By Shivaji Sarkar
Dreaded malaria can make a comeback amid global warming-heavy rains and needs three times more allocations a year. India suffers a severe economic hardship, wage and production loss as it accounts for 83 per cent of malaria cases and 82 per cent deaths in South-East Asia regions in 2021, says the World Health Organisation.
The South East Asia region has 4.2 million cases and 7341 deaths. Climate change and warming can accentuate the problem, according to Soumya Swaminathan, Chief Economist of WHO amid global commitment to eliminate malaria by 2030.
Annually India spends about $1.94 billion on malaria or over Rs 11000 crore, according to an estimate in 2017 by Indrani Gupta and Samik Chaudhury of Ambedkar University. But it may have to increase allocations as the WHO finds that its own estimates needs at least three times rise a year. Meeting global targets need robust funding. According to the WHO report, current funding levels (estimated at US$3.3 billion in 2020) will need to more than triple, reaching US$ 10.3 billion per year – $ 80.24 billion by 2030, target date for elimination of the disease. Malaria can strain national economies, impacting some nations’ gross domestic product by as much as an estimated 5–6 per cent. It includes 75 per cent losses on productivity/wages and the rest on treating the disease, says Gupta.
The WHO funding raise is important as it targets malaria elimination by 2030. India has also committed to it. It needs enormous budgetary allocation, a severe strain for a government under financial constraint. It is said that malaria is manageable and controllable. The 15th Finance Commission recommends unconditional grants of Rs 1 lakh crore for the health sector for five years and told the States to spend 8 per cent of their budget on health. The Economic Survey 2020-21 says that out of pocket expenses by households on health is one of the highest in the world more so if treated in private sector.
Mumbai warns of malaria spread as in June 2022 itself it detected 57 cases and 119 cases in the first week of July. Assam has recently issued a warning on vector borne diseases as 74 encephalitis cases have been detected. North-East has very high incidence and malaria related anaemia. Similarly, Delhi reports detection of 126 dengue cases in June itself but is silent on malaria. In western Uttar Pradesh, medical officer Dr Avanindra Kumar issues alert and creates special malaria-dengue wards at 10 primary health centres early July. Rajasthan has heavy rains this year. The incidence of malaria in 2021 had increased marginally to 649 cases from 449 cases in 2020 and dengue case 1022 cases from 717 cases foods.
The Union Health Ministry says despite powerful drugs to treat malaria, the last two years of covid pandemic has thrown up challenges for diagnosing malaria. Several symptoms are so common and adds, “it has become harder for medical professionals to discern from initial symptoms leading to misdiagnosis or worse no diagnosis”. No wonder that there remains a gap between Indian national data and that of the WHO.
Various data and information from Purulia, Jalpaiguri in West Bengal, Kheda in Gujarat and WHO may be an indicator of the losses because of the vector-borne disease. New data from the WHO reveals that the COVID-19 pandemic has disrupted malaria services, leading to a marked increase in cases and deaths. According to its latest World Malaria Report 2021, there were estimated 241 million malaria cases and 627,000 malaria deaths worldwide in 2020. This represents about 14 million more cases in 2020 compared to 2019, and 69,000 more deaths. Approximately two-thirds of these additional deaths (47000) were linked to disruptions in the provision of malaria prevention, diagnosis and treatment during the pandemic.
Malaria cases and deaths remain unacceptably high and are resurgent in several settings, though recent developments inspire optimism. The report also states between 2.7 and 5.9 million cases for India in 2020, whereas the official data records about 187,000 cases. Director of Malaria No More, Pratik Kumar, says that one of the reasons for disparity remains malaria burden diverted to the private health sector, which now are catering to a large segment of healthcare facilities. The disparity is also noticed in the numbers, 10.9 lakh malaria cases reported in 2016 while the sales of anti-malaria drugs were ten times more. Acknowledging the factor Odisha Chief Minister Naveen Patnaik has asked private healthcare facilities to report such incidence.
Despite gains over the last 15 years, malaria control has stagnated, with resurgence and rising morbidity in several highly endemic countries exacerbated by service disruptions due to the COVID-19 pandemic, says a study ‘Malaria in 2022: Increasing challenges, cautious optimism’ by Prasanna Jagannathan & Abel Kakuru in Nature Communications.
Indrani Gupta notes that an analysis of the trend and patterns in public expenditure by the National Vector Borne Disease Control Programme shows a declining focus of the central government on vector-borne diseases. Also, allocation of financial resources among States does not reflect the burden of malaria, the major vector-borne disease in the country.
Data reporting in public domain seems to be less during the past few years. It is stated that since larger numbers are treated in private hospitals and clinics data prospecting has suffered. “The fight against malaria has recorded immense progress in the recent years. However, as seen in the past, malaria has a history of bouncing back with a vengeance. Through active media attention, key gaps and issues can be regularly highlighted, ensuring that those are addressed in strategic and policy decisions. This will help India expedite efforts towards malaria elimination,” says Kirti Mishra, chief technical officer, Odisha, Malaria No More.
The 2020 report of the WHO Strategy Advisory Group on malaria eradication has looked at this in detail and does provide useful information, especially with respect to malaria transmission and the vulnerability of populations to malaria as 95 per cent of Indians live in malaria-prone areas.
Chief Economist of WHO, Soumya Swaminathan says, the basic WHO position is that climate change is likely to increase rather than decrease the risk of malaria transmission. The WHO is testing genetical modification of mosquitoes to counter malaria but warns that India should not use it as field trials are several years away.
Malaria manifests in several forms and often goes unreported due to misattribution. Committing to eliminate it by 2030 after a 70-year crusade is not easy, and the world may have to wait for some more years. — INFA