From a one-size-fits-all to a tailored approach for malaria control MMV 12 th Stakeholders Meeting New Delhi, India 07 November 2012 Robert D. Newman, MD, MPH Director, Global Malaria Programme newmanr@who.int
International funding for malaria; have we reached the peak?
Core global malaria control interventions John Rae, Global Fund WHO WHO WHO
Malaria mortality rates: 25% decline globally 29% decline in the SEA Region over past decade
Reduction in malaria burden, 2000-2010 Decrease in cases Malaria Free >50% 25-50% Wide-scale implementation, limited evidence of decrease Limited evidence of decrease Malaria free >50% 25-50% Wide scale implementation,limited evidence of decrease Limited evidence of decrease
Bonnie Gillespie / Photoshare Despite progress, malaria remains an enormous public health problem: 216M cases (uncertainty range: 149M to 274M) and 655,000 deaths (uncertainty range, 537,000 to 907,000) in 2010
Why do we need to adopt a tailored approach?
The greatest threat to continued success in malaria control and elimination is financial rather than biological
The role of parasites & mosquitos
Artemisinin Resistance: Proportion of patients with parasites detected 3 days post treatment with an ACT Eastern Shan WHO 2010 Phuoc Long from 2010 report new data
Global Plan for Artemisinin Resistance Containment (GPARC): January 2011 Contain or eliminate artemisinin resistance where it already exists Prevent artemisinin resistance where it has not yet appeared 1 2 3 4 Stop the spread of resistant parasites Increase monitoring & surveillance to evaluate the AR threat Improve access to diagnostics & rational treatment with ACTs Invest in artemisinin resistancerelated research 5 Motivate action and mobilize resources
Anopheles mosquito resistance to insecticides: 64 countries and counting
GPIRM: Worldwide launch May 2012 A call to action: maintain the effectiveness of malaria vector control
Managing insecticide resistance Rotations Combinations Pyrethroid DDT Carbamate Year 1 Year 2 Year 3 Year 4 Mosaics Region A Region B ITNs Mixtures IRS Pyrethroid Organophosphate Organophosphate Organophosphate DDT Urgent need for new active ingredients Do not yet exist
Plasmodium vivax: major burden and challenge globally, especially in Asia 2.6 billion people at risk ~20 million cases (2010)
The role of people
Focused Screening and Treatment, Western Cambodia Migrant and Mobile Populations Photo: Eva Christophel/WHO Seasonal Cambodian migrant workers in Pailin, Cambodia
Climate change is happening WWF-Canon / Jack Stein GROVE
Urban Malaria Mumbai Lagos Panoramio.com Panoramio.com
Infrastructure projects www.alternet.org
Opportunities
Reducing malaria transmission: like draining a pond
Malaria Stratification: India Courtesy: GS Sonal
Malaria Stratification: Lao PDR Courtesy: D. Gopinath
Malaria Policy Advisory Committee (MPAC) Provides independent strategic advice and technical input to WHO for the development of policies related to malaria control and elimination
Seasonal Malaria Chemoprevention (SMC) Prevents ~75% of all malaria episodes Prevents ~75% of severe malaria episodes
WHO recommendation on primaquine In: 1) areas threatened by artemisinin resistance where single dose primaquine as a gametocytocide for P. falciparum malaria is not being implemented, and 2) elimination areas which have not yet adopted primaquine as a gametocytocide for falciparum malaria: A single 0.25 mg base/kg primaquine dose should be given to all patients with parasitologically-confirmed falciparum malaria on the first day of treatment in addition to an ACT, except for pregnant women and infants <1 year of age
Global Technical Strategy for Malaria Control & Elimination, 2016-2025
Integrated Community Case Management (iccm) Diseases: malaria, pneumonia, diarrhea Tools: RDTs, timers, ACTs, antibiotics, zinc, ORS Workers: different cadres in different countries UN Child Mortality Report 2010
Elimination: helping countries cross the finish line Elimination case studies 10 case studies being produced jointly with Global Health Group Four launched in October 2012: Cape Verde, Mauritius, Sri Lanka, Turkmenistan To help NMCPs and other partners considering malaria elimination better understand process and risks
Surveillance: without it, we are flying blind Launched in Namibia by WHO Director-General on World Malaria Day 24 April 2012
Launch of T3: Test, Treat. Track. Namibia, World Malaria Day 2012
Product Development Partnerships (PDPs): Driving force in developing new tools
Concluding thoughts
Malaria control both contributes to and benefits from strengthened health systems and durable development
Why durable development matters Investment Control Dis-investment Resurgence
Need to fight false dichotomies Malaria control vs. Malaria elimination New tools vs. Existing tools Plasmodium falciparum vs. Plasmodium vivax Donor funding vs. Domestic funding Africa vs. Asia-Pacific We need both We need both We need both We need both We need durable progress in both
Today, no one should die from malaria for lack of a 5 dollar bednet, a 50 cent diagnostic test, and a 1 dollar antimalarial treatment
Focused Screening and Treatment, Western Cambodia