Edited Transcript of Opening Remarks by Minister for Foreign Affairs Dr Vivian Balakrishnan at the Launch of the Lancet Commission on Malaria Eradication, 8 October 2019, Singapore

1 I am delighted to be here this afternoon for the launch of the Commission.

Avoiding Complacency

2 We live in a time of historically low malaria prevalence. We can credibly discuss not only malaria control, but malaria eradication. This is thanks to the tireless efforts of scientists, clinicians, healthcare workers, policy makers, engineers, and many others over the past 60 years. The World Health Organisation (WHO) estimates that malaria incidence fell by about 37 per cent between the year 2000 and 2015. Malaria mortality rates have also declined by approximately 60 per cent since 2000.

3 As a former clinician and also a former Minister overseeing environment policy, it is clear to me that we should not be lulled into a false sense of complacency over the challenge posed by malaria. 

4 First, malaria remains a clear, present, and deadly threat to the world. The same WHO data source that I quoted earlier that points to decreasing malaria incidence also indicates that we have 219 million cases of malaria which occurred worldwide in 2017 and 435,000 malaria deaths globally. Second, we are now vulnerable to newer and more resistant strains of malaria. The progress in eliminating malaria has meant that the remaining parasites have adapted well to this new environment. This entails serious, emerging risks of anti-malarial drug resistance. Third, we live in an ever-more interconnected world. Diseases do not respect sovereign borders. The large migratory foreign workforce, influx of travellers and refugees add to the risks. Even countries declared malaria-free like Singapore cannot take the status quo for granted.

5 The solution, of course, is not to close borders. Rather, I would like to highlight three themes in the Commission’s recommendations that we need to be more mindful of to ensure that we do not lose the momentum we have achieved so far.

International Collaboration

6 First, international collaboration is crucial. As the commission highlights, success in eradication efforts requires action across the “country, regional, and global levels” in order to achieve the 2050 goal. It will require close coordination with international institutions, including the WHO and the United Nations (UN), as well as regional and sub-regional institutions. Singapore is a very small, city-state. By definition, we then have to be a believer and staunch advocate of the UN, and other international institutions that make up the international rules-based world order. Singapore is acutely aware of the need for a multilateral approach in dealing with complex, global challenges like malaria. Apart from malaria, these include poverty eradication, climate change, and the next pandemic.

7 Such planetary challenges cannot be solved by any one country, no matter how big. It requires an all-of-planet response. The Asia Pacific Leaders Malaria Alliance – or APLMA – has played a crucial role in forging political commitments within the region. It has sustained high-level political attention on this issue at the Leaders’ level in the East Asia Summit, ensuring some political impetus to address malaria. APLMA has also provided technical expertise undergirding these discussions. The APLMA Malaria Elimination Roadmap and Leaders’ Dashboard are also useful open resources for countries. These studies clearly highlight that eradication strategies can make a difference, particularly when there are some political imperatives.  

Technological Innovation

8 Second, I am also pleased to note the Commission’s emphasis on innovation. Today, human beings are not just living longer, but staying healthy for a larger proportion of their lives. Medical advances have been a major driver in this change. Two hundred years ago, the average life expectancy was 29 years; today, on a global level, we are on average living up to 72. In fact, in Singapore, life expectancy is 84 years. If you rewind to the 19th century, the industrial revolution provided employment to many, but was accompanied by negative externalities – pollution, overcrowding, urban decay, lack of clean water and air. It was a time ripe for medical innovations. For instance, today we take for granted the Germ Theory by Louis Pasteur and Robert Koch, but in its time that understanding was a breakthrough. This was thanks to the significant advances in microscope technology. The antiseptic theory by Joseph Lister led to cleaner operating theatres and higher survival rates. The use of quinine against malaria was also pioneered, and the standard treatment till the 1920s. Many of our routine surgical procedures and treatments today are due to the significant advances made in the 19th century. Similarly, it is important that new tools in terms of diagnostics, drugs, and vector control technologies are deployed in the fight against malaria. I have no doubt that the panels today will add to the enlightened debate in this regard.

Sustained Resourcing

9 Third, the Commission rightly addresses the need for sustained resourcing. According to the WHO, malaria investments need to be doubled to USD 6.6 billion to achieve the 2030 target of reducing incidence and mortality rates by 90 per cent. This is a fiscal responsibility that multilateral financial institutions, donors, and governments have to collectively bear. We are mindful that this meeting takes place just before the Replenishment Conference for the Global Fund to fight AIDS, tuberculosis, and malaria. Domestic governments need to play a part too. The reduction of malaria incidence in Asia-Pacific was underpinned by domestic financing. The economic development in the region over the past few decades has meant that countries like Singapore, Malaysia, and China were able to commit sufficient resources to healthcare issues and thereby contribute to the eradication of malaria. 

Conclusion

10 In closing, the challenges in malaria eradication are not insignificant, but they can also be overcome if we address them collectively. The expertise and technology to eradicate malaria is already available here in the region. Whether or not we succeed is actually a matter of political will. 

11 The Lancet Commission on Malaria Eradication is a clear testament to the value that collective and coordinated technical leadership from 41 researchers all over the world can produce. I am glad that we have cross-sectional representation here today, from the scientific community, industry, and domestic government officials, for this launch event. I would like to extend my congratulations to the Lancet Commission, APLMA, and the National University of Singapore (NUS) for this successful launch, the first in Asia. Singapore will continue to support these worthy initiatives, as we strive to make the world a healthier place for all. Thank you. 

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