Study Finds Spending on Malaria Prevention is Woefully Inadequate

The UN's Millennium Development Goal to halt and then reverse the increase in malaria by 2015 is unlikely to be met, according to a detailed scientific analysis of where international funding is spent.

The analysis found that the global spend on malaria prevention of around $1bn per year would need to increase by between 50% and 450% to achieve the goal. But the study also found that funding was not spread evenly, with some countries receiving far less per person at risk of the disease than others.

"What we have done in this paper is try to estimate how much money is awarded to countries according to how many people live at risk," said Prof Robert Snow at the Kenya Medical Research Institute in Nairobi, "What we can say at this stage is there isn't enough for a minimum package of interventions ... They are often getting much less than a dollar per person at risk and we know that you need at a bare minimum $4."

His team's analysis is based on a previous study ? the Malaria Atlas Project ? in which the group produced a map of global malaria risk. That study used medical and climate data to estimate the numbers of people within different countries at risk of Plasmodium falciparum, the most deadly species of the malaria parasite. They then matched this to funding received from major international donors such as the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM), the World Bank and the US President's Initiative.

In 2007, annual funding for malaria control, including insecticide spraying, use of insecticide-treated bed nets and access to rapid diagnosis and medicine was $1bn, less than a dollar per person at risk of the disease. The analysis also threw up huge disparities in funding. Burma, for example, received around one cent per person at risk while Suriname in South America spent $147 per person at risk.

Only 24 countries received more than $1 per person at risk, and only seven received more than 4$ per person. At the other end of the scale, Democratic Republic of the Congo, C?te d'Ivoire and Pakistan were awarded only US$0.11 annually per person at risk.

Snow said that South East Asia and Western Pacific nations such as India and Indonesia were particularly neglected. This region is home to 47% of the global population at risk. But it received 17% of funding from the GFATM and 24% of funding from non-GFATM sources.

"Even though risk is low in India, the overall population exposed to risk is very very high. Consequently the number of people who are likely to get malaria is very very high," he said.

The analysis of the UN's performance in tackling malaria is published in the journal PLoS Medicine and was funded by the Welcome Trust.

Number 6 of the UN's eight Millennium Development Goals is to halt and reverse the spread of HIV, malaria and other major diseases by 2015, but Snow said that much more money would be needed to achieve it. "The headline news from the GFATM and the WHO is that we now spend more money on malaria than we've ever spent before. That's true, but it's not enough and it's not true everywhere," he said.

In a comment article about the malaria study in the same issue of PLoS Medicine, Prof Anthony Kiszewski at Bentley College in Massachusetts, an expert on epidemiology, said it highlighted the "alarming gap" between the funding required and what is actually being spent. "The world invests only about US$1 billion per year, billions short of what several independent estimates suggest is necessary to achieve basic international goals for reducing malaria burdens. Because need estimates may undershoot actual needs, the true gap may be far wider," he writes.