Commentary: malaria elimination and the 2030 Sustainable Development Goals

Malaria elimination and the 2030 Sustainable Development Goals: The need for measurable and achievable goals and targets

by Rima Shretta, Deputy Lead for Policy and Finance, Malaria Elimination Initiative

In 2000, 193 countries adopted the Millennium Development Goals (MDGs), a historic milestone in establishing a global development framework. The MDGs have been instrumental in coalescing the global commitment towards development and health. Nearly fifteen years after their adoption, the MDGs are still used as a universal benchmark to measure progress, in part, because they are limited in number, measurable, achievable and easily articulated.

 Malaria control and elimination has its own goal: MDG 6—to halt by 2015 and begin to reverse the incidence of malaria and other major diseases. It has been one of the most successful goals and has contributed to several of the other MDGs. The tremendous increase in financing for malaria, and coverage of malaria interventions led to a wide-scale reduction in malaria incidence and mortality: 59 out of 103 countries are on track to meet the MDG target of reversing the incidence of malaria. Between 2000 and 2012 malaria mortality rates fell by 42% in all age groups, and by 48% in children less than 5 years of age, averting an estimated 3.3 million malaria deaths. Four countries were declared malaria-free between 2007 and 2012. Despite these gains, an estimated 627,000 malaria deaths occurred in 2012, and 3.4 billion people continue to live under the threat of this preventable and treatable disease. The recent stagnation in financial aid has slowed progress, and many low-endemic countries are at risk of resurgence, which would reverse progress and cause avoidable death and illness. 

As the mandate for the MDGs ends, we stand once again at a cusp: we need a revised global development framework that renews political and financial commitment to health and development. The new Sustainable Development Goals (SDGs), to be deliberated at the United Nations General Assembly this week, have the potential to be as powerful as the MDGs. However, the current draft needs substantial revision to set a bold vision and garner the support of the global community. The current draft goals lack specificity, are not measurable or achievable and in some cases are inappropriate.

Health is fundamental to global development, poverty eradication and climate mitigation. Yet, the multidimensional aspects of health have been combined in to one single goal—SDG3 promoting "wellbeing for all"—an immeasurable concept without articulated linkages to the others goals. Similarly, malaria is couched within this goal as target 3.3 to "end the epidemics of AIDS, tuberculosis and malaria." For malaria, this target is inappropriate. The mortality resulting from malaria is not the result of epidemics but rather endemic transmission of the parasite. Two other global plans for malaria are in development—the WHO's new Global Technical Strategy for malaria and the Second Roll Back Malaria Global Malaria Action Plan—which share the goal: "Reduce malaria mortality rates and clinical case incidence globally by at least 90 percent compared with 2015, eliminate malaria from at least 30 countries that had transmission of malaria in 2015, and ensure prevention of re-establishment in countries that are malaria free by 2030." The debates at the UN this week provide an opportunity for donors and member states to ensure that the SDGs are aligned with other global frameworks.

The SDGs need to have similarly articulated targets with ambitious but achievable interim milestones. 34 countries are working towards eliminating malaria, but without a global commitment, they may find it difficult to secure the necessary political and financial commitment. While we can remain hopeful that the upcoming year of member state negotiations and debates will strengthen the SDGs, the process will need strong leadership from donor countries and high-level engagement from member countries. Only this leadership will generate the long term vision of a world free of malaria.