Opening remarks at the 13th Roll Back Malaria Partnership Board Meeting
Dr Margaret Chan
Director-General of the World Health Organization
Honourable Minister Tewodros, Chair of the Board, Honourable Ministers, distinguished members of the board, ladies and gentlemen,
I am most pleased to address this 13th board meeting of the Roll Back Malaria Partnership. I am grateful to the government of Ethiopia for hosting this meeting. I am grateful to Ethiopia for some additional reasons, which I will mention shortly.
Around a decade ago, observers of the malaria situation had one positive statement to make. The malaria situation is stable, they said. It could hardly get any worse.
This no longer applies. Today, there is more than a whiff of optimism in the air. In fact, I believe we are experiencing a wind of change that could turn this disease around, and possibly very quickly.
I see solid reasons for optimism in the strength of international commitment, in the power of existing interventions, and in the coherence of evidence-based strategies for implementation. But the best reason for optimism comes from the results we are seeing in countries, here in Ethiopia and elsewhere in Africa.
At the international level, world commitment to reduce poverty, formalized in the Millennium Declaration and its Goals, placed malaria control in its rightful place as central to overall development, especially in Africa. Today, malaria receives high priority as a killing and debilitating disease, but also as a major constraint to economic progress.
In addition, more people understand that malaria is an eminently preventable and treatable disease. This increases the moral imperative to act. This massive burden of illness, this huge number of deaths, need not happen.
Concern about malaria has become more than just a health issue. Responsibility goes beyond the health sector. Heads of state are increasingly engaged. We see this in Africa, when presidents, prime ministers, and health ministers launch high-profile malaria campaigns. The African Union’s initiative in this regard is much appreciated. We also see the engagement of heads of state in countries that have no malaria within their borders. Malaria control has entered the realm of foreign policy.
This level of international commitment brings determination, and determination can bring out the best of human ingenuity. The number of innovative funding mechanisms continues to grow, as does the size of resources they command.
Two weeks ago, the Global Fund approved the largest ever total of grants made for malaria, amounting to almost half a billion dollars. I would like to commend the work of the Harmonization Working Group, which played a key role in this success. UNITAID was launched last year to facilitate the sustainable purchasing of drugs for HIV/AIDS, TB and malaria. Malaria programmes are already benefiting from the first deliveries of ACTs.
This Board will be considering the technical design of yet another innovation: a facility to support affordable medicines for malaria through subsidized co-payment. This proposal addresses a two-fold pressing need: first, to make ACTs more accessible and affordable, and second, to preserve the lifespan of these drugs.
Commitment and determination have also been expressed through the creation of public-private partnerships for product development. The Medicines for Malaria Venture is on track to launch four new ACTs, including a paediatric formulation.
Another signal of the significance given to malaria is the effort, spearheaded by the Bill and Melinda Gates Foundation, to place the best science in the service of better tools for prevention and control. This includes funding for a vaccine, a development that has long been the greatest hope for malaria.
As we all know, the availability of an effective and affordable vaccine would dramatically alter the prospects for combating this ancient scourge. It would allow us to set far more ambitious goals.
But the opportunities I have mentioned give us cause to be more ambitious right now. As we all know, we have lost precious time in the past. For a disease like malaria, the consequences of inaction are measured in avoidable deaths every day.
The world has woken up to malaria, and is watching the situation closely. The world is watching this partnership, and its performance.
There is much to act on, right now. The portfolio of interventions has been broadened. WHO has provided a clear and coherent strategy, with strong policy support.
This technical support extends to recommended drugs and recommended strategies for the delivery of treated nets. WHO has a clear policy on the use of indoor residual spraying with insecticides, including DDT. Evidence is mounting that home-based management of malaria is effective, and that ACTs can be sustainably delivered through community-directed approaches.
Evidence shows that these interventions, especially when delivered in an integrated way, can bring rapid and impressive results within countries.
Ladies and gentlemen,
With all this as a background, what actually contributes to successful results in countries? Let us look at Ethiopia.
The first and most important factor is political commitment at the highest level of government. I thank the government of Ethiopia, and several other countries in Africa, for this commitment.
Second, any initiative that wants to reduce mortality from malaria must set ambitious goals. It must aim to reach the poorest of the poor.
Third, a disease as complex and difficult as malaria is best addressed by a multi-pronged approach, based on sound science. For example, Ethiopia is using community volunteers to make ACTs widely available to the poor, virtually reaching the doorsteps of rural homes. In a mass campaign, almost 20 million long-lasting insecticide-treated nets have been delivered over the past two years. With government support, more than 30,000 health extension workers have received a full year of training.
These are some examples of strategies, backed by committed politicians and ministers of health, that are bringing down mortality. We all know the good results from Kenya published earlier this year.
Fourth, countries need to make good use of what already exists. We know the consequences of ineffective aid, of overlapping and fragmented activities among multiple partners. We know the burden placed on countries, the high transaction costs, and the frequent failure to align with country priorities and capacities.
In many cases, the poor are best reached through the use of existing delivery channels. These may be schools or antenatal clinics. Increasingly, immunization campaigns are being used to deliver a package of essential interventions, including treated nets, vitamin A supplements, and deworming tablets as well as vaccines for measles and polio. Immunization programmes generally do the best job of delivering interventions to hard-to-reach populations, and can achieve high population coverage, even in the absence of a well-functioning health system. Using them for integrated delivery of malaria interventions is a value-added approach that increases operational efficiency while also boosting the benefits for health.
My final point is this. Never forget the energy and resourcefulness of communities. In rural parts of Africa, when community views are assessed, malaria nearly always emerges as the number one priority. Community concern about mutual welfare is powerful social capital that should be tapped.
I will make one concluding observation, followed by a request. The winds of change are in our favour. Opportunities and momentum are on our side. Funds are flowing. Political commitment is yielding results in countries. We know what works and are increasingly able to prove it.
The best way forward is in your hands. The world is watching, but will not wait for long. Roll Back Malaria needs to agree on a single global plan for malaria control, and then operate in a way that upholds this plan. Each partner has core competencies and a unique contribution to make, and this contribution needs to be part of a coherent and cohesive whole.
Many elements are already available. For its part, WHO has contributed the strategic and policy directions. All elements need to be articulated in a single agreed plan.
Credible leadership depends on such a plan. The attention malaria is now receiving brings close scrutiny. Resources come with an expectation of results. This partnership needs to improve its operational efficiency, and a single global plan is the right step in this direction.
I challenge you to act on this proposal. As I said, the consequences of inaction are measured in avoidable deaths every day.