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Robert D. Newman, MD, MPH Director, Global Malaria Programme newmanr@who.int

Malaria in 2013: progress, challenges, and opportunities. APPMG London, UK 23 April 2013. Robert D. Newman, MD, MPH Director, Global Malaria Programme newmanr@who.int. World Malaria Report 2012. Has international funding for malaria reached a plateau?.

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Robert D. Newman, MD, MPH Director, Global Malaria Programme newmanr@who.int

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  1. Malaria in 2013: progress, challenges, and opportunities APPMG London, UK 23 April 2013 Robert D. Newman, MD, MPH Director, Global Malaria Programme newmanr@who.int
  2. World Malaria Report 2012
  3. Has international funding for malaria reached a plateau?
  4. Has international funding for malaria reached a plateau?
  5. Current core global malaria control interventions John Rae, Global Fund WHO WHO WHO
  6. Access to and use of ITNs in sub-Saharan Africa
  7. Major decreases in deliveries of insecticide treated nets (ITNs) over past 2 years
  8. Proportion of suspected malaria cases attending public health facilities receiving a diagnostic test
  9. 50 countries are on track to reduce malaria case incidence by 75% by 2015: these account for only 3% of total estimated cases
  10. Progress faster in smaller countries; greater number of cases and deaths averted in highest burden countries Majority of cases averted (52%) and lives saved (58%) are in the 10 countries with the highest estimated malaria burdens
  11. Global changes in malaria death rate, 2000-2010 2000 2010
  12. Malaria mortality rate estimates: 25% decline globally33% decline in the WHO African Regionover past decadeMore than 1 million lives saved
  13. Despite progress, malaria remains an enormous public health problem: 219 Million cases (uncertainty range: 154M to 289M) and 660,000 deaths (uncertainty range: 490,000 to 836,000) in 2010 Bonnie Gillespie / Photoshare
  14. Malaria burden 2010: deaths by region & age group
  15. Malaria burden 2010: cases and deaths by country 80% 80%
  16. WHO Global Malaria Programme: core roles
  17. 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
  18. Contain or eliminate artemisinin resistance where it already exists Prevent artemisinin resistance where it has not yet appeared 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 resistance-related research 1 2 3 4 Motivate action andmobilize resources 5 Global Plan for Artemisinin Resistance Containment (GPARC): January 2011
  19. Artemisinin Resistance Containment Areas CHINA MYANMAR VIET NAM LAOS THAILAND CAMBODIA Tier I Tier II Tier II (inactive)
  20. Importance of regional collaboration
  21. Anopheles mosquito resistance to insecticides: 64 countries and counting
  22. GPIRM: Worldwide launch May 2012 A call to action: maintain the effectiveness of malaria vector control
  23. 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
  24. Elimination: helping countries cross the finish line Elimination case studies 10 case studies planned jointly with UCSF Global Health Group Four launched in October 2012: Cape Verde, Mauritius, Sri Lanka, Turkmenistan Six to be launched 2013: Turkey, Philippines, Malaysia, La Reunion, Tunisia, Bhutan To help NMCPs and other partners considering malaria elimination better understand process and risks
  25. Launch of T3: “Test, Treat. Track.” – Namibia, World Malaria Day 2012
  26. Surveillance: without it, we are flying blind Launched in Namibia by WHO Director-General on World Malaria Day – 24 April 2012
  27. Malaria burden fatal: ~660,000 per year life-threatening febrile illness ~10 deaths per year in UK asymptomatic endemic areas UK, etc Slide courtesy M. Molyneux
  28. Malaria control & elimination beyond 2015 Global strategy for the control and elimination of Plasmodium vivax Global technical strategy for malaria control and elimination: 2016-2025 Roll Back Malaria Partnership: Global Malaria Action Plan II
  29. Future malaria R&D needs and projection: what’s missing in the armamentarium? Transmission blocking tools Antimalarial drugs Vector control Vaccines Highly sensitive field-ready diagnostics Mass treatment or mass screening and treatment options Safe, short course gametocytocidal drugs Optimum delivery systems Building capacity to use data for decision-making

  30. Extrinsic Challenges

  31. Malaria funding gaps by region, in billions Biggest resource gap for 2014-2016 is in Africa: 90% of total gap Increased domestic funding expected in Asia Africa Asia Gap 2014-16: $6.0B Gap 2014-16: $0.6B

  32. The greatest current threat to continued success in malaria control and elimination is financial

  33. Malaria cases 2000-2035: potential scenarios AzraGhani, MRC Centre for OutbreakAnalysis & Modelling, Imperial CollegeLondon & WHO
  34. Focused Screening and Treatment, Western Cambodia Migrant and Mobile Populations Seasonal Cambodian migrant workers in Pailin, Cambodia Photo: Eva Christophel/WHO
  35. Climate change is happening WWF-Canon / Jack Stein GROVE
  36. Urbanization Mumbai Lagos Panoramio.com Panoramio.com
  37. Infrastructure projects www.alternet.org

  38. Concluding thoughts

  39. Reducing malaria transmission: like draining a pond
  40. Malaria Stratification: Lao PDR Courtesy: D. Gopinath
  41. Seasonal Malaria Chemoprevention (SMC) Amodiaquine+SP: monthly treatment during transmission season Children 3-59 months Prevents ~75% of all malaria episodes Prevents ~75% of severe malaria episodes
  42. Why durable development matters for the future of malaria control & elimination Investment ► Control Dis-investment ► Resurgence Must not only continue to compress the spring, but must also shrink the space within which the spring can move
  43. The risk of interrupted investment: malaria resurgences Cohen et al.Malaria Journal 2012 11:122  
  44. Post-2015 Development Agenda
  45. Driving the malaria burden downward: a cycle of innovation Surveillance, monitoring & evaluation Basic and applied research Program implementation Policy change
  46. Product Development Partnerships (PDPs): Driving force in developing new tools
  47. Need to avoid false dichotomies Africavs. Outside of Africa Weneeddurable progress in both New tools vs. Existingtools Weneedboth Plasmodium falciparum vs. Plasmodium vivax Weneedboth Savinglivestoday vs. Eradication tomorrrow Attacking the vectorvs. Attacking the parasite Weneedboth Weneedboth
  48. Focused Screening and Treatment, Western Cambodia
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