Mapping how to defeat malaria

The fight against malaria has made tremendous gains in recent decades. Since I helped start the Malaria Atlas Project (MAP) at Oxford University in 2006, we’ve developed one of the largest databases available on this deadly disease. The most recent research from MAP and the Institute for Health Metrics and Evaluation at the University of Washington shows a substantial decline in infections and deaths from the two parasites that cause the majority of the global burden of malaria. Just last month, the World Health Organization announced that both Argentina and Algeria are officially malaria-free.

But it’s dangerous to be complacent in the fight against disease, and particularly malaria. If we don’t stay one step ahead, those gains are hard to hold on to.

The two papers just published in The Lancet show a decline in the burden overall, but they also identify areas we are losing ground to malaria. In Venezuela, a nation in political and economic upheaval, prevalence has risen since 2012; it is now the highest-prevalence country in the Americas. In Afghanistan, Yemen, and Somalia, progress towards eliminating the Plasmodium falciparum parasite reversed over the study period. And sub-Saharan Africa continues to bear a disproportionate burden, with over 90% of people living in areas where malaria is endemic. Globally, the disease was responsible for almost 620,000 deaths in 2017.

Declining funding is a major concern. An annual evaluation of global health financing projects a $2 billion shortfall in achieving the World Health Organization spending target for malaria in 2020. With fewer dollars available, it’s crucial to target resources where they are most needed and will have the biggest impact.

That’s where precise maps can make a difference. MAP’s work quantifies the burden of malaria at a fine geographic scale, allowing decisions to be made around specific districts and municipalities. That same tool can be leveraged for other dimensions of the problem. One example is resistance to insecticides. Mapping where mosquitoes have become resistant to the commonly used insecticides, or where drug-resistant malaria is prevalent, makes it possible to prioritize new or different treatments in an environment of limited funding. Understanding where malaria is making a resurgence and why is critical if we are to succeed in eliminating a major killer. As Bill Gates said recently of the malaria mapping project: “Better data and malaria maps will help us put all these breakthroughs to their best use, and bring us closer to the day when this disease is gone forever.”