Bi-annual letter to partners
Dr Pedro Alonso, Director, WHO Global Malaria Programme
Dear friends and partners,
In this December bulletin, I will briefly reflect on the following topics. You will find links to additional resources at the end of each section.
– Launch of World Malaria Report 2016
– RTS,S malaria vaccine programme
– New report: "Eliminating malaria in the Greater Mekong Subregion”
– Five-year WHO investigation on LLINs
– Elimination in Sri Lanka, and beyond
– New regional malaria frameworks
– Inaugural meeting of the Strategic Advisory Group on malaria eradication
– Tenth meeting of the Malaria Policy Advisory Committee
Our 2016 report, launched in London on 13 December, spotlights progress in the scale-up of core malaria-fighting tools for those most in need. Across sub-Saharan Africa, there has been a sharp increase in diagnostic testing for children and preventive treatment for pregnant woman over the last 5 years. A greater share of the population at risk of malaria is sleeping under insecticide-treated nets.
But major gaps in programme coverage remain, and progress towards key global targets must be accelerated. The Global Technical Strategy for Malaria (GTS) calls for a 40% reduction in malaria case incidence and mortality by 2020. According to our report, less than half of the 91 countries with malaria transmission are on track to achieve these milestones.
The GTS annual funding target for 2020 is US$ 6.4 billion, more than twice the level of financing available today. To reach our global goals, malaria investments will need to increase substantially, particularly in endemic countries.
In November, WHO announced that the world’s first malaria vaccine will be rolled out through pilot projects in sub-Saharan Africa. Vaccinations will begin in 3 countries in 2018.
The vaccine – known as RTS,S – provides partial protection against malaria in young children. It is being assessed as a complement to the existing package of WHO-recommended malaria preventive, diagnostic and treatment measures.
The pilot deployment of this vaccine marks a milestone in the fight against malaria. We thank and commend all partners who have made this programme possible.
In November, WHO released a report highlighting efforts to eliminate malaria in the Greater Mekong Subregion (GMS). According to WHO estimates, the 6 GMS countries cut their malaria case incidence by more than 54% between 2012 and 2015. Malaria mortality rates dropped by 84% in the same period of time.
But the rapid spread of multi-drug resistance continues to represent a significant threat. At a recent meeting of malaria partners in Cambodia, I congratulated GMS countries on their progress towards elimination while underscoring the urgent need to finish the job.
- Eliminating malaria in the Greater Mekong Subregion: United to end a deadly disease
- Partners in the Greater Mekong Subregion mobilize around malaria elimination goal
In 2011, WHO launched a large, multi-country evaluation to assess the impact of insecticide resistance on core malaria vector control tools, particularly pyrethroid-treated long-lasting insecticidal nets (LLINs). Results of the 5-year study were released at last month’s ASTMH conference in Atlanta.
The study showed that people who slept under LLINs had significantly lower rates of malaria infection than those who did not use a net, even though mosquitoes showed resistance to pyrethroids (the only insecticide class currently used in LLINs) in all of the evaluation areas.
While this finding is encouraging, WHO underscores the need for all endemic countries to develop and apply effective insecticide resistance management strategies. In parallel, WHO is calling for greater investments in new and improved tools to accelerate progress towards our global malaria goals.
- Five-year WHO investigation shows that LLINs remain a highly effective tool in the malaria fight
- Implications of insecticide resistance for malaria vector control
You no doubt saw the good news from Sri Lanka. In September, the WHO Director-General presented the official WHO certification of elimination to Sri Lanka’s Minister of Health. Our colleagues in WHO’s South-East Asia Office issued a press release that day and the Regional Director co-authored an excellent commentary in The Lancet.
Sri Lanka achieved a dramatic reduction in its malaria burden – from 2.8 million cases in 1946 to just 17 cases in 1963. But after the abandonment of the Global Malaria Eradication Programme in 1969, malaria came roaring back. Major epidemics of the disease were reported in the 1980s and 1990s.
In 1999, there were more than 250 000 confirmed cases of malaria in Sri Lanka. In the face of civil unrest and considerable exposure to mobile and migrant populations, the country managed to interrupt transmission in record time without significant external assistance.
Lessons learned from the elimination effort in Sri Lanka remind us that true country ownership and leadership are critical to success. This stunning achievement is a model for other endemic countries to follow, in the region and globally.
In November, Kyrgyzstan was certified by WHO as malaria-free. At least 3 countries will seek the elimination certification in early 2017, including Algeria, Argentina and Paraguay.
- WHO certifies Sri Lanka malaria-free
"Against the odds, Sri Lanka eliminates malaria"
- Kyrgyzstan receives WHO certification of malaria elimination
All endemic regions have moved quickly to develop and launch malaria action plans. In August 2016, WHO Member States in the African Region unanimously adopted a new framework that will guide countries and their partners as they implement the Global Technical Strategy for Malaria (GTS) across the region.
In September, health ministers in the Region of the Americas adopted an action plan that seeks, over the next 4 years, to further reduce malaria cases by 40%. The plan is fully aligned with the GTS and builds on major progress already seen in the region, including a more than 70% decline in malaria deaths since 2000.
Health leaders in the Western-Pacific approved a regional malaria framework in October, and a plan for South-East Asia will be launched in April 2017. The WHO Eastern Mediterranean Region led the way with the release of a regional action plan last year.
- Health ministers adopt new plan for malaria elimination in the Americas
- A new malaria framework for Africa
Recent success in the global malaria fight has sparked renewed discussion around the eradication agenda. In late August, members of a newly formed WHO Strategic Advisory Group (SAG) on Malaria Eradication convened in Geneva. The Advisory Group is comprised of leading experts across a variety of disciplines – from poverty and population growth to migration and urbanization.
SAG members agreed that WHO must lead the eradication debate and reaffirm its commitment to malaria eradication while explicitly not launching an eradication campaign at this point in time. The two key decision points from the meeting:
- To develop a position statement that clarifies the current terminology around malaria “elimination” and “eradication” and confirms WHO’s commitment to long-term malaria eradication.
- To provide advice to WHO on the determinants, expected cost, timeframe, and potential future strategies for malaria eradication over the ensuing decades.
As many of you know, the Malaria Policy Advisory Group (MPAC) plays a vital role in WHO’s policy-setting process for malaria. At our most recent meeting in September, MPAC members reviewed a draft manual on malaria elimination and the study findings of the Impact of Insecticide Resistance project. The agenda included, among other topics, an update on the RTS,S vaccine pilot implementation programme and on the WHO Strategic Advisory Group on malaria eradication.
Our MPAC meeting report provides a summary of the key discussions and decision points. See also our Q&A interviews with three outgoing MPAC members and a slide show of images from the meeting.
- Malaria Policy Advisory Committee meeting report (September 2016)
- Q&A interviews with outgoing MPAC members
- Slide show of images from the meeting
Wishing you and your loved ones a very happy holiday.