Letter to malaria partners (December 2018)

Dear friends and partners,

End-of-year greetings to all. This December bulletin captures snapshots of our work in the WHO Global Malaria Programme (GMP) in the second half of 2018.

If you would like to receive regular updates from GMP, I encourage you to subscribe to our electronic newsletter.

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World malaria report 2018

WHO’s World malaria report, published annually, provides an in-depth update on global and regional malaria data and trends. The report tracks investments in malaria programmes and research as well as progress across all key areas of intervention: prevention, diagnosis, treatment and surveillance.

Our 2018 report highlights some promising pockets of progress. The number of countries with less than 100 indigenous cases of malaria – a strong indicator that elimination is within reach – jumped from 15 in 2010 to 26 in 2017. China and El Salvador reported zero indigenous malaria cases in 2017, a first for both countries.

Some countries with a high burden of malaria have also made notable advances. India saw a 24% drop in cases in 2017 after stepping up malaria control measures in several highly endemic areas – including the state of Odisha, home to approximately 40% of the country’s malaria cases. Ethiopia, Rwanda and Pakistan recorded significant declines in cases over the same period.

Globally, however, the battle against malaria is failing to make new gains. According to our report, no significant progress was made in reducing the number of malaria cases worldwide in the period 2015 to 2017. The estimated number of deaths, at 435 000 in 2017, remains unacceptably high.

In many affected countries, access to core malaria interventions is too low; the report shows only marginal increases in coverage of insecticide-treated nets, preventive therapy for pregnant women and antimalarial medicines in recent years.

Malaria cases and deaths are heavily concentrated in sub-Saharan Africa. Eleven countries account for approximately 70% of the burden of disease. In the 10 African countries hardest hit by malaria, there were an estimated 3.5 million more cases in 2017 over the previous year.

Urgent action is needed. As our WHO Director-General noted in the report foreword: “We need to change course and improve how we combat malaria, particularly in those countries with the highest burden. The status quo will take us further off track and have significant negative socio-economic consequences beyond malaria.”

“High burden to high impact” response

In recent months, WHO, in collaboration with the RBM Partnership to End Malaria, has catalyzed a new approach to jumpstart progress against malaria in countries that carry the highest burden of the disease. This approach – called "High burden to high impact” – is based on 4 pillars:

• galvanizing political attention to reduce malaria deaths;
• driving impact through the strategic use of data;
• improving global guidance, policies and strategies;
• implementing a coordinated country response.

“High burden to high impact” – which we referred to previously as the “10+1” initiative – builds on the principle that no one should die from a disease that is preventable and treatable. It will be led, initially, by the 11 countries (10 on the African continent, plus India) that together account for 70% of the global disease burden. Lessons learned in this first group of countries will be applied, over time, to all countries with high transmission of the disease.

The attainment of the targets of the Global Technical Strategy – or the failure to do so – will define whether the approach succeeds in achieving its most pressing objective: getting the global malaria response back on track. You will be hearing more on this effort in the coming months.

High-level event in Mozambique

Mozambique – a country that carries the third highest burden of malaria globally – was the site of the official release of WHO’s latest World malaria report on 19 November. Following a technical briefing on the report’s key findings, we launched our new high burden response in collaboration with the RBM Partnership.

Dr Matshidiso Moeti, WHO Regional Director for Africa, led the launch of the “High burden to high impact” response, together with Dr Winnie Mpanju-Shumbusho, Board Chair of the RBM Partnership, and Hon. Nazira Karimo Vali Abdula, Mozambique’s Minister of Health. The event included a series of roundtable discussions with Mozambican stakeholders, leaders from malaria-affected countries, and development partners.

Country ownership of malaria responses was a key theme in the discussions. Hon. Abdula touched on the importance of a coordinated and multi-sectoral response, echoing pillar 4 of the new high impact approach. She noted efforts under way in her country mobilize a broad partnership in the malaria fight – one that engages citizens, communities and government institutions. An article and photo story published at the same time as the World malaria report provide more information Mozambique’s leadership in combatting the disease.

Mr Ismaril Anar, a representative from Niger’s Ministry of Health, spoke of his country’s role in piloting “Malaria Matchbox,” a new strategy for identifying vulnerable populations at high risk of the disease. The Deputy Prime Minister of Eswatini, H.E. Themba Nhlanganiso, cited a new national malaria elimination fund established in partnership with private sector entities as a vehicle to mobilize resources for the disease.

We were pleased to have such a strong showing at the event from senior leaders of global health agencies and coalitions, including from the African Leaders Malaria Alliance, the Bill  & Melinda Gates Foundation, the Global Fund, UNDP, UNICEF, Unitaid and the U.S. President’s Malaria Initiative.

Peter Sands, Executive Director of the Global Fund, spoke to the critical importance of next year’s Global Fund replenishment conference. “If we have a successful replenishment, you will be able to feel the difference through the ‘High burden to high impact’ approach,” he said. “If we do not succeed, it will put at risk the gains we have achieved so far.”

We developed a photo story of the event providing additional quotes.

Latest news from the Greater Mekong

On 30 November, we released our annual bulletin tracking progress towards malaria elimination in the Greater Mekong. According to available data, the 6 countries in the subregion – Cambodia, China (Yunnan Province), the Lao People’s Democratic Republic, Myanmar, Thailand and Viet Nam – saw a remarkable downward trend in cases (-75%) and deaths (-93%) over the period 2012 to 2017.

However, several provinces in the subregion reported a spike in malaria cases last year – a trend that continued through the first half of 2018. This increase has been attributed, in part, to stock-outs of antimalarial drugs, delays in rolling out the drug treatment for P. vivax malaria, low use of mosquito nets, and more population movement into areas of active transmission.

Most of the remaining malaria cases have been reported in remote, forested areas, where hard-to-reach populations are disproportionately affected by malaria. Mekong countries are boosting their efforts to reach at-risk communities in these areas, with a view to eliminating the disease from the subregion by 2030.

Malaria and Ebola in the Democratic Republic of the Congo

Malaria is also threatening the health of people in eastern Democratic Republic of the Congo (DRC), where medical personnel are currently battling Ebola. Last month, our colleagues in the town of Beni – the epicenter of the recent Ebola outbreak – reported that up to 50% of people screened in Ebola treatment units were found to have only malaria. In North Kivu province, the area experiencing the brunt of the Ebola outbreak, there was an 8-fold increase in reported malaria cases compared to the same period in 2017.

On 28 November, DRC’s National Malaria Control Programme, supported by WHO, UNICEF, the Global Fund and the U.S. President’s Malaria Initiative, launched a 4-day mass drug administration campaign (MDA) against malaria in Beni with the aim of providing up to 450 000 people with both antimalarial drugs and insecticide-treated nets. Preliminary results show that the campaign reached approximately 98% of its target population with antimalarial medicines and 97% with mosquito nets.

The campaign was modelled on 2 similar campaigns carried out during the 2014 Ebola outbreak in Liberia and Sierra Leone, which were instrumental in lowering the malaria disease burden. Patients treated for malaria through these campaigns were spared from seeking care in health centres, where they may have been at risk of exposure to Ebola. By effectively addressing malaria, the campaigns also substantially lowered the work load for emergency medical responders, enabling them to focus on containing the Ebola outbreak.

Uzbekistan certified malaria-free

Last week, we announced some good news: Uzbekistan, a Central Asian nation of 32 million people, received the official certification of malaria elimination from WHO. We tell the story of how the country succeeded in getting to – and maintaining – zero malaria.

A certification of malaria elimination is granted by WHO when a country has proven, beyond reasonable doubt, that the chain of indigenous transmission has been interrupted nationwide for at least the previous 3 consecutive years. A national surveillance system capable of rapidly detecting and responding to any malaria cases must be in place, together with an appropriate programme to prevent re-establishment of transmission.

Globally, a total of 36 countries and territories have been certified malaria-free by WHO. We recently published a complete list of countries that have received the certification.

Malaria Policy Advisory Committee

The Malaria Policy Advisory Committee (MPAC), established in 2011, provides independent, strategic advice to WHO on all policy areas relating to malaria control and elimination. The Committee, comprised of some of the world’s leading experts in the field, convenes twice each year.

At our latest MPAC meeting, held on 17-19 October, Committee members heard updates on 12 technical areas of work within the Global Malaria Programme. The outcomes of these discussions have been documented in the meeting report.

On the sidelines of the meeting, Dr Larry Slutsker – a founding member of MPAC –commented on the RTS,S malaria vaccine, data innovation and more. Professor Brian Greenwood, another founding member, shared his insights from fighting the disease over the span of a 50-year career. Brian and Larry recently stepped down from the Committee; I would like to thank them both for their outstanding contributions.

Over the last 6 months, the Global Malaria Programme has undertaken a deep review of our policy-making and dissemination process, with the aim of bringing greater transparency, consistency and predictability to the way in which our malaria guidance is developed and shared. Based on the review, we plan to roll out a number of changes in 2019; you will hear more on this in the coming months.

Malaria round-table at the UN General Assembly

On 25 September, Ministers of Health from Ghana, Ethiopia and Mozambique gathered on the sidelines of the 73rd United Nations General Assembly to share their views on challenges and opportunities in the fight against malaria. They were joined by the King of Eswatini, the Prime Minister of Solomon Islands, and other high-level representatives from malaria-affected countries. The round-table discussion featured interventions from our WHO Director-General, our Regional Director for Africa, and heads of partner and donor agencies, including the African Leaders Malaria Alliance, the Global Fund, the RBM Partnership, Unitaid and the U.S. President’s Malaria Initiative.

Speaking at the event, Mrs Amira Elfadil, African Union Commissioner for Social Affairs, sounded a positive note on Africa’s prospects for ending malaria. “We know the challenges, and we are working on overcoming them with our partners,” she said. “We will have zero malaria in Africa in a very short time – I am very optimistic on this issue. I know that malaria is a disease we can fight if we join hands.”

We captured other highlights from the event in a photo story, developed in collaboration with the UN Foundation and the RBM Partnership.

As 2018 draws to a close, I would like to thank our partners for your ongoing collaboration in the fight against malaria. With urgent and coordinated action between all stakeholders, we can save more lives and improve health outcomes for millions of people around the world.

Best regards,
Pedro