By Kate Kelland
LONDON (Reuters) - Global funding for the fight against malaria has stalled in the past two years, threatening to reverse what the World Health Organisation (WHO) says are "remarkable recent gains" in the battle to control one of the world's leading infectious killers.
After rapid expansion between 2004 and 2009, funding for malaria prevention and control leveled off between 2010 and 2012 - meaning there were fewer life-saving steps taken in hard- hit malarial regions such as sub-Saharan Africa.
"If we don't scale up vector control activities in 2013 we can expect major resurgences of malaria," said Richard Cibulskis, lead author of the WHO's World Malaria Report, which was published on Monday.
"Vector control" means stopping transmission of the disease with tools such as treated mosquito nets. The report found that deliveries of such nets to endemic countries in sub-Saharan Africa dropped from 145 million in 2010 to an estimated 66 million in 2012.
"This means that many households will be unable to replace existing bed nets when required, exposing more people to the potentially deadly disease," the report said.
Malaria is caused by a parasite carried in the saliva of mosquitoes and kills hundreds of thousands of people a year, mainly babies and children under the age of five in Africa.
According to WHO data, the disease infected around 219 million people in 2010, killing around 660,000 of them. Robust figures are, however, hard to establish and other health experts say the annual malaria death toll could be double that.
An estimated $5.1 billion a year is needed between 2011 and 2020 to get malaria medicines, prevention measures and tests to all those who need them in the 99 countries which have on-going transmission of the disease.
"Essentially, with the tools that we've got, we need to make sure that we continue the investments in the control measures that we have," Cibulskis told a news conference in Geneva.
"If we don't do that, malaria will bounce back. As soon as you take bed nets away, malaria will come back. If you stop indoor residual spraying, it will come back, and with a vengeance. So yes, we need to keep on investing in malaria ultimately until new tools are developed."
The WHO says while many countries have increased financing for malaria, the total available global funding remained at $2.3 billion in 2011 - less than half of what is needed.
"Global targets for reducing the malaria burden will not be reached unless progress is accelerated in the highest burden countries," Robert Newman, director of the WHO Global Malaria Programme, said in statement with the report.
"These countries are in a precarious situation and most of them need urgent financial assistance to procure and distribute life-saving commodities."
The WHO report found that by far the greatest impact of malaria is concentrated in 14 endemic countries which account for an estimated 80 percent of malaria deaths.
Nigeria and the Democratic Republic of the Congo are the most affected countries in sub-Saharan Africa, while India is the hardest hit in South East Asia.
WHO director general Margaret Chan wrote in a forward to the report that there is now an urgent need to identify new sources of funding to boost and sustain malaria control.
"We also need to examine new ways to make existing funds stretch further by increasing the value for money of malaria commodities and the efficiency of service delivery," she said.
The Roll Back Malaria Partnership, which includes the WHO, UNICEF and the World Bank, said it was already exploring several options, including financial transaction taxes, airline ticket taxes and a potential "malaria bond" to encourage more involvement from private sector investors.
Fatoumata Nafo-Traore, executive director of the Roll Back Malaria Partnership, said Mozambique and one other African country were preparing to pilot such a bond in 2013, with the hope that other countries would follow their example.
(Reporting by Kate Kelland; Additional reporting by Tom Miles in Geneva; Editing by Stephen Powell)