Partners in the Greater Mekong Subregion mobilize around malaria elimination goal

25 November 2016

Cambodian girls under bed nets
Him Lames, 6, (left) and El Phyyas, 10, (right), under a bednet in Svayor village, Cambodia.
Vlad Sokhin/ WHO 2016

Partners gathered this week in Phnom Penh, Cambodia, to assess progress in the malaria fight across the Greater Mekong Subregion (GMS). More than 55 representatives from ministries of health, WHO, funding agencies and other organizations shared updates on technical approaches, achievements and lessons learned.

According to a new report from WHO, there has been a major decline in cases and deaths across the GMS over the last 3 years. The six GMS countries cut their malaria case incidence by an estimated 54% between 2012 and 2015. Malaria death rates fell by 84% over the same period.

“Progress in the GMS was made possible through greater access to effective malaria control tools, particularly artemisinin-based combination therapies (ACTs), rapid diagnostic tests (RDTs) and long-lasting insecticidal nets (LLINs) as well as improved access to these services by vulnerable populations across the region,” said Professor H.E. Eng Huot, the Cambodian Secretary of State, who opened the meeting on 21 November.

But the spread of antimalarial drug resistance threatens to undermine these gains. To date, resistance of malaria parasites to artemisinin – the core compound of the best available antimalarial medicines – has been detected in five countries of the GMS. In some areas, resistance to artemisinin and its partner drugs has reached alarming levels.

Containing drug resistance

In 2013, WHO launched the Emergency response to artemisinin resistance (ERAR) in the Greater Mekong Subregion, a high-level plan of attack to contain the spread of drug-resistant parasites and to provide life-saving tools for all people at risk of malaria. That same year, WHO established a regional hub in Cambodia to coordinate multi-partner action.

The ERAR initiative brought fresh energy and resources to the GMS, generating new research, facilitating coordination and technical support and accelerating progress. But even as this work was under way, additional pockets of artemisinin resistance emerged independently in new geographic areas of the subregion. In parallel, there were reports of increased resistance to ACT partner drugs in some settings.

In view of the rapidly changing malaria landscape, WHO’s Malaria Policy and Advisory Committee (MPAC), a group of leading malaria experts, agreed in 2014 that there was only one way forward: eliminating the disease altogether from the subregion.

GMS elimination strategy

“Eliminating malaria in the GMS will not be accomplished with a ‘business as usual’ approach."

Dr Pedro Alonso, Director of the WHO Global Malaria Programme

In May 2015, GMS Ministers of Health endorsed the Strategy for malaria elimination in the Greater Mekong Subregion (2015–2030). Urging immediate action, this strategy calls for the elimination of P. falciparum malaria by 2025 and all species of human malaria by 2030.

Speaking at the forum in Cambodia, Dr Pedro Alonso, Director of the WHO Global Malaria Programme, reminded participants that there is a limited window of opportunity in which to act, and time is of the essence. “Eliminating malaria in the GMS will not be accomplished with a ‘business as usual’ approach. We need to quickly accelerate our efforts to achieve this ambitious goal, moving forward with strong determination and a deep sense of conviction.”

With technical support from WHO and partners, all GMS countries have developed malaria elimination action plans. WHO will provide ongoing support for country elimination efforts through the Mekong Malaria Elimination (MME) project – a new initiative that replaces the former ERAR hub.

Knowledge sharing

Best practices shared at this week’s meeting from the WHO European region and Sri Lanka showed that elimination can be achieved through the effective use of existing tools. Elimination success in these areas was attributed, in part, to the targeted application of effective control tools such as LLINs; the tailoring of interventions to local contexts and most at-risk populations; and strengthened health and surveillance systems – all outlined at the meeting as priority action areas for GMS countries.

In April 2016, WHO declared that all 53 countries of the European Region had reported at least 1 year of zero locally-acquired cases of malaria. Sri Lanka received the official WHO certification of malaria elimination in September 2016 after reporting more than 3 years of zero indigenous cases of the disease.

Partners highlighted the critical importance of country leadership as well as the need for strengthened collaboration across borders to accelerate progress and avoid duplication of efforts. WHO reiterated its commitment to providing coordination and technical support for this ongoing work.