Dear friends and partners,
This latest bulletin provides a bird’s eye view of some of the most visible areas of our work in the WHO Global Malaria Programme (GMP) since January.
If you would like to receive regular updates from GMP, I encourage you to subscribe to our electronic newsletter.
Topics covered in this letter
– Director-General calls for “aggressive new initiative” in the malaria fight
– The 10+1 initiative
– Update on the E-2020 initiative
– Spotlight on malaria elimination at the Assembly
– Signing
of GMS ministerial declaration
– World Malaria Day
– Malaria Summit in London
– 7th MIM Pan African Conference
– New policy guidance
– Latest MPAC meeting
– Integrated approaches
in complex settings
– RTS,S malaria vaccine
Director-General calls for “aggressive new initiative” in the malaria fight
Delegations from all WHO member states recently convened in Geneva for the World Health Assembly, the annual meeting of WHO’s decision-making body. In his opening speech at the Assembly, Dr Tedros, the WHO Director-General, highlighted several efforts the Organization is leading to protect the health of the world’s 7 billion people – among them, “an aggressive new initiative to jump-start progress against malaria.”
An aggressive response is, indeed, warranted in view of the findings of our latest World malaria report. In 2016, the estimated number of global malaria cases (216 million) marked a return to 2012 levels, while the malaria death toll (445 000) remained largely unchanged over the previous year. Global progress in the fight against malaria has unquestionably levelled off, and our 2020 targets calling for 40% reductions in cases and deaths are unlikely to be met.
On a global scale, the plateau in malaria financing seen in recent years remains a serious concern. The US$ 2.7 billion invested in 2016 represented only 41% of our annual funding target for 2020. Inadequate funding has resulted in major gaps in access to core malaria control tools, especially in Africa.
The question now: how do we get back on track to reach our global targets for 2025 and beyond? Clearly the status quo is not an option. As Dr Tedros warned in the foreword of the World malaria report: “If we continue with a business as usual approach, employing the same level of resources and the same interventions, we will face near-certain increases in malaria cases and deaths.”
The 10+1 initiative
Approximately 70% of global malaria cases and deaths are concentrated in 10 countries in sub-Saharan Africa, as well as in India. All of these countries, except India, reported increases in malaria cases in 2016 compared to the previous year.
In a series of meetings with WHO senior management, held alongside last month’s Assembly, Ministers of Health from these 11 countries expressed a keen interest in getting malaria responses back on track – both at home, and globally. They pledged to lead a focused initiative aimed at reducing the toll of malaria-related death and disease.
The initiative, called “10+1,” will embrace all African countries with high malaria transmission. However, it will be driven by the 10 countries in the region that carry the heaviest burden of disease: Burkina Faso, Cameroon, Democratic Republic of the Congo, Ghana, Mali, Mozambique, Niger, Nigeria, Uganda and United Republic of Tanzania. The “+1” refers to India, which accounts for more than 60% of all malaria cases outside of Africa.
In view of current funding constraints, universal coverage of core malaria control tools will not be possible in all settings. As such, WHO will develop customized guidance for each high burden country, identifying where resources could best be targeted for maximum impact.
10+1 builds on the principle that no one should die from a disease that can be easily prevented and diagnosed, and that is entirely curable with available treatments. The support and engagement of all partners will be critically important to the success of this country-led initiative. Stay tuned – you will be hearing more on this in the coming months.
Update on the E-2020 initiative
A greater focus on priority, high burden countries does not signal a strategic shift away from the elimination agenda. The E-2020 initiative supporting 21 malaria-eliminating countries is a critical work stream within the Global Malaria Programme – one we are devoting significant resources and attention to.
From 11–13 June, malaria programme managers from E-2020 countries convened in Costa Rica at a WHO global forum to map progress, review elimination strategies and share solutions to common challenges. On the opening day of the forum, WHO certified Paraguay as malaria-free – an event that made news headlines around the world. Alongside this announcement, GMP released a new progress report and interactive map featuring preliminary case figures from E-2020 countries for 2017; final figures will be published in the World malaria report later this year.
To support countries on the path to elimination, 2 new WHO advisory bodies were recently formed. The role of the Malaria Elimination Oversight Committee (MEOC), established in April 2018, is to guide countries as they work to achieve malaria-free status. The Malaria Elimination Certification Panel (MECP), formed in December 2017, recommends to WHO when a country is ready to be certified as malaria-free.
Spotlight on malaria elimination at the Assembly
Malaria elimination was also in the spotlight at a recent World Health Assembly side event, co-hosted by Sri Lanka, Myanmar and China, with support from WHO and the RBM Partnership to End Malaria. Sri Lanka, as you’ll recall, was certified malaria-free by WHO in 2016 – an achievement made possible through a country-led response to the disease and a total commitment to universal health coverage for its citizens. Myanmar has significantly reduced its malaria burden in recent years and China, for the first time in 2017, reported zero indigenous cases of the disease.
Health ministers and senior officials from these and other countries – including Lao People’s Democratic Republic, Maldives, Papua New Guinea, United Republic of Tanzania and Zambia – spoke of the importance of ensuring that all people, wherever malaria is present, have access to quality services to prevent, diagnose, and treat malaria without facing financial hardship.
Signing of GMS ministerial declaration
As part of the side event, senior representatives from the 6 countries of the Greater Mekong Subregion (GMS) – Cambodia, China, Lao PDR, Myanmar, Thailand and Viet Nam – signed a Ministerial Call for Action to Eliminate Malaria in the GMS before 2030. The call places a particular emphasis on the threat of multidrug resistance to elimination efforts, which has been detected in a number of GMS countries over the last decade.
Speaking at the event on 22 May, Dr Myint Htwe, Myanmar’s Minister for Health and Sport, said: “This signing represents a landmark in the Greater Mekong Subregion. I am proud to say that Myanmar stands ready to beat malaria once and for all, together with my counterpart ministers in the GMS.” Our photo story provides further quotes and snapshots.
World Malaria Day
To mark this year’s World Malaria Day, on 25 April, and WHO’s 70th anniversary, on 7 April, we published a series of 7 interviews with leaders and advocates in the global response to malaria, as well as a set of related animations. I am delighted that Dr Matshidiso Moeti, Regional Director of the WHO African Region, agreed to lend her voice to our series.
Dr Moeti was joined by Bill Gates, Co-Chair of the Bill & Melinda Gates Foundation, Dr Kesete Admasu, CEO of the RBM Partnership to End Malaria, and others in interviews that covered a range of topics – from the challenges of beating back malaria in Africa to the latest advances in malaria research. Our World Malaria Day communications package also includes a video message from Dr Tedros.
Malaria Summit in London
On 18 April, the WHO Director-General participated in a gathering in London with Heads of State, Bill Gates, Prince Charles and other dignitaries. The Summit was strategically held alongside a Commonwealth Heads of Government Meeting (CHOGM), which brings together leaders from the 53 Commonwealth countries every two years. About 90% of Commonwealth citizens live in malaria-affected countries.
By all accounts, the Summit was a success, with more than US $4 billion secured in new and renewed commitments. Commonwealth leaders also committed to the goal of halving malaria across all 53 countries by the year 2023.
7th MIM Pan African Conference
In 1997, I was fortunate to be part of the original team that established the Multilateral Initiative on Malaria (MIM) Pan African Conference. Over the last 2 decades, the meeting has become the largest forum of its kind globally – convening, every 3 to 4 years, leading experts in malariology, research and policy, particularly from the African region.
At the 7th MIM meeting, held in Dakar from 15-20 April, I delivered a keynote address in which I echoed many of the messages from the latest World malaria report. The emerging picture among malaria-affected countries, I noted, has become increasingly polarized. On the one hand, more countries are approaching elimination. However, in a second set of countries with a high burden of malaria – mainly in Africa – the pace of progress has stalled. This “dual narrative”, I think, closely reflects the current state of play.
Throughout the week, GMP colleagues participated in 4 symposia spanning a variety topics and technical areas.
New policy guidance
Mosquito resistance to insecticides is a growing concern. A new report, released by GMP in May 2018, tracks the extent of mosquito resistance worldwide and provides a baseline against which future trends can be measured. To complement the report, we developed a photo story highlighting the critical importance of malaria vector control and surveillance.
WHO has also published a new reference manual to support countries as they strengthen their national malaria surveillance systems. It is designed for staff in ministries of health, national malaria programmes, malaria surveillance partners, and WHO country staff.
As the Rapid Access Expansion Programme (RaCE) draws to a close, WHO colleagues are analysing results from the implementation of the iCCM (integrated community case management) approach in 5 African countries. Our RaCE team will present key outcomes and lessons learned in a webinar on 25 July. In the meantime, in case you missed it, this video, developed in collaboration with the Malaria Consortium, provides a personal look at the impact of iCCM at country level.
Latest MPAC meeting
Vector control was high on the agenda at the latest meeting of the Malaria Policy Advisory Committee (MPAC), held from 11-13 April. Members of the Committee reviewed an advanced draft of new vector control guidelines and heard updates on WHO’s work to streamline our process for the evaluation of vector control tools.
Updates were also provided on a number of other technical areas and initiatives, including – among other topics – elimination efforts in the Greater Mekong Subregion, an Evidence Review Group (ERG) on malaria mortality estimates, and a proposed ERG for malaria control in humanitarian emergencies.
Integrated approaches in complex settings
Last fall, WHO launched a targeted campaign in Borno State that succeeded in reaching 1.2 million children with monthly rounds of antimalarial medicines during the high-transmission season. The campaign was carried out in the wake of an 8-year conflict in north-eastern Nigeria that left two thirds of health facilities completely or partially destroyed and millions at risk of malaria.
This 5-month initiative leveraged the existing machinery of the polio campaign and the health emergencies programme to reach children living in remote areas. It resulted in very significant declines in both malaria case incidence and mortality in the intervention areas. This year, the same intervention will be applied in targeted areas of Borno State during the rainy season.
In South Sudan, where WHO estimates show that malaria is the primary cause of death following a protracted conflict, we are exploring a similar integrated approach with the World Food Programme and UNICEF to allow for the provision of health care services together with airborne food distribution in hard-to-reach areas.
We are also very concerned about Venezuela, which saw a nearly 5-fold increase in malaria cases between 2010 and 2016. Preliminary estimates from 2017 show a further sharp increase in cases over the previous year. The WHO Pan American Health Organization (PAHO) is working with health authorities to mitigate the impact of this complex public health situation.
RTS,S malaria vaccine
Finally, a brief update on the Malaria Vaccine Implementation Programme (MVIP), a WHO-coordinated effort to support the introduction of the RTS,S malaria vaccine in selected areas of Africa through country-led routine immunization programmes.
We recently received some very good news: the national regulatory authorities of Ghana, Kenya and Malawi have authorized the RTS,S vaccine for use in the pilot areas, removing one of the last remaining obstacles to the roll-out of this vaccine.
Through the MVIP, at least 360 000 children will be vaccinated across the 3 countries annually. The programme will evaluate the vaccine’s public health impact in the context of routine use and inform policy around its potential deployment on a broader scale. You can learn more about the vaccine programme by reading our new brochure and through a Q&A.
Best regards,
Pedro