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Progress against malaria stalled, and the disease remains a significant threat to billions of people despite decades of costly efforts to contain it, the World Health Organization reported Monday.
According to the latest annual assessment of W.H.O., an estimated 220 million cases of malaria and about 435,000 deaths from the disease. Of the deaths, 262,000 were children under 5 years old.
The disease is caused by parasites transmitted to humans by mosquitoes. The rate of malaria worldwide – which began to drop in the early 2000s with the injection of insecticide-treated mosquito nets, new drugs and much more money into the fight – has been about the same since 2013, says the report.
Without openly criticizing a particular country, officials made it clear that some were not doing enough to protect their citizens. "The past year has been marked by shadows and bright lights," said Dr. Pedro L. Alonso, director of the W.H.O. malaria program.
Pakistan, Ethiopia, Rwanda and India have performed well, he said. India registered 3 million fewer cases in 2017 than in 2016, a decrease of 24%.
On the other hand, Nigeria, Madagascar, the Democratic Republic of Congo, Mozambique, Mali, Niger, Indonesia, Burkina Faso and a few others are losing ground against the disease.
Nigeria, which accounts for a quarter of all malaria cases worldwide, reported 1.3 million more than last year in 2016, according to the report.
Latin America has only a few hundred deaths from malaria every year, but it has increased last year, especially in Venezuela, where the economy collapsed.
For the first time, China has not reported any cases transmitted within its borders.
Alonso said donor governments should double their contributions if they hope to bring down new infection rates fast enough to meet the 2030 targets set by the United Nations.
However, global contributions to the fight against malaria – and against AIDS and tuberculosis – have remained essentially unchanged since the 2008 financial crisis.
Of the approximately $ 3 billion spent annually to roll back malaria, the United States is by far the largest contributor, providing nearly 40% of all funds. This has not changed under the Trump administration.
"There is bipartisan support in Congress, which does not depend specifically on an administration," said Dr. Alonso.
In addition, the President's Malaria Initiative, launched in 2005 by former President George W. Bush, The program has recently expanded its program in West Africa, said Dr. Kesete Admasu, Managing Director of the Roll Back Malaria Partnership.
Dr. Admasu joins Dr. Alonso last week in a press conference to discuss the report.
The main means of donation is the Global Fund to Fight AIDS, Malaria and Tuberculosis; his next tri-annual fundraiser will take place in October in Paris.
But donors have complained that some countries have become too dependent and have to spend more of their own money.
Success, according to both doctors, depends primarily on strong political leadership in each country.
Although the number of malaria cases in Nigeria has doubled since 2010, according to the report, it spends much less per capita than many other African countries.
When asked why Nigeria was so bad when it was a big oil exporter, Alonso said he would not blame any particular country. Nigeria is a "home of transmission", he said, with a decentralized government and a rapidly growing population.
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The country has recently added $ 18 million to its malaria budget to win an equivalent grant of $ 36 million from the Global Fund, said Dr. Admasu. In April, Nigeria pledged $ 300 million to the World Bank, the Islamic Development Bank and the African Development Bank to improve its response.
The modern campaign against malaria has not yet been slowed by technical problems, as it has gradually destroyed the one that began in the 1950s.
This trend collapsed when mosquitoes developed resistance to DDT and the parasites are immune to chloroquine, the miracle treatment introduced after the Second World War.
Although modern miracle drug resistance, artemisinin, has appeared, it remains largely confined to Southeast Asia.
Last month, a team from Oxford University based in Thailand announced that it had completely succeeded in curing hundreds of patients in Southeast Asia with new combinations of three drugs combining fast-acting two-drug artemisinin of longer duration.
"Triple therapy should become the norm for all treatments," said Dr. Adrianus Dondorp, head of malaria research at the Mahidol Oxford Research Unit on Tropical Medicine. "It's a problem because it's a bit more expensive and has a few more side effects – but you have to balance that against what you've won."
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