Malaria

Letter to partners

Dr Pedro Alonso, Director, WHO Global Malaria Programme

19 December 2017

Dr Pedro Alonso
M. Henley/ WHO

Dear friends and partners,

As 2017 draws to a close, I am pleased to share with you some recent highlights of our work in the Global Malaria Programme (GMP). Many of you receiving this email have contributed to the activities and results described below; your contributions are very much recognized and appreciated.

This December bulletin will provide a brief update on the followings topics. Highlights from the first half of the year can be found in my June bulletin.


Malaria response at a crossroads

There are some notable bright spots in our latest World malaria report, released on 29 November. For the second consecutive year, the WHO European Region remains malaria-free. Since 2010, many countries in the WHO African Region have reported major improvements in diagnostic testing and surveillance. Globally, more countries are moving towards the ultimate goal of elimination.

However, the overall picture painted by the data is less than encouraging. In 2016, the estimated number of malaria cases reached 216 million, an increase of 5 million cases over the previous year. Deaths stood at 445 000 in 2016, a similar number to the previous year.

The WHO African region continues to carry more than 90% of the burden of disease. New data suggest that the estimates for this region presented in our report are conservative. GMP will embark on a comprehensive review of this new data and burden estimation methods in 2018.

Malaria funding has plateaued since 2010. The investment of US$ 2.7 billion in 2016 represents only 41% of our annual funding target for 2020. Worryingly, in many high-burden countries, per capita funding for the population at risk of malaria was lower in the period 2014-2016 compared to the previous 3-year period.

Progress in the global malaria response has unquestionably stalled. Clearly, to get the response back on track, increased funding is urgently needed from international donors and endemic countries. Critical gaps in access to tools that prevent, diagnose and treat malaria must be found and filled.

Saving young lives in Nigeria

After an 8-year conflict in north-eastern Nigeria, two thirds of health facilities in the region are completely or partially destroyed. Millions of internally displaced persons lack access to basic medical care. In early 2017, WHO estimated that malaria was claiming more lives in Nigeria’s Borno State than all other diseases combined, particularly among young children.

Last spring, GMP joined forces with our colleagues in Nigeria and the Regional Office for Africa to develop a framework aimed at dramatically lowering the toll of malaria on children under 5 years of age. As part of the initial response, the framework called for monthly rounds of age-targeted mass drug administration (MDA), a WHO-recommended approach for rapidly reducing malaria death and disease in complex emergency settings.

In collaboration with the Borno State Ministry of Health, WHO rolled out an MDA campaign this year during peak malaria transmission season, from July through November. Through the campaign, 1.2 million children were reached in 5 high-transmission areas of Borno State with both antimalarial medicines and the oral polio vaccine.

This campaign marked the first time that antimalarial medicines were delivered on a mass scale alongside the polio vaccine in an emergency humanitarian setting. The campaign benefited greatly from WHO's well developed network of polio vaccinators who have extensive experience reaching vulnerable children in this region.

Preliminary results from this time-limited campaign show a major reduction in malaria case incidence and mortality in the intervention areas; we will share the full impact data in 2018. You can learn more about the campaign through our online Q&A and photo slide show. See, also, WHO’s new guidance on mass drug administration.

Strengthening our work in emergency settings

The campaign in Borno State was designed and carried out in close collaboration with colleagues in WHO’s Health Emergency Programme (WHE). Throughout the 4-month campaign, the Organization’s health emergency teams in Nigeria procured, airlifted and distributed the monthly rounds of antimalarial medicines to children in targeted areas.

Lessons learned from the campaign in Nigeria will be applied in other emergency humanitarian settings. Together with WHE and focal points in our regional and country offices, GMP is also supporting, for example, the response to malaria outbreaks in South Sudan, Burundi, Cape Verde and Yemen. We will keep you informed in the coming months on our work in these emergency settings.

Drug resistance in the Greater Mekong

You may have seen recent news articles on the presence of a drug-resistant lineage of malaria parasites in south Viet Nam that is responsible for “alarming rates of failure” of dihydroartemisinin-piperaquine (DP), a first-line antimalarial medicine. Several media organisations reported on the rapid spread of a “dangerous” malaria parasite that “cannot be killed with the main anti-malaria drugs” – a parasite they described as “super malaria.”

While we are obviously concerned with the problem of multidrug resistance in the Greater Mekong Subregion (GMS), we feel these news reports sounded alarm bells unnecessarily. GMP has developed a public Q&A that articulates our position on this issue.

WHO is committed to working with countries in the Greater Mekong as they accelerate progress towards a common goal: eliminating malaria by the year 2030. In collaboration with partners like the Global Fund – which has made unprecedented malaria investments across the subregion – we are making significant headway.

Since 2008, when artemisinin resistance was first detected in the GMS, there has been a major decline in the rate of malaria cases and deaths across the subregion. According to the latest bulletin from the WHO Mekong Malaria Elimination programme, malaria cases and deaths in the six GMS countries fell by 74% and 91%, respectively, between 2012 and 2016.

Meeting on 8 December in Myanmar, representatives from the 6 GMS countries pledged to further accelerate efforts to eliminate malaria by, for example, improving cross-border collaboration, strengthening surveillance systems and ensuring antimalarial medicines are safe and effective. The press release, below, includes more details on their call to action.

New WHO Malaria Threats Map

In October, GMP launched a new interactive map of biological threats to malaria control and elimination. The WHO Malaria Threats Map provides a visual overview of vector insecticide resistance, parasite gene deletions and parasite drug resistance globally. It displays data provided by national malaria control programmes and their partners, and from scientific publications. Such information is essential to inform appropriate prevention, diagnosis and treatment strategies and to guide the development of new tools.

Our mapping tool is currently available in beta version in English, French and Spanish, and is accessible from desktop computers only. We encourage you to use the tool and send us your feedback.

Europe commits to staying malaria-free

Just 15 years ago, there were malaria foci reported in Moscow. By 2015, the Russian Federation, and all other countries in the WHO European Region, were free of malaria. This vast region, comprised of 53 nations, has indeed been a trailblazer in the elimination arena.

In early September, I attended a meeting in Moscow with health authorities from 10 countries of Central Asia and the Caucasus – those representing the last stronghold for malaria in the region. Through the Ashgabat Statement, launched at this meeting, these countries confirmed their commitment to prevent the reintroduction of malaria in the region.

It is fitting that this meeting was held in the Russian Federation, a country that has played an important role in the European malaria elimination story. Over the course of three decades, Russia’s Martinovsky Institute provided critical technical and financial support to strengthen the skills of those fighting malaria in endemic countries of the Caucuses and Central Asia.

Russia was also, until recently, a donor for WHO’s work on malaria; through financial support from the Government of the Russian Federation, WHO trained nearly 800 national malaria control programme managers and senior health professionals from 79 countries in state-of-the-art knowledge on malaria control and elimination.

New policy guidance

In addition to new policy guidance on mass drug administration, the Global Malaria Programme issued new guidelines this month on how to achieve and maintain universal coverage with long-lasting insecticidal nets (LLINs).

The WHO process for the evaluation of vector control tools, technologies and approaches was recently revised to better meet the needs of countries endemic for, or at risk of, vector-borne diseases.

You will find all of the latest WHO policy guidance on our website. Stay tuned for new guidance on malaria surveillance, which we are aiming to release in the first quarter of 2018.

Latest meeting of the Malaria Policy Advisory Committee

Our latest meeting of the Malaria Policy Advisory Committee (MPAC) was attended by national malaria control programme managers from Armenia, Cameroon, Democratic People’s Republic of Korea, Malaysia, Pakistan and Zimbabwe, as well as by our WHO regional malaria advisors, GMP colleagues and about 50 observers.

The meeting report is available on the GMP web site together with all MPAC presentations and pre-reads. We have also published a special “Women of MPAC” series comprised of interviews with the five female members of this advisory body. See what some of the world’s leading malaria experts have to say about the disease from a variety of perspectives – entomology, medical anthropology, mathematical modelling, and more.

Wishing you and yours my very best wishes for the holiday season,
Pedro

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