Spotlight on migrants in World Malaria Day pledge to end killer disease for good
Nenette Motus says despite major advances in malaria prevention, drug resistance and the high vulnerability of migrant and mobile populations in remote border areas mean efforts must be renewed to completely eliminate the disease
Today, on World Malaria Day, we are calling for renewed efforts to prevent and eliminate the disease, which continues to kill over 400,000 people every year.
Children are particularly vulnerable – in 2015, almost 70 per cent of all malaria deaths were among children under five. The theme of World Malaria Day 2017 is “End Malaria for Good”.
Advances in malaria prevention, including new methods of testing, the widespread distribution of insecticide-treated nets and the introduction of artemisinin-based combination therapies (ACTs) have contributed significantly to major reductions in malaria cases and deaths in the Greater Mekong subregion – Cambodia, Laos, Myanmar, Thailand, Vietnam and China’s Yunnan ( 雲南 ) province.
There has been a major decline in cases and deaths across this region over the last three years, according to the WHO. Malaria case incidence was cut by an estimated 54 per cent between 2012 and 2015, while malaria death rates fell by 84 per cent over the same period.
But, despite these achievements, the emergence of drug resistance in many areas across the region, particularly in border areas, has required a change in strategy to completely eliminate disease in the Asia-Pacific region, or “end malaria for good”.
Migrant and mobile populations are considered highly vulnerable to malaria for a variety of reasons. The Greater Mekong subregion, which is home to some 300 million people, hosts an estimated 4 million cross-border migrants, mainly in Thailand. Many others migrate internally in search of work.
Migrants’ vulnerability to the disease is linked to the fact that they often live and work in forest-related industries, agriculture or construction in remote rural areas, where the anophleles mosquito that carries the malaria parasite still exists.
In addition, due to their lack of official status and their exclusion from public health services, they may be less aware of malaria and have less access to health services than host communities.
Their biological immunity may also be lower if they come from non-forested areas where there is no malaria. And they often live in poor housing with few mosquito screens or bed nets.
While malaria elimination efforts need to target all at risk populations,the International Organisation for Migration believes the vulnerability of such migrant and mobile persons in the region could be dramatically reduced through better outreach, education, protection, service provision and surveillance by national health systems and their implementing partners.
The International Organisation for Migration is working across the subregion with migrants, host communities, work sites, employers and governments to improve access to malaria diagnosis and prevention services. But more needs to be done.
Governments and society as a whole need to rethink a commonly held view that migrant and mobile populations are “a problem that needs to be addressed”. In fact, they are a group that is sometimes excluded because we often fail to fully understand their situation and don’t always know where, when or how they can best be reached. The problem which needs to be addressed is therefore the failure of our health systems to always reach migrants.
The World Health Organisation recognised this challenge in 2008, when it called on member states and partners to advance migrant-friendly practices and policies to achieve universal health coverage – on the grounds that healthy migrants are necessary for healthy societies.
The International Organisation for Migration believes that in order to move forward, we now need to rapidly improve the tools, methodologies and practices for assessing and understanding local mobility dynamics, and how they affect the transmission of malaria.
We also need to link malaria prevention, treatment, and surveillance data and initiatives across migration routes and borders. Cross-border cooperation will show us where these populations are currently being missed.
In addition, we need to strengthen multisectoral engagement to combat malaria beyond health, to include relevant public sector bodies like immigration, labour ministries and private sector players, notably forest product companies.
Finally we must promote and encourage migrant inclusion in national/state/provincial health service planning and all malaria services in all six Greater Mekong countries.
These initiatives reflect the four-pillar approach that the International Organisation for Migration recommends for combating malaria worldwide. They include: the introduction of migrant-inclusive policies and legal frameworks; the creation of migrant-sensitive health systems and programmes; the establishment of partnerships, networks and multicountry frameworks; and better monitoring of migrants’ health.
Dr Nenette Motus is director of the regional office for Asia and the Pacific of the International Organisation for Migration