https://orcid.org/0009-0009-8111-9137
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Kirsten A L Morris, Hugo Turner, Anna Checkley, David Ross, Peter Chiodini, Malaria chemoprophylaxis provision in the UK: a call to evaluate the cost-effectiveness and equity implications of universal provision, Journal of Travel Medicine, Volume 32, Issue 3, April 2025, taaf017, https://doi.org/10.1093/jtm/taaf017
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Malaria is the leading cause of fever in travellers returning from malaria endemic areas. The UK reports ⁓1600 cases of imported malaria annually with 2023 figures exceeding 2000 cases for the first time since 2001. Between 2000 and 2021, there were 164 reported deaths attributed to malaria in the UK.1 Many cases of malaria are preventable through anti-vectoral methods (e.g. bed nets, insect repellents) alone or with chemoprophylaxis; the primary pharmaceutical prevention method. Chemoprophylaxis offers excellent efficacy when the prescribed regimen is tailored to an individual’s circumstances and risk profile.
Provision of malaria chemoprophylaxis for travel to malaria endemic regions is an exception to the UK’s universal healthcare coverage [through the National Health Service (NHS)]. In the 1990s ecosystem of foreign travel practices, malaria clinical management and prescribing, an analysis of national epidemiological and economic data showed that funded malaria prophylaxis results in reduced healthcare costs and productivity losses from malaria relative to the low cost of chemoprophylaxis.2 Based on incidence per visit to malaria endemic regions, Behrens et al. found chloroquine and proguanil and mefloquine cost-effective with cost–benefit ratios of 0.19 and 0.57, respectively, and >9 deaths prevented per year.2 Yet in 1995 the UK government opted to remove malaria chemoprophylaxis from universal healthcare coverage, allowing healthcare providers to charge for it.3 Reasons were not provided for the change in the announcement3 but the NHS follows the principle of funding travel medicine interventions for diseases that pose a public health risk to UK residents, like hepatitis A, typhoid and polio, whilst interventions for individual traveller protection, such as malaria chemoprophylaxis, Japanese encephalitis, and rabies, are privately funded. The decision not to fund malaria chemoprophylaxis prompted immediate concern from clinicians (Badrinath et al., 1998) who observed a > 8 fold decrease in prescriptions for malaria chemoprophylaxis by March 1996 and a steady rise in malaria notifications to over three times the number of cases in March 1997 compared to March 1995, in Walsall, UK. The before and after study by Badrinath et al. (1998) did not include travel data and does not prove causation but suggests a relationship between policy implementation and disease notifications.
