WHO – Investing in Malaria Makes Sense

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GENEVA — In marking World Malaria Day on April 25, the World Health Organization says investing in malaria control is good health policy and makes good economic sense.

Great progress is being made in controlling malarial infection, and WHO officials think now is the time to capitalize on recent successes in the battle against this preventable and treatable disease.

Dr. John Reeder, the WHO’s acting director of  Global Malaria Program, says international funding for malaria control has increased from $100 million in 2000 to $1.94 billion in 2012, and that during that time malaria-related death rates have decreased 42 percent globally and 49 percent in Africa.

More than three million children’s lives have been saved, he says.

“So, clearly, ramping up investment in malaria can work and does work,” he said. “And we have seen things like the vast expansion of bed net programs. Over the last couple of years, it has gone from 70 million nets that went out in 2012 to 136 million last year. This year there is going to be something in the region of 200 million nets put out there.”

Despite this progress, however, malaria remains a worldwide scourge, especially in Africa, where WHO figures show 207 million cases, including 627,000 deaths. The U.N. health agency says 90 percent of these deaths have occurred among children under five in sub-Saharan Africa.

WHO notes 80 percent of malaria cases are found in 18 African countries, with Nigeria and the Democratic Republic of Congo accounting for half of those cases. It says malaria disproportionately affects the poor and thwarts African economies.

It estimates Africa loses $12 billion each year in lost productivity, and says the disease places a heavy burden on national health systems, accounting for as much as 40 percent of public health expenditure in some countries.

Reeder says it is possible to slow the spread of the disease. But, he notes, one of the problems affecting malaria control is the difficulty of delivering effective programs in the context of a weakened health system.

“So, malaria in itself is a disease, which has got particular needs and really needs an investment,” he said. “But part of that investment really has got to be in strengthening health systems in a more general way.”

Reeder says growing resistance to Artemisnin-based Combination Therapies, the most effective anti-malarials on the market, could unravel the hard-won gains to date.

Efforts to contain resistance and research and development of new tools to control the disease are important, he says, even if it requires lots of money.

The International Roll Back Malaria Program will need $5.1 billion every year through 2020 to provide insecticide-treated nets, indoor spraying, quick diagnostic testing and treatment for all those at risk.

 

Source: VOA News

WHO Sets Roadmap Goal for Vaccines to Reduce Malaria by 75%

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Malaria infects hundreds of millions of people every year and causes well over a half million deaths. The World Health Organization and its partners Thursday announced a new goal to license vaccines by 2030 that would sharply reduce malaria cases and eventually eliminate the disease.

The 2013 Malaria Vaccine Technology Roadmap was unveiled in Washington. It expands the scope of vaccine research, calling for vaccines that can reduce malaria cases by 75 percent and that are suitable for use in all endemic-areas. Malaria affects nearly 100 countries and territories, with a particularly heavy burden in sub-Saharan Africa.

“The most recent figures that we have from the World Health Organization are for an estimated 660,000 deaths each year. It’s hard to get your head around that number because it’s such a large figure, said Dr. Vasee Moorthy, who’s with the World Health Organization’s Department of Immunizations and Vaccines. “So another way of thinking about it is that’s about 2,000 deaths each day from malaria. Now most of those deaths are in children under five in Africa, but there are also deaths elsewhere in parts of the Americas, in the Middle East and in Asia. And in terms of the number of cases, those deaths are from about 219 million cases of malaria.”

While there are no licensed vaccines yet against malaria, progress has been made in reducing cases. That’s due to better diagnosis, drugs, insecticide-treated mosquito nets and control of mosquito populations, which carry the malaria parasites.

“We’ve seen a 26 percent reduction in global malaria death rates over the last decade. If we could successfully develop malaria vaccines, they could have an important complementary role together with these malaria control measures,” Moorthy said.

Moorthy said that the 2013 Malaria Vaccine Technology Roadmap builds upon the original roadmap unveiled in 2006.

“It’s a more ambitious target now — in that the roadmap is now being expanded to include Plasmodium vivax as well as falciparum,” he said. “So falciparum is the form of malaria that causes most of the deaths, but vivax wasn’t previously included.”

While Plasmodium vivax may not cause as many deaths, it’s the source of many new cases. This is true in many countries – especially in the Americas and Asia — where progress has been made against the falciparum form of the disease. It often strikes adults, leaving them unable to work.

“The original roadmap included a goal of having a licensed vaccine by 2015 against the most deadly form of malaria, falciparum. And this is retained in the new roadmap — and adding the new goal of having a second generation of vaccines licensed by 2030,” said Moorthy.

It’s not clear whether the 2015 goal will be met. There are 27 malaria vaccine candidates in clinical trial. The most advanced candidate, RTS,S/AS01, is in Phase III trials. The results will be available in 2015 and then undergo regulatory review.

The new Malaria Vaccine Technology Roadmap is a collaborative effort led by the WHO, along with the U.S. and European governments and agencies, donors, developers and NGOs.

–Joe DeCapua

Source: VOA News

World Health Organization Seeks Funding for Emergency Response to Drug-resistant Malaria

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BANGKOK — The World Health Organization is warning that about $450 million is needed over the next three years to stop a strain of drug-resistant malaria from spreading beyond Southeast Asia to the rest of the world.

Researchers say the artemisinin-resistant strain has spread to Burma and Vietnam since it was first detected along the Cambodian-Thai border in 2008. In addition to sounding the alarm about drug-resistant malaria, the World Health Organization is rolling out an emergency response to what it terms a potentially serious global health threat. [Read more…]

WHO Launches Program to Counter Drug-Resistant Malaria

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On World Malaria Day, the World Health Organization has launched an emergency program in Phnom Penh to tackle a worrying regional trend – a strain of malaria that is proving resistant to the most important anti-malarial drug.

Six years ago, health researchers were worried after a strain of malaria in western Cambodia began to show resistance to the world’s key malaria treatment – Artemisinin-based Combination Therapy, known as ACT.

In response, the Cambodian government and its health partners, including the World Health Organization, put in place a program to prevent the resistant strain (falciparum malaria) from spreading within Cambodia and beyond its borders.

That program appears to have contained the resistant strain. But Thailand, Burma and Vietnam have reported pockets of artemisinin-resistant malaria strains.

The WHO malaria specialist in Phnom Penh, Stephen Bjorge, said it is likely the strains in those countries arose independently of Cambodia’s – which means the containment efforts have worked.

But because artemisinin is the standard treatment, it is important the resistant strains in all of these areas are contained and then eradicated. That is the purpose of a three-year, $400-million program the World Health Organization announced Thursday.

“The risks are significant – not only are they significant for the region in terms of having a reversal of the gains that have been made against malaria, but they are actually significant globally,” said Robert Newman, director of the WHO’s Global Malaria Program. “If history is any guide, if we were not to contain this problem then it is very likely to spread elsewhere. Especially risky is to sub-Saharan Africa, where the greatest burden still exists. And, if we were to lose the efficacy of the ACTs today, this really would be a public health catastrophe in Africa.”

The WHO-led program is being funded by the Global Fund, the Bill & Melinda Gates Foundation and by the Australian government’s development arm called AusAID.

It will cover six countries: the four where resistance has already been found, as well as two more considered to be “at risk” from the resistant strain: Laos and an area of southern China.

Newman said some of the lessons learned from Cambodia’s efforts are being used.

“This is not starting from zero,” he explained. “It is building on the experience initially on the Cambodia-Thailand border where those countries gained a lot of experience in how to reach the populations that are actually most difficult to reach – migrant and mobile populations, how to use village health care workers, how to more aggressively remove substandard medicines from the market.”

The program will distribute insecticide-treated bed nets; monitor fake drugs; ensure people have access to reliable testing and treatment; and track the disease. Migrant communities and people living in border regions will be key targets of the program.

AusAID has provided $5 million of funding for the program.

“Well, our initial funding is fixed, but the reality is Australia is part of this region,” said AusAID’s principal health advisor Ben David. “We are part of the Asia-Pacific and we see this as a critical investment to protect the poor in the region from malaria, but also to protect the interests of countries because if this problem gets out of control and we see malaria drug resistance spread in the region and beyond, then we are in to face a big set of problems.”

David says, last year, malaria killed 42,000 people in the Asia-Pacific region and more than half a million worldwide, most of them children in Africa.

Recent years have seen good progress in tackling malaria, but the WHO warns that could be undone should the resistant strains escape the current pockets in the countries of the Greater Mekong sub-region.

David believes governments will do their part to prevent the spread.

“It has actually got significant economic implications, if this problem of resistance continues. So, we really need to make the economic case to governments to continue to invest in this problem,” he added.

The chloroquine-resistant malaria strain has caused millions of deaths globally since it emerged 60 years ago from the forests of western Cambodia.

The World Health Organization warns the world cannot afford a similar repeat outbreak by allowing the new strain or strains of artemisinin-resistant malaria to escape the region.

Source: VOA News

Can my 14 day old daughter have malaria?

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QUESTION

My 14 day old daughter has a body temperature of about 38.3 C and breathes a bit rapidly.  Can it be a sign of malaria?

ANSWER

In newborns, it is sometimes difficult to tell exactly what is wrong.   The majority of newborns who get sick after delivery,  get an infection (from bacteria, not malaria).  WHO and UNICEF have identified the following “danger signs.” If the baby has  one or more of the following signs, take the baby to a hospital with qualified personnel and drugs immediately. Once there, the staff can treat the baby and test for malaria if indicated.

 

  1. Not feeding since birth or stopped feeding
  2. Convulsions
  3. Respiratory rate of 60 or more
  4. Severe chest indrawing
  5. Temperature ≥ 37.5 C
  6. Temperature ≤ 35.5 C
  7. Only moves when stimulated, or not even when stimulated

or        Yellow soles (sign of jaundice)

Signs of local infection:

  1. Umbilicus red or draining pus, skin boils, or eyes draining pus

All newborns, infants and young children in malarial areas  need to be protected from malaria and should sleep under an long acting, insecticide treated bed net.

 

Malaria Treatment Statistics

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QUESTION

Where can I find information on the ratio of malaria cases treated annually globally or per country?

ANSWER

A great resource for information on malaria is the World Health Organisation (WHO). They publish an annual malaria report which also includes lots of statistics about numbers of cases, numbers treated, and numbers of deaths from malaria. Some of the data is even available at the country level, I believe. You can download these reports, and also find out a lot more information about malaria, at the World Health Organisation malaria page.

World Malaria Day 2012

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“Sustain Gains, Save Lives: Invest in Malaria.”

World Malaria Day was established in May 2007 by the 60th session of the World Health Assembly, the decision-making body of the World Health Organization (WHO). The day was established to provide education and understanding of malaria and disseminate information on  malaria-control strategies, including community-based activities for malaria prevention and treatment in endemic areas.

According to the World Health Organization, approximately half the world’s population is at risk from malaria. And while malaria  is a preventable and treatable disease, it still claims the life of a child every minute, with more than 90% of all malaria deaths occurring in Africa. [Read more…]

EDITORIAL – Reflections on World Malaria Day 2011

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How far have we come in the last four years?

Four years ago, it was estimated that a child died every 30 seconds from malaria, and that more than a million people each year were killed by this devastating and debilitating disease. Four years ago, the malaria advocacy partnership Roll Back Malaria organized the first World Malaria Day, and published the Global Malaria Action Plan (GMAP), which set comprehensive goals for the control of malaria world-wide, with the ultimate aim to eradicate malaria completely. [Read more…]

“SMS for Life” Malaria Initiative for Tanzania Announced

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In commemoration of World Malaria Day 2011 (25 April), organizations in an innovative public-private initiative announce the nationwide roll-out of a unique malaria treatment access initiative, “SMS for Life,” across the United Republic of Tanzania. The roll-out follows a successful pilot project where mobile and electronic mapping technology was used to track the stock levels of anti-malarial drugs at health facilities to manage supplies of these essential treatments.

Launched in 2009, the “SMS for Life” pilot ran across three districts in Tanzania, ensuring access to essential malaria treatments for 888,000 people. 99% of health facilities involved avoided stock-outs of the artemisinin-based combination therapy (ACT), one of the main anti-malarial medicines.2 “SMS for Life” will now be deployed across 5,000 health facilities in 131 districts in Tanzania, covering a population of over 40 million.

Under the auspice of the Tanzanian Ministry of Health and Social Welfare, this roll-out is led by Novartis and supported by Vodacom, Medicines for Malaria Venture (MMV) and the Swiss Agency for Development and Cooperation, all under the umbrella of the global Roll Back Malaria Partnership.

Malaria kills about 800,000 people each year, the vast majority of whom live in sub-Saharan Africa where the disease is a leading cause of death for children under five, claiming the life of a child every 45 seconds.2 Although malaria is preventable and treatable, life-saving medicines do not always reach the patients who need them, particularly those living in remote areas. Stock-outs are a major hurdle in the maintenance of access to essential malaria treatments.

H.E. Dr Hadji Hussein Mponda, Minister for Health & Social Welfare in Tanzania, said “the simple truth is that if there are no effective malaria treatments available in the health facilities then people will likely die, especially young children and pregnant women who are most at risk of the disease. Reducing antimalarial drugs stock-outs saves lives, and so we are delighted that the SMS for Life programme that improves stock position information will now be rolled-out across Tanzania and we welcome this innovation.”

“SMS for Life” has demonstrated that we can overcome the longstanding problem of stock-outs at the health facility level. This flexible scheme can be implemented quickly and at relatively low cost in any country to track any medicine,” said Jim Barrington, “SMS for Life” Program Director and former Chief Information Officer at Novartis. “It’s rewarding to see how a unique partnership, which combines the specific skills and experience of its various members to deliver an innovative use of everyday technologies, positively impacts the lives of malaria patients, their families and communities. “SMS for Life” also has great potential to be implemented in all malaria endemic countries and within other disease areas.”

In addition to the roll-out in Tanzania this year, two further pilots will start. Kenya, with funding from Novartis via the global employee survey donation program, will implement a five district pilot to track ACTs and rapid diagnostic tests (RDTs), in addition to collecting weekly case management data. MMV, through partnership with University of Oxford, will provide technical support for the implementation and evaluation of the pilot project. Ghana, with funding from Swiss TPH, will implement a six district pilot to track malaria medicines, an antibiotic and RDTs. Accurately monitoring the amount of essential medication, such as ACTs and quinine injectables, available in a given location, reduces the risk of shortages and stock-outs and ensures that treatments are available to malaria patients, even in the most remote areas, where and when they are needed.

Each week, automated SMS messages are sent to staff at participating healthcare facilities, prompting them to check the stock of anti-malarial medicines, and reply with an SMS detailing current stock levels. These messages are collected in a central web-based system that provides the District Medical Officers and other users with real-time stock level information, accessible via the Internet or their mobile phone. Using this information, District Medical Officers are able to redistribute essential medicines to where they are most needed and coordinate emergency deliveries to health facilities if necessary.

The Global Business Coalition on HIV/AIDS, Tuberculosis and Malaria (GBC) Business Action on Health Awards Review Committee has recently selected the “SMS for Life” program as a Finalist for the Technology for Health award.

About “SMS for Life”
“SMS for Life” is an innovative public-private partnership that harnesses everyday technology to improve access to essential malaria medicines in rural areas. It uses a combination of mobile phones, SMS messages and electronic mapping technology to track weekly stock levels at public health facilities in order to eliminate stock-outs, increase access to essential medicine and reduce the number of deaths from malaria.

“SMS for Life” was initially piloted across three districts in the United Republic of Tanzania, covering 129 health facilities and 226 villages, representing 1.2 million people. When launched in 2009, 26% of all health facilities did not have any ACTs in stock, but by the end, 99% had at least one ACT dosage form in stock. In addition, 888,000 people in the three pilot districts had access to all malaria treatments at the close of the pilot, versus 264,000 people at the start, which helped to reduce the number of deaths from malaria.

About the partners
Under the Tanzanian Ministry of Health and Social Welfare and the National Malaria Control Programme (NMCP) is the Directorate of Preventive Services. NMCP is the custodian of all malaria prevention and control activities in the country. The NMCP is the owner and main user of the ‘SMS for Life’ solution and coordinates all project activities in the country, including planning, implementation & evaluation of the project. The NMCP also makes sure that all the districts selected are fully engaged in the process.

Novartis drives the overall initiative and has taken the lead in defining the solution, sourcing the partners, establishing a steering committee, liaising with the Ministry of Health in Tanzania and RBM Partnership Secretariat and providing all the resources and funding necessary to complete the pilot in Tanzania.

Medicine for Malaria Venture (MMV) is, along with SDC, one of two funders of the country implementation of the solution. They also manage funds from SDC, giving them the role of managing all project funding. In addition, MMV is coordinating the national training program and is contracting technology deployment required to affect this rollout.

The Swiss Agency for Development (SDC) is the second and major funder of the Tanzanian nationwide roll-out. Its grant is managed by MMV.

Vodacom, a local Tanzanian Mobile operator is providing, in addition to promotional materials like tshirts, smart phones with Internet and data access for use by all District Medical Officers and Malaria Focal persons.

Vodafone supported the design, development and the implementation of the technical solution for the Tanzanian Pilot in 155 health facilities until its completion in February 2010.

IBM supported the overall management of the pilot project and the provision of an on-line collaboration tool, “Lotus Live”. The tool allowed all the project partners to coordinate their inputs.

RBM Partnership Secretariat facilitates oversight, including the work of the steering committee and leads advocacy activities. It helps provide ongoing guidance throughout the project, placing it in the broader context of RBM’s activities.

About RBM
The Roll Back Malaria (RBM) Partnership is the global framework for coordinated action against malaria. It provides a neutral platform for consensus-building and developing solutions to challenges in the implementation of malaria control interventions and strategies. RBM is a public-private partnership that also facilitates the incubation of new ideas and lends support to innovative approaches.

The Partnership promotes high-level political commitment and keeps malaria high on the global agenda by enabling, harmonizing and amplifying partner-driven advocacy initiatives. Founded by UNICEF, WHO, the World Bank and UNDP and strengthened by the expertise, resources and commitment of more than 500 partner organizations, the Partnership secures policy guidance and financial and technical support for control efforts in countries and monitors progress towards universal goals.

Source: World Health Organization (WHO), Roll Back Malaria

Urgent Action Essential to Protect Malaria Therapies, Says WHO

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The world risks losing its most potent treatment for malaria unless steps are quickly taken to prevent the development and spread of drug resistant parasites, according to a new action plan released today by WHO and Roll Back Malaria partnership (RBM).

The Global plan for artemisinin resistance containment outlines the necessary actions to contain and prevent resistance to artemisinins, which are the critical component of artemisinin-based combination therapies (ACTs), the most potent weapon in treating falciparum malaria, the deadliest form of the disease. Resistance to artemisinins has already emerged in areas on the Cambodia-Thailand border. Although ACTs are currently more than 90% efficacious around the world, quick action is essential. If these treatments fail, many countries will have nothing to fall back on.

Stop the emergence of drug resistance at its source

“The usefulness of our most potent weapon in treating malaria is now under threat,” said Dr Margaret Chan, WHO Director-General. “The new plan takes advantage of an unprecedented opportunity in the history of malaria control: to stop the emergence of drug resistance at its source and prevent further international spread. The consequences of widespread artemisinin resistance compel us to seize this opportunity.”

The global plan aims to contain and prevent artemisinin resistance through a five-step action plan:

1. Stop the spread of resistant parasites

A fully funded and implemented malaria control agenda, as outlined in the Global malaria action plan, would address many of the needs for the containment and prevention of artemisinin resistance. However, additional funding will be needed to stop the spread of resistant parasites in areas where there is evidence of artemisinin resistance. The global plan estimates that it will cost an additional US$ 10–20 per person in areas of confirmed resistance (Cambodia-Thailand border) and US$ 8–10 per person in the at-risk areas of the Greater Mekong area.

2. Increase monitoring and surveillance for artemisinin resistance

WHO estimated in 2010 that only 31 of the 75 countries that should be conducting routine testing of the efficacy of ACTs actually did so. There is a risk of artemisinin resistance emerging silently in areas without ongoing surveillance.

3. Improve access to malaria diagnostic testing and rational treatment with ACTs

These therapies are frequently used to treat causes of fever other than malaria. Unnecessary use of ACTs can increase the risk of resistance. In order to reduce the number of patients who do not have malaria taking the therapies, WHO recommends diagnostic testing of all suspected malaria cases prior to treatment.

4. Invest in artemisinin resistance-related research

There is an urgent need to develop more rapid techniques for detecting resistant parasites, and to develop new classes of antimalarial medicines to eventually replace the ACTs.

5. Motivate action and mobilize resources

The success of the global plan will depend on a well-coordinated and adequately funded response from many stakeholders at global, regional and national levels.

”Effective containment of artemisinin resistance will significantly improve our capability to sustain current control achievements at country level,” said Professor Awa Coll-Seck, Executive Director of the Roll Back Malaria Partnership. ”We now have a coordinated plan to stop the spread of resistant parasites, but we need additional funding to fully implement it,” Coll-Seck reminded the international donor community.

WHO estimates that the number of malaria cases has fallen by more than 50% in 43 countries over the past decade. A recent modeling analysis of malaria prevention in 34 African countries estimates that more than 730 000 lives were saved between 2000 and 2010; nearly three quarters of them since 2006, when the use of both insecticide treated mosquito nets and ACTs became more widespread. The loss of ACTs as an effective treatment would likely result in a significant increase in malaria-related deaths.

Tremendous progress against malaria

“We have made tremendous progress over the past decade in the fight against malaria,” noted Dr Robert Newman, Director of the WHO Global Malaria Programme. “If we are to sustain these gains and achieve the health-related Millennium Development Goals, then it is essential that we work together to overcome the threat of artemisinin resistance.”

The Global plan for artemisinin resistance containment was developed by the WHO Global Malaria Programme through consultation with over 100 malaria experts from across the Roll Back Malaria Partnership. Funding was provided by the Bill & Melinda Gates Foundation.

Source: WHO