered to endemic countries in sub-Saharan Africa dropped from a peak of 145m in 2010 to an estimated 66m in 2012. Families will not be able to replace them when they need to – the useful life of a treated net is estimated to be about three years.

"Nets delivered in 2007 and 2008 are therefore now due for replacement, soon to be followed by those delivered in 2009 and 2010," says the report.

Indoor spraying programmes – to rid homes of mosquitoes – were also on the increase but have levelled off in line with funding. Between 2010 and 2011, indoor spraying coverage flatlined in the WHO African region, reaching only 11% of the population at risk.

"During the past eight years, scaled-up malaria control helped us avert over a million deaths. We must maintain this momentum and do our utmost to prevent resurgences," said Ellen Johnson Sirleaf, the president of Liberia and chair of the African Leaders Malaria Alliance, who held an official launch event for the report in Monrovia, Liberia.

The report says millions of people continue to lack access to preventive therapies, diagnostic testing and quality-assured treatment. "Considerably more work is needed before the target of universal access to malaria preventive interventions, diagnostic testing and appropriate treatment will be attained," it says.

There used to be talk of the potential elimination of malaria, but the levelling off of funds means that targets for controlling the disease are likely to slip.

"Global targets for reducing the malaria burden will not be reached unless progress is accelerated in the highest burden countries," said Dr Robert Newman, director of the WHO Global Malaria Programme in Geneva. "These countries are in a precarious situation and most of them need urgent financial assistance to procure and distribute life-saving commodities."

Credit: Guardian graphics

Another major concern is the growth of resistance to the newest and best antimalarial drugs – the artemisinin compounds. Deliveries of the drugs to affected countries have substantially increased, from 181m packs in 2010 to 278m in 2011, largely because of a scheme to subsidise their sale in the private sector.

But the malaria parasite has proved adapt at developing resistance to drugs, which is why the old antimalarials no longer work in many countries.

Resistance to artemisinins has been identified in four countries – Cambodia, Burma, Thailand and Vietnam. The WHO has recommended that artemisinins should only be used in combination with other drugs, which helps to prevent resistance, but the single drug is still allowed to be sold in 25 countries (mostly in Africa) and 28 pharmaceutical companies are still marketing them (mostly India-based).