Malaria

Letter to partners

Dr Pedro Alonso, Director, WHO Global Malaria Programme

13 June 2017

Dr Pedro Alonso

Dear friends and partners,

This latest bulletin follows the 141st session of the WHO Executive Board (EB) and the Seventieth World Health Assembly (WHA). Two agenda items, beyond the election of the new Director-General, were of particular interest and relevance to our work: a report by the Secretariat on malaria eradication, reviewed on 1 June by the EB, and deliberations on the Global Vector Control Response 2017-2030 by WHA delegates on 30 May.

I will touch briefly in this letter on the outcomes of these discussions and on 2 malaria events held alongside the Assembly. I’ll also update you on other strategic areas of our work in the first half of 2017.


Malaria eradication report

As you will recall, WHO established a Strategic Advisory Group (SAG) in 2016 to analyse future scenarios for malaria, including eradication. Last fall, the SAG developed a report clarifying current terminology and affirming WHO’s long-standing commitment to the goal of eradication. Importantly, the report does not specify an end date for that goal.

Meeting on 1 June in Geneva, EB members and other delegates expressed support and appreciation for both the report and creation of the SAG. They called on the WHO Director-General to report back to the EB after the work of this advisory group has been completed.

To date, WHO has convened 2 meetings of the SAG. At their second meeting in February 2017, members defined a set of work streams for the next 2-year period. We will continue to inform you on the work and outputs of the SAG in the months ahead.

Global vector control response

On 30 May, we were delighted when delegates at the World Health Assembly adopted a resolution on the new integrated approach to vector control outlined in the WHO Global Vector Control Response 2017-2030 (GVCR).

The GVCR, developed in the wake of the Zika emergency, aims to reposition vector control as a core public health intervention. Its ambitious targets are aligned with other WHO disease strategies, including the Global Technical Strategy for Malaria 2016-2030.

This cross-cutting initiative – led by the Global Malaria Programme, the Department for Control of Neglected Tropical Diseases, and the Special Programme for Research and Training in Tropical Diseases – is the result of a broad consultative process that drew on inputs from ministries of health, technical experts, development partners and WHO regional offices.

The comprehensive document is available online in 6 languages together with a Lancet commentary and a related feature story.

RBM side event: “Country-led efforts to end malaria”

On 25 May, I participated in a WHA side event hosted by the Government of Ethiopia and the Roll Back Malaria (RBM) partnership. The 10-person panel, skillfully moderated by Dr Winnie Mpanju-Shumbusho, RBM Board Chair, included representatives from ministries of health (Angola, Brazil, Ethiopia, Iran, Namibia), donor agencies, civil society and the private sector.

The need to strengthen country ownership was a key theme during the 90-minute discussion. Political commitment was seen as vital to accelerating progress towards elimination, particularly in countries with a low malaria burden which may be de-prioritized by donors and partners.

Participants spoke of the need for increased domestic financing and for a diversification of funding sources. The importance of engaging with partners “in their own language” was emphasized, particularly with reference to ministers of finance and the private sector.

Celebrating elimination in Sri Lanka and the Maldives

On 22 May, ministers of health from the WHO South-East Asia Region gathered at the Palais des Nations in Geneva to celebrate the accomplishment of malaria elimination in the Maldives (2015) and Sri Lanka (2016). This event, held alongside the Assembly, provided a platform to share best practices and lessons learned, with a view to accelerating progress across the Region.

Health Ministers from the Maldives and Sri Lanka attributed their successes, in part, to strong political commitment, robust policies and evidence-based strategies, a deeply committed group of partners, and coordination at every level – including from communities.

In recent years, the South-East Asia Region has made impressive strides in its response to malaria. Asked whether malaria will be eliminated region-wide by 2030, Dr Poonam Khetrapal Singh, WHO Regional Director for South-East Asia, sounded a positive note: “We have every reason to be hopeful,” she said.

World Malaria Day: Closing the prevention gap

Last year, on World Malaria Day, we shone a spotlight on countries that are well placed to eliminate malaria by 2020. This year, we shifted our focus back to sub-Saharan Africa, a region that reported nearly 400 000 malaria deaths and some 190 million new cases of the disease in 2015.

As I have said before, any death from malaria – a preventable and entirely treatable disease – is simply unacceptable. Malaria cases and deaths mirror critical gaps in access to effective control tools. They serve as a stark reminder that the first 2 milestones of the Global Technical Strategy are at risk of not being attained: reducing case incidence and death rates by at least 40% by 2020.

Closing gaps in access to proven prevention tools was the focus of our communications effort on and around World Malaria Day 2017. A new advocacy report, Malaria prevention works: let's close the gap, summarized WHO-recommended tools in the prevention arsenal, with an emphasis on coverage gaps in sub-Saharan Africa. Next year, we will release a more comprehensive analysis of coverage gaps across all key interventions in all regions.

In collaboration with WHO colleagues based in Africa, the Global Malaria Programme organized a high-level forum in Nairobi on 24 April with participation from partner and donor agencies, including USAID, UNICEF, CDC, the RBM Partnership and Kenya’s National Malaria Control Programme. Dr Matshidiso Moeti, WHO Regional Director for Africa, served as a keynote speaker alongside Dr Cleopa Mailu, the Kenyan Cabinet Secretary for Health.

Malaria vaccine country selection announcement

Innovation was another key theme around World Malaria Day, with a call for greater investment in the development and deployment of new malaria control tools. On 24 April, Dr Moeti publicly announced, for the first time, the 3 countries that will participate in the RTS,S/AS01 malaria vaccine pilot programme: Ghana, Kenya and Malawi.

The pilot programme has been designed to assess the feasibility of delivering the required four doses of RTS,S, the vaccine’s potential role in reducing childhood deaths, and its safety in the context of routine use. Vaccinations are due to begin in mid-2018.

Our colleagues in the WHO Regional Office for Africa issued a press release focused on the RTS,S country selection announcement. Additional background information can be found in the following Q&As:

The Rapid Access Expansion (RAcE) programme

As part of a broader effort to prevent unnecessary illness and death in Africa, WHO has been supporting, since 2013, an integrated strategy for the treatment of common childhood diseases in 5 countries. The RAcE programme, funded through a generous grant from the Government of Canada, is a collaborative effort between the Global Malaria Progamme, locally-based NGOs and ministries of health.

To date, nearly 8400 community health workers have been trained through the programme in the Democratic Republic of the Congo, Malawi, Mozambique, Niger, and Nigeria; they, in turn, have treated more than 6 million cases of malaria, pneumonia, and diarrhoea in children under five living in remote areas. Over half of children seen through the programme are treated for malaria.

The RAcE programme is largely is achieving its dual objectives: introducing and scaling-up integrated community case management (iCCM) and stimulating a policy review to adapt health systems for community based service delivery. Each country is incorporating iCCM into national policy. Tools and guidelines have been developed with WHO support, and partners share lessons learned and programme innovations.

The first phase of the programme is drawing to a close and preliminary results are encouraging, with significant improvements reported in access to quality diagnosis and treatment. Detailed results will be shared this fall.

New framework for elimination

For the first time in 10 years, WHO has published new policy guidance on malaria elimination. The Framework for malaria elimination, published in March, is designed to support all malaria-endemic countries, regardless of where they lie across the spectrum of malaria transmission.

Our new framework introduces a streamlined process for WHO certification of malaria elimination and clarifies the threshold for reestablishment of transmission. It offers new guidance on setting targets and systems to verify malaria-free areas within a country’s borders – an important foundation for future national certification.

The framework was developed by the WHO Secretariat and an independent Evidence Review Group in consultation with malaria programme managers in the 6 WHO regions. The broad consultative process culminated in a final review in September 2016 by the Malaria Policy Advisory Committee (MPAC).

“E-2020” initiative

As you will recall, WHO has identified 21 countries with the potential to achieve zero indigenous cases of malaria by 2020. Our analysis was based on recent trends in malaria case incidence; the declared malaria objectives of affected countries; and the informed opinions of WHO experts in the field. Together, these 21 countries represent the “E-2020.”

From 16-17 March, the Global Malaria Programme convened a 2-day global forum in Geneva with representatives from “E-2020” countries, WHO staff and invited observers. The forum provided a platform to review country-level progress towards elimination, share lessons learned and devise strategies for the way forward.

WHO’s “E-2020” initiative will support countries that are nearing or have arrived at the final stages of the malaria elimination process, as well as those working to prevent reintroduction of the disease. E-2020 global forums will be held annually from here forward.

Malaria Policy Advisory Committee

At its most recent meeting in March, MPAC strongly supported the establishment of a Malaria Certification of Elimination Panel; the Global Malaria Programme has launched a call for applications for membership on this panel. MPAC also recommended the establishment of a global malaria elimination oversight committee to monitor progress, provide technical advice, identify risks to elimination, and recommend actions.

The meeting included updates on a range of topics, from the RTS,S vaccine pilot programme to a review of a new surveillance, monitoring and evaluation operational manual. You will find a summary of the 10 sessions in our latest MPAC report. See also our interview with Dr Kevin Marsh who has chaired MPAC since its inception in 2012.

Best wishes,
Pedro

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