Last week, the Maryland Department of Public Health announced a case of locally acquired malaria in a Maryland resident who lives in the greater Washington, D.C. area. The news, which comes on the heels of several locally acquired cases in Florida and Texas, is cause for some measured concern. Although all patients were promptly treated at area hospitals and are recovering, the recent cases are the first since 2003 to be caused by domestic mosquitoes that appear to have bitten one person with malaria and transmitted the parasite to another person.
Fortunately, malaria is both preventable and treatable, and the risk to Americans is very low. An efficient, comprehensive response led by state and local health departments with support from the U.S. Centers for Disease Control and Prevention (CDC) has all but eliminated the threat in Florida and Texas and will likely do the same in Maryland.
But focusing on the cases in Maryland, or Florida, or Texas, only tells one piece of a much larger story.
Malaria was one of the country's leading causes of death in the 19th century, but it was eliminated from the United States by 1952 through targeted efforts led by the Office of Malaria Control in War Areas—the predecessor to the CDC. Malaria continues to flourish in many other parts of the world, fueling the threat of its return to the United States. Indeed, approximately 2000 cases of malaria are imported into the United States annually, primarily from U.S. travelers returning from trips abroad. Therefore, it is important that the United States continues to strengthen its malaria surveillance system to ensure quick detection and response to prevent reintroduction of this deadly disease. But it cannot stop there.
With nearly half the world's population at risk of the disease, efforts like the U.S. President's Malaria Initiative (PMI) have been at the forefront of addressing that threat, with remarkable success. Global efforts have prevented 11.7 million malaria deaths and 2 billion malaria cases since 2000 and helped 42 countries eliminate malaria within their borders. In PMI partner countries alone, malaria death rates have declined 45 percent on average since the start of the initiative in 2006, and malaria case rates have declined 27 percent.
Unfortunately, as COVID made its way across the globe in 2020, the pandemic's impacts on the delivery of malaria services compounded a number of challenges that had slowly begun to hamper malaria control and elimination efforts, and the progress seen since 2000 stalled. More than 600,000 people—roughly the population of Baltimore—died last year of malaria globally; the majority of them were children under five years of age. Increasing resistance to commonly used insecticides and drugs, changing weather patterns, a new invasive mosquito, conflict, and stagnated funding added greater complexity to the fight against malaria globally, contributing to the slowed progress.
With over 30 U.S. states home to the species of mosquito that can transmit malaria, the risk of this potentially deadly disease will persist until these threats are addressed.
Accomplishing this will require renewed commitment, as global funding has fallen woefully short. The World Health Organization estimated that $7.3 billion was needed to fight malaria in 2021 alone, and the global resources that were mobilized fell far short of that goal. Increased funding will help ensure the ongoing effectiveness of existing treatments, like the medicines given to the recent American patients, and allow us to unlock new tools that can be used to combat the disease and stop its spread.
One such tool is the world's first malaria vaccine, created with support from the Department of Defense, the U.S. Agency for International Development, the Department of Health and Human Services, and many others. This new vaccine, when deployed as part of a comprehensive approach alongside tried and tested interventions such as mosquito nets, will move us closer to eliminating malaria globally, which in turn will save lives around the world and help minimize the risk of locally acquired cases in the United States. This is an investment worth making.
Ridding the world of malaria would also unleash stifled economic potential in some of the poorest parts of the globe. Estimates show every $1 invested in malaria control returns $19 in economic growth, leading to more parents who are able to work and feed their families, healthy children who can go to school, and stable and prosperous communities.
Ultimately, the story out of Maryland isn't simply a local one, or even a national one. It's a global one—one that began long ago and that continues to evolve as new challenges emerge and intensify. Addressing it in earnest requires prioritizing the elimination of malaria worldwide, a solution that will save lives, reduce illness, and safeguard the health of Americans.
A world without malaria is possible, and the United States is leading global efforts to make this vision a reality. By recommitting ourselves, this is a fight we can win.
Let ours be the generation that ends malaria once and for all—because whether in Maryland or Madagascar or the Mekong, no one should die of a mosquito bite.
Dr. David Walton is the U.S. Global Malaria Coordinator at USAID. Dr. Walton is charged with oversight and coordination of all resources and international activities of the U.S. government relating to efforts to combat malaria globally, including the U.S. President's Malaria Initiative.
The views expressed in this article are the writer's own.
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