His Excellency Jakaya Kikwete, who served as President of the United Republic of Tanzania from December 2005 to October 2015, is the founding Chair of the African Leaders Malaria Alliance (ALMA). He speaks about the extraordinary progress in the fight to eliminate malaria on the African continent and the challenges that remain as we close in on one of the world’s oldest and deadliest diseases.
Are we making progress in the fight against malaria?
There has been tremendous progress over the last decade and a half in the fight against malaria. Since 2000, a 60 percent reduction in the rate of deaths from malaria has resulted in saving an estimated 6.2 million lives. In the same timeframe, malaria mortality rates in Africa have fallen by 66 percent in all age groups and 71 percent among children under five. The World Health Organization, through modeling, projects that the United Republic of Tanzania will have reduced malaria incidence by 50 to 75 percent between 2000 and 2015. Yes, we are making excellent progress.
How has this progress impacted the lives of Africans?
When I was President of Tanzania, I was told that in one district 70 percent of children were absent from school and the reason was malaria. I dispatched my Minister of Health to the district to verify this and was surprised when he returned and told me “Yes, it’s true. There is a malaria epidemic of unimaginable proportion.” So I contacted the United States ambassador to Tanzania, the President’s Malaria Initiative and other partners and together we dispatched a team of doctors who camped in the district to address the problem. We used three main interventions: Artemisinin-based Combination Therapies (ACTs), for effective treatment of malaria; the distribution of Long-Lasting Insecticidal Nets (LLINs); and Indoor Residual Spraying (IRS) for households. In the following year, school attendance reached 90 percent.
Why is it important to have a continent-wide effort against malaria?
If you deal with malaria effectively in one country, but you don’t deal with it in a neighboring country, you’ll be able to control it, but the parasites will come back from the neighboring countries. I discussed this with Ray Chambers, the United Nations Secretary-General’s Special Envoy for Malaria in New York City, and in September 2009 at the United Nations General Assembly, eight African heads of state joined me in launching ALMA. Today we have 49. ALMA is focused on eliminating malaria in Africa by 2030. ALMA now meets twice a year at the African Union summits and uses the ALMA Scorecard to track progress and drive action. Every time ALMA meets, leaders see updated scorecards for their countries. When there is too much red on their scorecard, they realize there is more work to do. This helps them stay committed. These kinds of interventions have helped accelerate the remarkable progress we have seen in the past decade. With ALMA, we are proving that when we have heads of state and government involved and guiding the process, we get results.
With so many pressing issues in Africa, what is the secret to convening African heads of state twice a year around malaria?
When you go to hospitals, many beds are full of malaria patients. African leaders have seen first-hand the effect on our communities when adults are too sick to go to work and fever-stricken children cannot go to school. Malaria has taken a devastating toll on our countries. The promise of a malaria-free Africa is one that motivates all of us.
Is it possible to truly eliminate malaria from the African continent?
Yes, this is ALMA’s main objective. The World Health Organization recently reported that six African countries – Algeria, Botswana, Cape Verde, Comoros, South Africa and Swaziland – could eliminate malaria by 2020. The African Union’s adoption of the Catalytic Framework to End AIDS, TB and Eliminate Malaria in Africa by 2030, outlines a pathway to eliminate malaria in all countries by 2030. We need to continue doing what we know works and at the same time support innovation in the tools and approaches we use to fight this disease. All of this, of course, requires national and international financial resources. We need more “country ownership” and domestic funding, and continued support from the international community to reach our goals.
How is innovation helping eliminate malaria?
Technology and innovation are playing a key role in the malaria fight. Surveillance tools and modeling and mapping of malaria data are helping us better understand and fight the disease. Rapid diagnostic tests for malaria are helping health care workers, especially in rural areas, make quick and accurate diagnosis before treatment is administered. There is research underway for other innovations such as a single-dose pill that could rid a person of all parasites or even block malaria transmission – and other exciting innovations in vector control that could accelerate our path to elimination.
Do you think African leaders will put more of their own domestic resources into the malaria fight?
They are already doing it. When I became President of Tanzania, the overall annual health budget was around $250 million. By the time I left office it was $1.1 billion. Cameroon, Chad, Mauritania, South Africa and other countries have also increased domestic funding to fight malaria. And of course, the problem is most challenging for the poorest countries with very little of their own resources. This is where international support is critical.
What role has the international community played in fighting malaria in Africa?
The malaria fight has benefited from strong global leadership and partnership. The Global Fund to Fight AIDS, Tuberculosis and Malariahas played a significant role in the progress to date. The U.S. President’s Malaria Initiative, the United Kingdom’s Department for International Development, the Bill & Melinda Gates Foundation and UNITAID, which plays a role in market shaping for affordability and increased access, have been critical supporters and partners in the malaria fight, along with many other donors and partners. We need to continue to work together to stay on track to end this disease.
Currently, there is a lot of discussion in the global community about women and girls. How does fighting malaria help them?
Malaria is one of the leading killers of children and pregnant women in Africa. A child dies every two minutes from malaria. The progress against malaria has contributed greatly to reducing the number of child deaths and reducing maternal morbidity on the continent, but no mother should go through the pain of losing a child from a mosquito bite. Malaria is preventable and treatable. It puts a major burden on families – keeping adults from work and children from school – and contributes to the cycle of poverty in our communities. Eliminating malaria benefits all of us.
You seem to take the fight to end malaria personally. Why?
When I was a child, I lost my brother to malaria. If he contracted the disease today, he’d probably still be alive. Millions of Africans have this same story. It is something our children should not have to experience. We have made outstanding progress, but we can’t let up now. A malaria-free Africa is in sight.
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