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Dear friends and partners,
Greetings from Geneva. This is the first in a series of bi-annual letters that will contain key updates from the WHO Global Malaria Programme as well as my reflections on some of the most pressing issues we face in the fight against malaria.
This June bulletin will briefly address the following topics. You will find links to additional resources at the end of each section.
– Malaria vaccine RTS,S/AS01
– World Health Assembly
– WHO response to Zika virus
– Angola battling malaria (and yellow fever)
– Strategic Advisory Group on Malaria Eradication
– Investigating reports of hrp2 deletions
– New report: “Eliminating malaria”
– New WHO guidelines on iron supplementation in children
– Launch of national elimination strategy in India
– New initiative to combat insecticide resistance
– Malaria Policy Advisory Committee (MPAC)
Malaria vaccine RTS,S/AS01
As you may have seen, the Gavi Vaccine Alliance pledged its support this week for a WHO-coordinated malaria vaccine pilot programme. WHO welcomes the announcement and is encouraging other donor agencies to fill the remaining funding gap so the programme can proceed as planned.
The vaccine, known as RTS,S/ASO1, confers partial protection against malaria among young children. The pilot programme is designed to generate further evidence on the programmatic feasibility, impact and safety of the vaccine in real-life settings.
World Health Assembly
At the latest World Health Assembly, delegates embraced the 2030 Agenda for Sustainable Development and laid the groundwork for pursuing its health-related goals. They pledged to expand efforts to address infectious diseases in developing countries and to place a greater focus on equity between and within countries, leaving no one behind.
For those of us working on malaria, it was a quiet meeting compared to last year’s historic launch of the Global Technical Strategy. Nonetheless, in her opening speech, the Director-General shone a spotlight on malaria recognizing, in particular, the impressive advances seen in cutting mortality rates across Africa.
WHO response to Zika virus
The Zika emergency has placed the need for robust vector control programmes at centre stage. Many vector control specialists hail from the malaria world and are playing a key role in WHO’s ongoing response to this devastating outbreak.
As part of the broader response to Zika, WHO has established a Vector Control Group comprised of senior experts in entomology and vector control from across the Organization. In recent months, the group has developed a vector control operations framework and other guidance for Zika-affected countries.
We continue to keep a close eye on the development of new vector control tools. In March, the Vector Control Advisory Group (VCAG), convened jointly by the Global Malaria Programme and the WHO Department of Neglected and Tropical Diseases, recommended the carefully planned pilot deployment of Wolbachia-based biocontrol and OX513A transgenic mosquitoes, accompanied by rigorous independent monitoring and evaluation.
- WHO vector control operations framework for Zika virus
- VCAG recommendations: Mosquito (vector) control emergency response and preparedness for Zika virus
Angola battling malaria (and yellow fever)
You are no doubt aware of the epidemics of malaria and yellow fever in Angola. According to government reports, there has been a significant increase in the number of malaria cases and deaths in Luanda since late 2015.
Last month, I travelled to Luanda to meet with the Minister of Health and other partners in the national response to the malaria epidemic. The mission included visits to 2 hospitals in Luanda where I saw first-hand a number of patients with severe cases of malaria. Hospital reports showed very high case fatality rates, mainly among older children and adults.
Across the country, weak data collection systems are hampering a timely and effective response to malaria. The epidemic in Angola offers a stark reminder of the importance of strong surveillance to measure the extent of increases in disease burden and to ensure targeted interventions for those most in need.
Strategic Advisory Group on Malaria Eradication
With the approval of the Director-General, WHO recently established a 13-member Strategic Advisory Group (SAG) on Malaria Eradication. The SAG will act as an advisory body to WHO, providing recommendations on the potential relevance of an eradication programme in the next decades.
Members have been chosen for their expertise across a range of disciplines. At the inaugural SAG meeting in August, they will define a portfolio of work for the next 2-year period.
Investigating reports of hrp2 deletions
In recent months, we have been reviewing reports of hrp2/hrp3 gene deletions among P. falciparum malaria parasites in some African settings and in India. Parasites with hrp2/hrp3 gene deletions cannot be detected by HRP2-based rapid diagnostic tests (RDTs).
We are taking this issue very seriously. In May, the Global Malaria Programme published an information note for manufacturers, procurers and users of HRP2-based RDTs. In July, we will host a technical consultation to develop a coordinated response and comprehensive guidance on laboratory and surveillance methods.
At this point in time, there is no reason to question the critical role that RDTs play in diagnosing malaria and in ensuring timely and appropriate treatment. RDTs save lives – we must remain very conscious of that. We will keep you informed as events unfold.
New report: “Eliminating malaria”
On World Malaria Day, the Global Malaria Programme released a new report focused on country progress towards elimination. According to our report, 21 countries are in a position to achieve at least 1 year of zero indigenous cases of malaria by 2020. The analysis is based on recent trends in malaria cases, the stated malaria objectives of countries and the informed opinions of our WHO experts in the field.
At the report launch in Geneva, I commended the countries that are approaching elimination while also highlighting the urgent need for greater investment in settings with high rates of malaria transmission, particularly in Africa. Saving lives must be our first priority.
New WHO guidelines on iron supplementation in children
For years, children living in countries ongoing malaria transmission – particularly in Africa – were not treated with iron supplementation due to concerns that it may increase their risk of malaria. This practice was based on insufficient quality evidence and may have caused thousands of unnecessary deaths.
In March 2016, WHO issued a clear set of guidelines recommending iron supplementation for anaemia among children in malaria-endemic countries. These guidelines are important and rectify a long-term misconception in global health.
Launch of national elimination strategy in India
Through the scale-up of combined interventions such as rapid diagnostic testing, indoor residual spraying and antimalarial treatment, India has achieved a major decline in malaria case incidence since 2000. However, this one country continues to account for approximately 70% of the regional malaria burden in South-East Asia.
In February, I attended the launch of India’s national strategy together with the WHO Regional Director for South-East Asia and other colleagues. Speaking with the Minister of Health and senior government officials, it was clear that India is committed to devote the resources and infrastructure required to meet the task at hand. There was a real sense of urgency and action to get the job done.
New initiative to combat insecticide resistance
Mosquito resistance to insecticides is a growing concern. According to the 2015 World Malaria Report, 60 countries have reported mosquito resistance to at least one insecticide used in nets and indoor spraying since 2010.
In February, WHO welcomed the launch of a new initiative from UNITAID and the Innovative Vector Control Consortium (IVVC) to make alternative insecticides for indoor residual spraying more readily available in countries with a high burden of malaria. The US$ 65 million project aims to protect as many as 50 million people from malaria in 16 African countries.
Malaria Policy Advisory Committee (MPAC)
At our latest MPAC meeting in Geneva, members heard updates on hrp2 gene deletions, the malaria vaccine pilot programme, the Strategic Advisory Group on Malaria Eradication and other key areas of our work. A summary of the 11 sessions covered in the meeting and MPAC recommendations can be found in our meeting report.
Sending you all my very best wishes.
Take care,
Pedro