In the fourth and final paper in The Lancet Series on Malaria Elimination, Oliver Sabot and colleagues examine the financial feasibility of eliminating malaria. They conclude that elimination will cost more than continuing to control the disease and those increased costs are unlikely to be offset by future savings. They stress, however, that the overall benefits of eliminating, which have never been seriously measured, may justify the higher cost. The authors also emphasise that for many countries to achieve elimination, there will need to be a paradigm shift in the way international funding is channeled to malaria programs.
The authors conducted the study because a thorough understanding of the economics of malaria elimination is critical to determining whether governments and global donors should invest limited health resources in this strategy. After finding little existing evidence on this issue, the authors conducted in-depth case studies on the costs and potential cost-savings of elimination in four countries. They found that the probability that elimination would be cost-saving over 50 years is small (less than 10%) in three of the countries (China, Mauritius, and Swaziland) and moderate in one (Tanzania=Zanzibar).
The authors say: "Although yearly costs were lower than were those for control after elimination was achieved, reductions were less substantial than commonly assumed because of the need to continue interventions to prevent reintroduction of malaria and thus were outweighed in most countries by the initial spending increases needed to achieve elimination."
They add: "These findings suggest that the potential for elimination to yield cost-savings—and therefore pay for itself—should not be a primary rationale to pursue this strategy, as has been argued in recent years. They do not, however, show that elimination is a poor investment. Elimination could generate additional benefits that must be weighed against the greater costs."
The paper also shows that many countries will need substantial financial support from international donors to pursue elimination. However, the authors say the present structure of global malaria financing, which is designed to achieve immediate reductions in burden rather than long-term maintenance of malaria at very low rates, is poorly aligned with the needs of elimination programmes. Successful elimination will thus need a fundamental shift in the perception of malaria investment from a so-called quick win to a routine expenditure, such as that for immunisation, with corresponding changes in financing mechanisms and policies.
The authors conclude: "Many countries will need substantial financial support from international donors to pursue elimination. However, the present structure of global malaria financing, which is designed to achieve immediate reductions in burden rather than long-term maintenance of malaria at very low rates, is poorly aligned with the needs of elimination programmes. Successful elimination will thus need a fundamental shift in the perception of malaria investment from a so-called quick win to a routine expenditure, such as that for immunisation, with corresponding changes in financing mechanisms and policies."
Oliver Sabot, Clinton Health Access Initiative, Boston, USA. T) +1 617 774 0110 E) osabot@clintonhealthaccess.org
Alternative contact for Oliver Sabot: Jennifer Gregorie, Clinton Health Access Initiative, Boston, USA. T) +1 617 774 0110 E) jgregoire@clintonhealthaccess.org
For full Series paper 4, see: http://press.thelancet.com/malelim4.pdf
NOTE: THE ABOVE LINK IS FOR JOURNALISTS ONLY. IF YOU WISH YOU CAN PROVIDE A LINK TO THE DEDICATED SERIES PAGE ON THE LANCET.COM, WHERE ALL USERS CAN DOWNLOAD PAPERS FOR FREE ONCE THEY HAVE REGISTERED (ALSO FREE). THE LINK TO USE IS BELOW (NOTE THIS WILL GO LIVE WHEN EMBARGO LIFTS): http://www.thelancet.com/malaria-elimination
Journal
The Lancet