Malaria is obstinate. A massive effort by the international community along with the determination of committed individuals, scientists, health workers , governments, charities and other organisations have made a huge dent on its impact. Globally, cases are down 25%, deaths are down 42% since 2000 - but malaria is far from gone.
Malaria still kills more than 620,000 people every year, most of them children in sub-Saharan Africa. More than three billion people still live under the threat of malaria. Walk into a school in Ghana, Congo, Tanzania or any other endemic country and ask the children if they have had malaria and you will see nearly all of the hands go up. Many will have had it more than once.
It is hard to articulate the cost of malaria to Africa. Certainly the human cost is immense. Those who survive malaria are weakened, often left anaemic where the parasite has destroyed their red blood cells. Some are permanently damaged by the effects of the parasite on their brain. The economic burden is estimated at $12 billion each year - more than Africa receives in aid each year.
For a doctor treating malaria patients, as I was a few years back, the malaria season arrives with a real sense of dread.
This World Malaria Day offers us the opportunity to take stock, to reflect on what has been achieved so far, consider what we could have done better and apply those lessons as we continue our fight. The theme, 'Invest in the future, defeat malaria' reminds us of the goal to not just reduce the impact of this prehistoric disease but to be relentless in our efforts to maintain the fight until malaria is controlled and, ultimately, eliminated.
What will it take to make that shift? Here are my three ideas:
1. Malaria must remain at the top of the agenda. Even as we tackle the rising challenge of non-communicable diseases in Africa , we must not forget that the job is not yet done with malaria. This disease must preserve its place on the post-2015 development agenda, or we risk failing millions of people. Making malaria a priority disease has secured necessary investment and resource over the last decade to rapidly scale up use of current tools, such as bed nets, but also to progress development of much needed new interventions.
This is working and in the face of so many other competing health priorities, we can't lose focus - indeed history has shown us that malaria bounces back viciously whenever we let up. There is much we can take from the fight against malaria to help treat other diseases. For example Nigeria is integrating programmes to defeat malaria and lymphatic filariasis (LF) - which in its most severe form leads to elephantiasis - given that both are spread by mosquitoes (more of this later).
2. Human creativity at its best can defeat malaria. As the parasite evolves, we need to keep innovating, deploying the best science to find new ways to prevent and treat malaria. The arrival, for example, of rapid diagnostic tests for malaria which can tell you in 10 minutes if a feverish baby has the parasite in its blood or not has revolutionised treatment approaches.
Now a vaccine against malaria is on the horizon. After almost 30 years of dedicated research, GSK's malaria vaccine candidate is in final stages of testing in young children across Africa. This year, safety and efficacy data will be provided to regulators. If the candidate vaccine is approved and recommended by global and national public health policy makers, we could have the world's first malaria vaccine within the following few years.
To help a vaccine reach those who need it most - young children in Africa - GSK will price it at cost of manufacturing plus a small return of 5% to reinvest in R&D for malaria and other neglected tropical diseases.
While a vaccine is not a 'silver bullet', when used with other malaria interventions, it has the potential to make another significant dent on the impact of malaria.
3. Unusual partnerships will make the difference. How can we make sure that even the most remote communities can access the education, prevention and treatment they require to defeat malaria? Here, we need to work within existing structures that are tailored to an individual community's needs and resources. These might be linked to healthcare, or not at all; but they will provide the right set of people, skills and locations.
Business, both big and small, with its resources, reach and expertise has an important contribution to make here - it should be encouraged and challenged to do so. The ubiquitous village corner shops have a role to play here as much as GSK does.
Also, I am surprised by the largely untapped potential of faith-based communities - especially with encouraging changes in behaviour. I see a future where unlikely partners will come together in ways that we have not seen before.
The point about partnerships is why I'm so excited about GSK's support for a project with The Carter Center in Nigeria. It exemplifies the type of innovative thinking and co-ordination that are needed to defeat malaria - and other neglected tropical diseases - for good.
Nigeria has the highest malaria death rate of any country and one of the world's largest populations at risk for LF. Is there a way that we can tackle both diseases simultaneously? Yes, the same bed net can fight both diseases by reducing mosquito bites. So, The Carter Center is focusing its efforts in Nigeria, supporting the government's efforts to make sure more people have access to bed nets and know how to use them. This is an efficient and effective method of tackling two debilitating diseases.
These kinds of partnerships show the power of thinking laterally about how we involve communities to ensure our efforts are sustainable and cost effective. If we are to stay one step ahead of malaria, we must continue to think beyond the obvious.