Key WHO guidance and support for malaria elimination

1. Key WHO guidance and support for malaria elimination Dr Tessa Knox Technical Advisor Malaria and Other Vector-Borne and Parasitic Diseases WHO Country Liaison Office, Vanuatu

2. WHO Strategy for 2019 – 2023 • 13th General Programme of Work established the new “triple billion” targets • By 2023: • 1 billion more people benefit from universal health coverage (UHC) • 1 billion more people have better protection from health emergencies • 1 billion more people enjoy better health and well-being

3. Vision – A World Free of Malaria WHO Global Technical Strategy for Malaria, 2016 – 2030 (GTS) Global technical strategy for malaria 2016–2030 Pillar 1 Ensure universal access to malaria prevention, diagnosis and treatment Pillar 2 Accelerate efforts towards elimination and attainment of malaria-free status Pillar 3 Transform malaria surveillance into a core intervention Supporting element 1. Harnessing innovation and expanding research Supporting element 2. Strengthening the enabling environment

4. GTS Milestones and Targets

5. Why Eliminate Malaria? Malaria disproportionately affects the poor and vulnerable Equity Malaria rebounds very quickly if the foot is taken off the gas pedal Resurgences Malaria takes away resources from other diseases that are not as easily preventable or treatable Public Health Malaria harms national economies, prevents investment and limits tourism Economics

6. Trends in Morbidity and Mortality Source: World malaria report 2018

7. Global Progress Towards Malaria Elimination Source: World malaria report 2018

8. Multi-sectoral Collaboration is Critical Finance and economy Agriculture and Environment Infrastructure and transport • Civil society • Education • Industries • Tourism

9. WHO Support for Malaria Elimination Strategy documents Global technical strategy for malaria, 2016 - 2030 Regional action framework for malaria control and elimination in the Western Pacific: 2016 - 2020

10. WHO Support for Malaria Elimination Other key documents A Framework for Malaria Elimination Compendium of WHO malaria guidance Malaria surveillance, monitoring & evaluation: a reference manual Malaria terminology

11. WHO Support for Malaria Elimination Training materials Malaria elimination training course (12 units) E2020 • Principles, goals • Epidemiology • Surveillance • Case management • Vector control • Mass drug administration • Prevention of re-establishment of transmission • Stratification to target interventions • Innovation and research • Program management and planning • Multi-sector collaboration and community engagement • Certification of elimination

12. WHO Support for Malaria Elimination Independent committees • Malaria Elimination Certification Panel • Malaria Elimination Oversight Committee

13. WHO Support for Malaria Elimination E2020 Initiative

14. Countries WHO Certified as Malaria-Free * 38 countries and territories certified malaria-free (June 2019) *reference is made to the official name of WHO Member States as of 13 June 2018

15. Countries Approaching Elimination VANUATU 644

16. Differences in Approaches and Tactics Between Control and Elimination * 'Control' refers to the general approach to reducing disease burden, as opposed to elimination that is aiming at interrupting transmission.

17. Differences in Approaches and Tactics Between Control and Elimination * 'Control' refers to the general approach to reducing disease burden, as opposed to elimination that is aiming at interrupting transmission.

18. Risk of Resurgence Cohen et al. Malaria Journal 2012 • Malaria easily roars back after control efforts are reduced • Populations with little to no immunity can suffer serious outbreaks

19. Essential to Maintain Vector Control In areas with ongoing local malaria transmission (irrespective of both the pre-intervention and the current level of transmission): Vector control interventions should not be scaled back. In areas where transmission has been interrupted for at least one year: The scale-back of vector control can be considered only on the basis of a detailed analyses that includes: assessment of the receptivity and risk of importation active disease surveillance system capacity for case management and vector control response Vanuatu: receptivity & significant risk = no scale-back

20. Core interventions for malaria vector control are applicable for all populations at risk of malaria Vector Control Core Interventions The core interventions are: a) deployment of insecticide-treated nets (ITNs) that are prequalified by WHO, which in most settings are long-lasting insecticidal nets (LLINs) Photo Credit: Kenya, AIRS/J.Scranton Photo Credit: Cambodia, Myanmar WHOV. Sokhin b) indoor residual spraying (IRS) with a product prequalified by WHO

21. Vector Control Core Interventions WHO views ITNs and IRS as being of equal effectiveness. Preference for either is usually based on operational factors such as perceived or actual implementation challenges and the requirement for insecticide resistance prevention, mitigation and management. ITNs are considered appropriate where: Most vectors feed inside houses (endophagy) People mainly sleep indoors at night Housing structures are suitable to hang nets The population accepts and uses nets consistently Vectors are susceptible to insecticides on available ITNs People use ITNs year-round Houses are amenable to hanging ITNs

22. Vector Control Core Interventions WHO views ITNs and IRS as being of equal effectiveness. Preference for either is usually based on operational factors such as perceived or actual implementation challenges and the requirement for insecticide resistance prevention, mitigation and management. IRS is considered appropriate where: Most vectors rest inside houses (endophily) People mainly sleep indoors at night Indoor wall surfaces are suitable for spraying The population accepts spraying of their houses Vectors are susceptible to insecticides available for IRS The population can be protected year-round by IRS i.e., 1-2 spray rounds Housing structures are not scattered over a wide area.

23. Malaria Elimination Malaria elimination is achievable – Vanuatu is well on its way to elimination. Malaria elimination must be country-owned and country-driven. Malaria elimination can only be achieved through a multi-sectoral approach with coordinated partner support. Malaria elimination requires a “whatever it takes” approach – vector control must be maintained unless it is clear that scale-back is justified.

24. Hot off the press Malaria eradication feasibility assessment • 2000-2015 marked a period of success in reducing malaria burden • No global reduction since 2015 – progress has stalled • Progress in some countries for elimination • But off-track to meet GTS 2030 target of 90% reduction in morbidity • Most important and urgent threat • New WHO “High burden to high impact” approach

25. Tankyutumas for your attention “If you want to go fast, go alone. If you want to go far, go together.”