Corporate Leadership in the Fight to End Malaria

Tremendous progress has been made in the fight to end malaria. Seventeen countries have reduced malaria cases to the point where it is no longer endemic – and eight of these have fully eliminated malaria. Since 2000, malaria prevention and treatment programs have saved an estimated 4.3 million lives.

Companies have helped to both accelerate this progress and shape malaria policies, impacting communities, through workplace initiatives, product and service innovations, advocacy, research and investment.

Yet despite these significant advances, communities and countries still face steep challenges in ending malaria for good. Millions of people are without access to preventive measures and most cases go unreported and untreated, and often are misunderstood or misdiagnosed. Malaria perpetuates a cycle of poverty, disrupts education, causes stunting in children under-five and has devastating effects on maternal and newborn health.

Climate change will very likely result in an increase in malaria burden in parts of the world where it is already endemic, while deforestation and urbanization are expected to alter transmission dynamics in vulnerable populations. Today, the disease remains endemic to all six WHO regions with the heaviest burden in Africa –where 90% of all malaria deaths occur.

The WHO’s Global Technical Strategy for Malaria 2016-2030 provides a roadmap for private sector action in this challenging context. While not explicitly naming the corporate sector, the strategy emphasizes several trends – technological advances; innovations in medicines, vaccines and vector control; and improved efficiency in delivering commodities – likely to shape the malaria space over the next 15 years. The corporate sector is poised to play a leading role in each of these areas. Furthermore, beyond innovation and efficiencies, business is well positioned to work closely with governments to shape policy, implement complementary workplace and community programs, and provide financing knowhow and resources in support of national malaria elimination plans.

Here’s how:

Innovation: Companies, often in partnership with academic researchers, are the engines for medical innovation. Current needs present immediate opportunities for malaria-related innovations including diagnostics, vaccines, drug development, vector control and surveillance. The pipeline for malaria products is actually quite robust and has been labeled by some as the “envy of the global health world”. Yet, priority interventions have either not yet been developed or are not yet fully deployed. These include:

• Point of care diagnostic devices: low-level parasitaemia in asymptomatic carrier, P. Vivax hypnozoites, glucose-6-phosphate dehydrogenase status, and molecular markers for resistance
• Vaccine: protective efficacy of at least 75%
• Vector control: new active chemical ingredients, improved or prolonged residual effect and better physical integrity of nets, procedures and technology to ensure rotation of chemical agents and quality assurance to reduce the risk of resistance
• Drugs: safe, effective and affordable single dose treatment that can cure and reduce transmissibility of both primary types of infection
• Surveillance and delivery: new data and technology platforms to reduce potential resistance, improve the efficiency of supply chains, target prevention and treatment activities and share data across borders.

Policy: A comprehensive national malaria strategy in each endemic country that responds to the particular nature of the threat in that country, can support, encourage and enable effective interventions to be enhanced and sustained. A comprehensive strategy:

• Provides instructions to public and private providers on how to adequately identify and treat malaria in line with WHO guidelines
• Strengthens the health workforce and malaria expert base as well as commodity-delivery systems, and pharmaceutical and chemical quality control
• Promotes strong coordination between malaria and other health program areas; ensures cohesive donor activities and shares information across borders
• Increases high-level political commitment to the sustainable financing of malaria programs, particularly as countries move closer to elimination
• Creates appropriate and efficient regulatory frameworks for products deemed by the WHO to be safe and effective.

Business is in a unique position to advocate on behalf of these priorities to ensure commitment from lawmakers and global decision makers.

Implementation: Many successful malaria programs have been initiated, funded and managed by the private sector, most frequently in the extractive and agricultural industries and often in partnership with National Malaria Control Programs. Companies are exercising leadership in indoor residual spraying, treatment, and malaria information programming, ensuring that their workforces and the surrounding communities are protected from malaria through integrated and comprehensive programs.

When designing a workplace malaria program companies should:

• Identify particular transmission risks for staff and their dependents: this requires mapping transmission routes based on staff movement and identifying high-risk areas and prime biting times
• Define the appropriate program size and intervention components: how far beyond immediate staff does the program need to go to adequately achieve its goals
• Understand and document the complete costs of malaria to the business: absenteeism, presenteeism (working while sick), insurance payments or reimbursements need to be measured against cost of programs to reinforce the true business case
• Work within the framework of existing national malaria plans: ensure the company is complementing national efforts rather than duplicating or replacing more sustainable sources of care and official information channels
• Develop an appropriate implementation strategy: who are the partners that will help bring this program to life? How can we coordinate with existing public and private providers?

Financing: In 2015, malaria financing totaled $2.9 billion. The WHO technical strategy calls for a combination of domestic and international funding to increase to a $6.4 billion target by 2020. Beyond providing resources on the three areas previously discussed, the private sector has considerable financial expertise that can enhance the community’s acumen and create opportunities for innovative financial partnerships.

Within the SDG movement, partnerships with the private sector are acknowledged as critical to address the funding gaps for all of the Global Goals including Goal 3 on health. Yet, significant barriers remain that limit private capital investments in malaria endemic countries. Overcoming these barriers will require:

• Mapping current private investments and private provider care seeking to improve data and refine gap estimates
• Building platforms to identify vetted investments that strengthen health systems
• Sourcing blended and innovative finance opportunities underwritten by donors or multilateral development banks to de-risk investments and provide risk-adjusted returns to impact investors (see the Nigeria Malaria Bond for example)
• Reducing costs of national malaria programs through better donor coordination, forecasting of product requirements and supporting pooled procurement.

By mitigating risk and reducing costs, the malaria community can enhance confidence, stabilize markets, reduce prices for commodities and encourage further investments in R&D.