Dani used to work in Eswatini (previously known as Swaziland) in a small food processing plant. His family remained in Mozambique and he often went there to bring them the money he had earned. For a few weeks, Dani could not go to work because he had contracted malaria like some of his colleagues in Eswatini.
In 2015, Eswatini was virtually free of malaria. The authorities had noted that labour migration is a substantial cause of the disease's presence in the country. Indeed, most of the imported malaria cases are Mozambican (63%), from workers who, like Dani, earn a living in Swaziland and support their families in Mozambique. Having understood the cause, Eswatini began to rapidly identify cases and prevent the spread of the disease. Collaboration with local communities and other sectors, such as migration, is crucial. Other countries where malaria is endemic have also realised that cross-sectoral approaches are needed to combat the disease effectively.
Forging cross-sectoral links is important for facilitating joint efforts and tackling a problem at all levels. This view is also the basis for multilateral cooperation to achieve the Sustainable Development Goals of the 2030 Agenda. The Swiss Agency for Development and Cooperation (SDC) does this on several fronts. It encourages the implementation of programmes targeting health determinants such as water, air pollution, climate change and migration.
"Preventing and treating malaria remains essential, be it through insecticide-treated nets or medication. Other measures, like installing water distribution and treatment facilities and raising awareness among at-risk communities, have a direct impact on the disease's prevalence," explains Olivier Praz of the SDC's Global Programme Health Division.
Malaria is increasingly becoming geographically and demographically concentrated in communities with common characteristics, i.e. the same social context and similar customs. For example, some people's jobs require them to work outside at night, which increases their contact with mosquitoes and thus with the disease.
Cooperation across several sectors therefore means bringing together multiple actors. For example, the SDC is a member of the Swiss Malaria Group (SMG), which brings together all Swiss institutions active at national and international levels in the fight against malaria.
With its expertise in fighting malaria, Switzerland is engaged in bilateral and multilateral cooperation, fostering collaboration between civil society, the private sector and the scientific community. This expertise stems from the work of research institutions such as the Swiss Tropical and Public Health Institute (Swiss TPH) and major pharmaceutical companies such as Novartis, Syngenta and Merck.
Novartis has been part of the fight against malaria since the 1990s. In 2001, it was the first company to pledge to provide antimalarial drugs to the public sector in malaria-endemic countries at no profit. The company is working with partners in Switzerland and Africa to bring new antimalarial drugs to communities in need, where markets have collapsed and there is limited private sector investment in research and development.
"We recognize that malaria cannot be eliminated without a multi-sectoral approach that includes insecticide-treated nets, case detection and monitoring, and treatments. We are one piece of a jigsaw puzzle to which various Swiss partners are also contributing actively and substantially," explains Caroline Boulton, Global Program Head Malaria at Novartis.
Swiss TPH is another piece of this puzzle, complementing the work done by governments, NGOs and the private sector. The institute's scientific expertise and operational experience are complemented by its presence in the field, be it in Tanzania, Chad or Côte d'Ivoire. Prevention is a key word here.
In Tanzania, for example, 100 million insecticide-treated nets were distributed between 2002 and 2021 thanks to a programme run by the Swiss TPH. Moreover, in 2021 the World Health Organization (WHO) recommended the widespread use of a malaria vaccine that is the result of decades of research and development to which Swiss TPH contributed across the entire development pathway from discovery to preclinical studies, and to human clinical testing in both early and late studies with many African collaborators. "With a moderate efficacy of 30% for severe malaria cases, the vaccine still makes a very important contribution to public health, as this disease is so common and harms the lives of millions of children in Africa," explains Christian Lengeler, Head of the Health Interventions Unit, Swiss TPH. The teamwork between these and other players has put Switzerland at the forefront of efforts to win the international fight against malaria.