Delivering Malaria Innovations

The World Health Assembly, at the end of May 2021, adopted a resolution urging countries to increase their efforts in scaling up the recommendations of WHO’s updated global malaria strategy and the WHO Guidelines for malaria. The resolution calls on countries to extend investment in and support for health services, ensuring that no one is left behind; sustain and scale up sufficient funding for the global malaria response; and boost investment in the research and development of new tools.

As of today, tools available to fight malaria include bed nets treated with insecticide, indoor residual spraying, rapid diagnostic tests, drugs, and the first-generation malaria vaccine that is being piloted in Africa—the result of innovation by the private sector, but also governments, research organizations, international organizations, and civil society. Developing novel tools to prevent, treat, and diagnose the disease is crucial—and opportunities have expanded to creating new ways of using the tools we already have, finding how to effectively reach the most at-risk and often distant populations[i], as well as finding innovative financing mechanisms. Examples include digital health solutions, such as the digital health platform UpSCALE, which was developed by the Malaria Consortium together with the Ministry of Health (MoH) and UNICEFs to support community health workers in Mozambique in diagnosing and treating malaria; Zipline, an aerial logistics company that specializes in the delivery of medical products by drones (learn more in our Q&A below); companies working on developing innovative diagnostic tools as outlined in our next article; and innovative finance for malaria such as blended finance, outcome-based financing, and other financing mechanisms as currently developed by the Global Fund.

Innovating for malaria requires a strong support from every sector, to implement and scale the tools we already have and develop some new ones. For key messages around malaria and innovation, check out RBM’s Malaria Innovation Narrative here. To learn more about how non-traditional sectors can get involved in malaria innovation, from banking to the extractive industry, agriculture, and others, check out the Business Alliance’s Against Malaria Investment Case here.

[i] Gonzales M. “the long-term bet on innovation for malaria.” 9 September 2019. Accessed June 2021. https://bit.ly/2SDgt2w

Malaria Innovation Series: Diagnostics

The private sector plays a crucial role in developing the diagnostic tools of tomorrow. Companies are at work making diagnostic tests more sensitive, more accurate, and easier to use and transport. Further, several smaller companies have also recently entered the market, with innovative products that use blood, urine, light or body temperature to improve detection.[i] Additional innovations in malaria diagnosis will speed elimination efforts by providing health systems and national malaria programs with a fuller picture of the disease landscape, and interrupt outbreaks before they start.

     Selected Malaria Diagnostic Innovations:

●            In early 2016, Meridian Biosciences launched a molecular diagnostic test that allows for a robust detection of malaria parasites in blood using amplified DNA. Unlike other tools, the test can be conducted at constant temperature, which makes for easier transport on the field.[ii]

●       In 2014, Sight Diagnostics Ltd. launched an enhanced automated microscopy system that functions as a one-stop point of care. The technology leverages breakthrough hardware, machine vision and AI to provide doctors with an almost instant diagnosis of the disease.[iii] 

●       TermoTell[iv], a socially focused start-up, has designed an innovative bracelet and patch that helps diagnose malaria in children earlier by tracking changes in body temperature and sweat patterns. The company was among the finalists of UNICEF's Wearables for Good Challenge in 2015.[v]

●       UK-based biotech company QuantuMDX is designing a rapid diagnostic tool to help professionals detect the DNA of malaria parasites in blood samples.[vi]

●       Alere, an Abbott-owned company, also recently launched a product that helps improve detection of HRP2 protein, which is present in higher levels in individuals with malaria.[vii]

[i] PATH. “Finding the final cases of malaria using more sensitive diagnostics.” 30 August 2019. Accessed June 2021. https://bit.ly/34yvF1J.

[ii] Meridian Bioscience. “Platforms”. Accessed June 2021. https://bit.ly/2Drl7FB.

[iii] Sight. “Blood diagnostics, meet machine vision.” Accessed June 2021. https://bit.ly/2Dpa3ZI.

[iv] TermoTell. Accessed June 2021. https://bit.ly/2QZ1EUN.

[v] UNICEF. “Meet UNICEF wearables finalists series: TermoTell.” 10 November 2015. Accessed June 2021. https://bit.ly/2L61mri.

[vi] Fedor L. “Demand for good, rapid malaria tests outstrips supply.” Financial Times. 17 April 2018. https://on.ft.com/2Otx5Vs.

[vii] PATH. “Finding the final cases of malaria using more sensitive diagnostics.” 30 August 2019. Accessed June 2021. https://bit.ly/34yvF1J.

Ask a Malaria Expert: Kwasi Antwi

This quarter’s malaria expert is Kwasi Antwi. Kwasi is a Health Systems Integration Lead at Zipline and is based in Ghana. Kwasi has a background in business and pharmacy, having earned a Bachelor of Pharmacy from the Kwame Nkrumah’ University of Science and Technology and an Executive Masters in Business Administration and Marketing from the University of Ghana. He has worked at Zipline since March 2020.

Zipline's mission is to provide every human on Earth with instant access to vital medical supplies. In order to fulfill its mission, Zipline developed and utilizes the world's fastest and most reliable delivery drone, along with the world's largest autonomous logistics network.

1)      What do you find engaging in the malaria space? Can you tell us more about Zipline activities in relation to malaria? What are the biggest challenges of delivering medicines and other health products using drones in Africa?

Zipline is a U.S. multinational aerial logistics company that specialises in the delivery of medical products by drones. Here in Ghana, Zipline has been contracted by the Government to partner the Ministry of Health in strengthening the national supply chain system with its just-in-time drone delivery service. Under the existing contract with the Government, Zipline is to deliver blood products, routine and emergency essential medicines as well as routine and emergency vaccines especially to facilities in rural areas. Antimalarials are key within the portfolio of products delivered. Currently we deliver not just antimalarial products but also Malaria test kits. The objective of this partnership is to help improve timely access to health commodities and by extension the quality of rural health care services.

2)       What innovations in the supply chain and logistics sector are you most excited about?

Zipline’s innovation in supply chain system is helping to strengthen Ghana's health supply chain system by:

·       eliminating stock-outs at facilities

·       eliminating cold chain breakages during transportation of medical supplies

·       evening distribution of scarcely available medical supplies across facilities

·       improving emergency response in rural areas

·       reducing wastage from expiries

Many of our service areas are hard-to-reach as a result of poor roads. With our drones, we are able to fly to all these places with ease. Above all is timely/reliable delivery of all the emergency medical commodities above. We are able to deliver by our drones within 45 mins; a journey that could take about 4 hours by road and even sooner when the facility is closer. During the rainy season last year, Zipline partnered with the Ghana Health Service to deliver medical products to facilities in the Northern sector of the country cut off by floods as a result of the rains. This challenge is a perennial problem that forces communities to manage for weeks and sometimes months without access to any form of medical supplies. Incidentally the season also records spikes in malaria cases making matters even worse. The partnership with the Ghana Health Service helped to ensure access to health commodities including antimalarials and antipyretics throughout the rainy season. Stocks from the Ghana Health Service were centralised at Zipline’s warehouses and flown over the flooded areas to facilities directly by drones.

3) What are the biggest challenges of delivering medicines and other health products using drones in Africa?

There are many gaps within healthcare systems in Africa that present opportunities for aerial logistics intervention. Delivering medical products with drones is just as easy as delivering any other product. The challenge however comes with building problem solving drone use cases with systems that neatly and seamlessly fit within the existing standard operating procedures designed by the managers of healthcare systems. Building an uncomplicated process that works from ordering of a product by the customer, to its delivery by a drone to a specific facility requires alignment with several stakeholders within and without the healthcare space. Given the novelty of drone technology, adoption by stakeholders may take a lot of time and effort. So far, Zipline is the only company delivering medical products at national scale with both Ghana and Rwanda. In Ghana, Zipline has managed to build and integrate distribution systems to complement the country’s last mile distribution system. The country currently has 4 distribution centers reaching close to 12 million people. With the Ministry of Health’s approval, plans are in place to add on 4 more distribution centers to cater for more hard to reach areas in the country made up of islands and riverine communities.

Introducing the Malaria Innovation Series

Private sector organizations are leading the way in developing the next generation of vector control, diagnostic, and treatment tools that will accelerate efforts to eradicate malaria, and there are always opportunities for new product innovations across the disease cycle.

Many of the tools being used in today’s fight against malaria - such as insecticide-treated mosquito nets, indoor residual spraying, and artemisinin-based treatments - were developed in the last century and have begun to diminish in efficacy as drug- and insecticide-resistance spreads. Promising new diagnostics, medications, insecticides, and vector control approaches are under development, and have the potential to turn the tide in the fight against malaria.

This forthcoming quarterly series will seek to showcase innovative new tools across malaria prevention, diagnosis, and treatment:

Prevention: Bed nets remain the primary tool for effective malaria prevention and are most effective when treated with long-lasting insecticides. However, mosquito resistance to traditional insecticides is on the rise, indicating that new vector-control tools and approaches are needed to continue to keep communities in malaria-endemic regions safe.

 Diagnosis: The private sector also plays a crucial role in developing the diagnostic tools of tomorrow. Further innovations in malaria diagnosis will speed elimination efforts by providing health systems and national malaria programs with a fuller picture of the disease landscape, and interrupt outbreaks before they start.

Treatment: The private sector is also driving innovation to more effectively and efficiently combat the disease in another critical area: treatment. There is a need for treatments that are able to cure drug-resistant infections and better address the needs of pediatric patients. Further, the private sector has identified opportunities to streamline treatment regimens by curing the disease using fewer doses of medication.

While health and vector control product supplies will be featured heavily, as they play an obvious and key role in providing innovations in the fight against malaria, other industries also have the potential to make critical contributions and will be highlighted accordingly. For example, data and mobile technology companies can develop solutions for case monitoring and tracking medical records, while electronic media companies can help to design public communications campaigns to raise awareness about the disease.

Should you have any suggestions of innovative tools that we can feature please reach out to us!

Read, Watch, Listen

The BAAM Secretariat is still hunkering down at home this winter as the COVID-19 pandemic continues. We’ve taken advantage of so much time relaxing on the couch to dig into all sorts of malaria-related media. From a 1943 film by Walt Disney, to a podcast on the ways in which malaria influenced the building of the Panama Canal, there is something for everyone.

 We’ve organized these resources by type, and have tried to estimate the amount of time they require to enjoy. We hope that you enjoy this tour of malaria cultural artifacts as much as we did!

 Read:

The New Yorker’s “How Mosquitos Changed Everything” (20-minute read)

This 2019 article offers an impressive comprehensive cultural history of malaria. Drawing on Timothy Winegard’s book, The Mosquito: A Human History of Our Deadliest Predator, the article attributes major global events--from the destruction of the dinosaurs, to fall of ancient Rome, and the ultimate unification of Great Britain—to the mosquito and malaria. Bold claims!

 The Economist’s “History, written by vectors” (15-minute read)

Dr. Seuss on Malaria

More recently, in its Christmas Special edition, The Economist shows how malaria shaped human choices—for example, we learn that malaria was once widespread in Europe, one reason why ancient Rome was so hard to conquer. When Hannibal crossed the Alps in 218 BC, malaria cost him his right eye, his wife, his son and much of his army. At the time, Romans thought that the fevers people caught in the Empire were caused by noxious fumes, hence the name mal’aria, from “bad air”.  

 NPR’s “Dr. Seuss on Malaria” (3-minute read)

In 2012, NPR dug up a public health campaign on malaria commissioned by the U.S. Army. It was illustrated by none other than Theodor Geisel—better known by his nom de plume, “Dr. Seuss.”

Watch:

“The Winged Scourge” Showcases Bednets

Walt Disney’s “The Winged Scourge,”  (9 min 45 sec)

In 1943, Walt Disney released a short educational film on malaria wherein Snow White’s seven dwarves fight “public enemy number 1: the anopheles malaria mosquito.” The animated film showcases bed-nets, IRS, and eliminating standing water, among other vector control techniques. The short is available to watch for free on YouTube.

Richard Curtis’s Mary and Martha (1 hr 34 min)

For those interested in a feature-length malaria film, Mary and Martha may fit the bill. This 90-minute movie, released in 2013, chronicles the experience of the fictitious Mary, an American, and Martha, a Brit, who have both lost sons to malaria during trips to South Africa and Mozambique, respectively. The Guardian calls the movie “a call to arms in the eminently winnable battle against malaria.” It is available for free on HBOMax, or as a $3.99 rental from Amazon.

Listen:

 NPR’s Throughline Podcast’s “The Mosquito’s Impact on the Shaping of the U.S.” (7 minutes)

Timothy Winegard, of “How Mosquitos Changed Everything” fame, participated in 7-minute interview with NPR on the mosquito’s impact on the birth of America and the Revolutionary War. The interview is available to listen to for free from NPR.

Stuff You Missed In History Class’s “Malaria and the Panama Canal.” (15 minutes)

Another quick and interesting podcast on the huge cultural and historical significance of malaria comes from the fantastic “Stuff You Missed in History Class.” In 2009, the hosts dove into malaria’s impact on the construction of the Panama Canal. The 15-minute episode is free from iHeartRadio and is linked here.

Ask a Malaria Expert: Dr. Fiona Angrisano

This quarter’s malaria expert is Dr. Fiona Angrisano – Fiona focuses on anti-malarial transmission blocking vaccines and is currently a Senior Research Officer with the Burnet Institute in Melbourne.

 Fiona completed her PhD at the Walter and Eliza Hall Institute, with Professor Jake Baum in 2015. Her research focused on investigating the way in which Plasmodium parasites move, both into the red blood cell during the process of invasion, and through the mosquito midgut during the process of malaria transmission.

 After her PhD, Fiona moved to Imperial College London and Cambridge University with Dr. Andrew Blagborough as a Research Associate. During this time, her research focus shifted to incorporate a more translational emphasis, with the overall aim of identifying and developing anti-malarial transmission blocking vaccines.

Fiona’s key interests involve the discovery of multiple new anti-malarial vaccine antigen candidates, the establishment of new delivery systems, and the design of multiple pre-clinical and clinical studies to assess vaccine effectiveness.

 Q&A:

1)      What first drew you to focus your research on malaria?

I have always found host/pathogen interactions fascinating. The ability of a parasite to manipulate the host in order for its’ own survival has always intrigued me. This curiosity led me to begin working on Plasmodium (the parasite that causes the disease, malaria) during my honors year at university. The complexity and unique idiosyncrasies of Plasmodium biology has sustained my interest for the last 14 years. It is also easy to stay motivated and focused when working on understanding and preventing a disease that affects the most vulnerable individuals in malaria endemic countries.

2)      What are the biggest challenges – both in terms of scientific discovery and practical application at the community level – of developing and deploying a vaccine for malaria?

There are many obstacles frustrating malaria vaccine development. From a scientific discovery point of view, Plasmodium parasites are genetically complex, with a complicated lifecycle that takes place in both humans and mosquitoes. This makes developing a vaccine against the parasite technically complex. The development of immunity to malaria from exposure to Plasmodium parasites does not confer lifelong protection; unlike diseases we currently have effective vaccines against. Any acquired immunity only partially protects an individual against future disease. This means we cannot approach a malaria vaccine with the same strategy we do for other diseases.

Traditionally, malaria is a disease of the low- and middle-income countries and this in turn means there is a lack of a traditional investor market funded vaccine development, due to a perception of lower commercial return on investment.

Current vaccines available against malaria require huge logistically complex pipelines in order to reach remote settings of endemic countries to administer the vaccine. An example of which is the requirement for cold chain logistics to keep temperatures from varying too much so as to not reduce the potency of the vaccine.

3)      What are you working on now? 

My current research expands on my parasitology and vaccinology background to incorporate sero-surveillance assays of not only malaria, but other mosquito borne diseases, vaccine preventable diseases and neglected tropical diseases in Papua New Guinea. I am developing assays to monitor the spread of multiple pathogens allowing rapid identification of outbreaks, resurgent and resistant pathogens. The data arising from these assays will contribute towards decision making and policy options for key health systems within PNG.

Partner Happenings Q4 2020

African Leader’s Malaria Alliance

 Joy Phumaphi, ALMA’s Executive Secretary, commented on the release of the World Malaria Report 2020, which shows that Africa is not on track to achieve its 2020 target of reducing malaria incidence and mortality by 40% and goal of eliminating malaria by 2030: “In line with the Abuja Declarations and the bold and ambitious targets set in the Catalytic Framework to End AIDS, TB and Eliminate Malaria in Africa by 2030, and in the context of COVID-19 that has affected health systems across Africa, we need renewed commitment. It is only through strong leadership by the African Heads of State and Government and joint action through partners and communities that we can achieve the shared vision of malaria elimination in Africa”. To reinvigorate ongoing engagements, WHO and the RBM partnership to End Malaria catalyzed the “high burden to high impact” (HBHI) approach in 2018. The response is led by 11 countries – including 10 in sub-Saharan Africa – that account for approximately 70% of the world’s malaria burden.

Sub-Saharan countries took a number of initiatives to prevent disruptions in malaria programs due to the pandemic, including the distribution of insecticide-treated nets door-to-door, record implementation of seasonal malaria chemoprevention for children, freighting of malaria medicines to avoid stock-outs, and intensified advocacy and communications efforts to ensure malaria remains high on national agendas.

ALMA developed online training courses in French to help countries improve the impact of their scorecard management tools and strengthen accountability. The online trainings and webinars will be part of a digital platform that the President of ALMA, His Excellency President Kenyatta, will launch in early 2021.

Asia Pacific Leader’s Malaria Alliance (APLMA)

APLMA celebrated the fact that the South-East Asia region is on track to achieve 40% reduction in malaria cases by 2020, driven by continued progress in the Greater Mekong Region and in India. Nonetheless, the COVID-19 pandemic and its economic fallout threatens long-term gains made. Notably, the pandemic has reinforced the critical importance of timely, accurate and localized data and innovation to effectively fight infectious diseases like malaria. Dr Sarthak Das, CEO of the Asia Pacific Leaders Malaria Alliance, added: “Consistent leadership across much of Asia Pacific amidst emerging antimalarial resistance and COVID-19 has protected hard-earned progress over the past decade. While there is much to celebrate in regard to progress, we must continue to not only support nations on the verge of elimination but also ensure that higher-burden countries like India, Indonesia and Papua New Guinea are not forgotten. These actions will sustain the momentum towards our goal of eliminating malaria in the Asia Pacific by 2030”.

 In November 2020, Leaders at the East Asia Summit recommitted to the 2030 malaria elimination goal and welcomed ongoing efforts to implement proposed actions in the Asia Pacific Leaders’ Malaria Elimination Roadmap, including the five-year progress report delivered. The five-year report (2015-2019) highlights the importance of engaging with the private sector. The report can be accessed here.

In October, the Alliance published an article detailing how Asia Pacific Leaders Malaria Alliance (APLMA) and U.S. Pharmacopeia (USP) have been working with a consortium of partners to raise awareness among policymakers in the Asia–Pacific region about SFs and propose concrete steps to strengthen the global medical product supply chain through the Medicines We Can Trust campaign and other initiatives.

The President’s Malaria Initiative

PMI celebrated its 15th anniversary at the American Society of Tropical Medicine and Hygiene (ASTMH) during a virtual session moderated by former ASTMH President Dr. Dyann Wirth. The event featured a fireside chat with past and present U.S. Global Malaria Coordinators -- Rear Admiral Tim Ziemer and Dr. Ken Staley -- and remarks from national malaria control leaders from Uganda, Cambodia, and Cameroon.

The Global Fund to Fight HIV, TB, and Malaria

The Global Fund has full deployed all of the nearly US$1 billion it awarded to 106 countries to support their responses to the pandemic. But more support is required to meet ongoing challenges, including the need for more funding for manufacturing and distribution of personal protective equipment (PPE), testing supplies, and treatment programs. Unfunded country requests now exceed US$355 million.

Earlier in December, The Global Fund appointed Tracy Staines, a seasoned executive with over 20 years of multi-sectoral experience in audit and risk management, including eight years at the Global Fund, as Inspector General. Joining Staines is Hui C. Yang, a highly experienced supply chain executive, who was appointed head of the Global Fund’s Supply Operations Department.

Malaria and Universal Health Coverage: How curbing malaria can improve health systems, and vice-versa

The COVID-19 pandemic has emphasized the need for stronger health systems, which are crucial to expanding universal health coverage (UHC). The current crisis has shown, however, that inadequate investments have been made in the very foundations of health systems – including in emergency preparedness and in the development of a robust healthcare workforce.[1] These issues undermine two important health goals: delivering healthcare for all by 2030 and reducing global malaria incidence and mortality rates by at least 90% by 2030.[2], [3] One solution to address these gaps is to make investments in malaria programs, which have the add-on effect of strengthening overall health systems.

The Fighting Malaria, Improving Health, a five-year partnership program funded by Comic Relief and GSK, aims to reduce the impact of malaria and strengthen health systems in several malaria endemic countries across sub-Saharan Africa and the Greater Mekong sub-Region. The program helps to increase the overall resilience of the health system and in doing so improves progress towards UHC in three main ways: 1) by improving the supply of quality healthcare and products; 2) by building strong surveillance and data management systems—a key aspect in fighting and preventing other diseases, including COVID-19[4]; and 3) by facilitating critical partnerships, including with sectors that are not directly operating in the healthcare space. By focusing on some of the hardest-to-reach communities in Sierra Leone, Tanzania, Ghana, Mozambique, Myanmar, Laos and Cambodia, the program empowers community health workers to strengthen local healthcare systems. As malaria interventions often serve as an entry point to the health system in these countries, well-trained primary health care workers who can provide safe, quality health services are essential to ensuring inclusive malaria responses but also care for other diseases, including non-communicable diseases and other infectious diseases. 

Ensuring the quality of essential medicines helps deliver effective treatments and results in health care savings that can be reinvested towards UHC. Substandard and falsified malaria drugs result in 200,000 preventable deaths each year, according to a WHO estimate[5], and also results in large economic losses for countries.[6] Improving the supply of quality malaria medicines, and fighting fake and substandard medicines, are therefore key steps on the path towards achieving UHC.[7]

Strengthening surveillance and information systems also play an important role in achieving UHC. As the COVID-19 pandemic has shown, timely, reliable and quality data is absolutely crucial in preventing pandemics. This is true for the malaria response as well, where such systems are used to track and identify areas where malaria might spread or is already spreading and to implement targeted solutions.[8] [9] [10]

Lastly, working in partnership and looking beyond health will also be key to building stronger health systems and achieving UHC. The pandemic has shown that controlling malaria while driving progress towards UHC demands that organizations come together and work together to achieve common objectives. Effective partnership means governments working with local and international NGOs, the private sector and academia, but also boosting political leadership at all levels, by improving coordination between governmental ministries, agencies and department to elevate malaria beyond the health agenda.

References:

[1] https://www.who.int/news-room/feature-stories/detail/responding-to-covid-19-and-building-stronger-health-systems-for-universal-health-coverage

[2]https://apps.who.int/iris/bitstream/handle/10665/176712/9789241564991_eng.pdf;jsessionid=C0C8EF56FE0139EC4A4A3BC85EBE4AEE?sequence=1

[3] https://www.who.int/campaigns/universal-health-coverage-day-2020

[4] https://www.gsk.com/media/6375/comic-relief-gsk-uhc-booklet-final-2020.pdf

[5] https://www.who.int/medicines/regulation/ssffc/publications/SE_Study_EN.pdf?ua=1

[6] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7347121/

[7] http://fightthefakes.org/

[8] https://apps.who.int/iris/bitstream/handle/10665/272284/9789241565578-eng.pdf

[9] https://www.measureevaluation.org/measure-evaluation-tz/malaria-surveillance-and-operations-research#:~:text=In%20Mainland%20Tanzania%2C%20malaria%20surveillance,system%20linked%20to%20DHIS%202.&text=In%20Zanzibar%2C%20the%20malaria%20surveillance%20work%20is%20focused%20on%20malaria%20elimination.

[10] https://malariajournal.biomedcentral.com/articles/10.1186/s12936-017-1774-3

The Malaria Live Talks: Continuity through Crisis: COVID-19 and Malaria Webinar is Now on Demand

We are excited to announce the first Malaria Live Talks episode, part of our series of webinars exploring how the coronavirus will impact ongoing efforts to combat malaria, was launched in early December and is now available on demand on BAAM’s LinkedIn page. The webinar was broadcast live on LinkedIn on the 4th of December. BAAM thanks panelists Joy Phumaphi, Executive Secretary, African Leaders Malaria Alliance (ALMA), Rima Shretta, Honorary Visiting Research Fellow, University of Oxford’s Center for Tropical Medicine and Global Health, and Patrik Silborn, Senior Director Resource Mobilization and Financing, Asia Pacific Leaders Malaria Alliance (APLMA) for sharing their perspectives. We would as well like to think moderator Eric Olander, Managing Editor and Co-Founder of the China Africa Project for facilitating an insightful discussion.

The webinar identified the main challenges prompted by the current COVID pandemic, including difficulties with diagnosis of both diseases due to the overlap of some symptoms, limitations on access to health facilities (due to lockdowns), and ongoing interruptions of case management and prevention programs. Additionally, panelists examined economic factors impacting the future of malaria initiatives, noting that countries are likely to face shortfalls as the demand for services outpaces their ability to generate the revenues needed to sustain funding over the long term.

Panelists also identified some examples of successful private sector malaria initiatives. Joy Phumaphi commented that the private sector in Sub-Saharan Africa is very conscious of the economic cost of malaria. She then highlighted that “malaria on its own, before COVID-19, has a huge impact on GDP, so the private sector has been very keen to engage in treatment and preventive efforts.” She reported that the Zambia End Malaria Council has effectively coalesced members from the public and private sector organizations, civil society and other groups to execute an advertising campaign via public radio and television to reduce the stigma associated with COVID-19 and to inform people to which entity they should turn to when they have fever —a symptom that both COVID-19 and malaria share. Other countries have set up End Malaria Councils and Funds where the private sector is engaged as well. Patrick Silborn noted that The M2030 initiative in Asia, led by ALMA, has done a good job of empowering CEOs of companies to help champion malaria programs.

The group also looked at opportunities to improve malaria initiatives in the coming years. Rima Shretta outlined some next steps to address funding challenges, including continuing advocacy efforts for malaria, investigating other sources of funding beyond traditional donors and implementing innovative financing programs. Of note, Patrik added that community health workers could leverage skills, training and lessons learned from the pandemic to support mobilization campaigns against other infectious diseases, including malaria. Panelists also noted the World Economic Forum and other events could be utilized to help reshine the spotlight on malaria.

Listen to the whole webinar here.

Partner Happenings: Q3 2020

African Leader’s Malaria Alliance

Over the summer, a number of malaria funds and initiatives were launched across East Africa. An End Malaria Fund was established in the Kingdom of Eswatini in 2019, providing the vision and strategic direction for African countries to establish similar funds and councils to promote resource mobilization, advocacy, increased action and accountability. The Fund’s office opened in August of this year. Already in its first year of operation, the Fund has converted pledges made during 2019 during the launch of the Fund to contributions amounting to Emalangeni 7, 5 million to support the National Malaria Programme. Between 2020 and 2021, it is expected that 15 similar funds or councils will be operational across Africa. Mozambique launched its National End Malaria Fund, a public-private partnership between the government, the private sector, and community leaders for championing the fight against malaria. The new Fund adds to the two initiatives “Zero Malaria Comeca Comigo” campaign and “High Burden to High Impact” initiative, that had been launched in 2018.

President of Liberia Her Excellency Ellen Johnson Sirleaf, Nobel Laureate who also served as the ALMA Chair (2012-2013), was appointed as Co- Chair of the Independent Panel for Pandemic Preparedness and Response (IPPR) to evaluate the world’s response to the COVID-19 pandemic.

ALMA welcomed the initiative by the African Union of the Pan African Youth Digital Consultation to Develop a Malaria Youth Engagement Strategy, a youth dialogue that will provide a strong foundation for further engagement to ensure a common position for intergenerational dialogue where young people are fully engaged in co-creating adequate and sustainable solutions for the Africa they want.

Asia Pacific Leader’s Malaria Alliance (APLMA)

In early September, APLMA conducted its annual Malaria Week, a convening of high-level government officials and other national, regional and global stakeholders, to work together for elimination of malaria from Asia and the Pacific by 2030. The meeting welcomed the Asia Pacific Malaria Elimination Network (APMEN), a network of national malaria programs (NMP) and partner institutions that provide technical and operational support to NMPs for accelerating malaria elimination. Topics covered included surveillance systems, domestic resources for malaria elimination, new treatment regimens and diagnostic tests. The event closed with the APLMA Leaders’ Roadmap call for a Senior Officials’ Meeting (SOM) to be convened to facilitate high-level discussions and analysis of progress against priorities for elimination.

The Alliance also launched a roadmap for improving access to radical cure for vivax malaria in Thailand. APLMA and APMEN, in consultation with countries and partners, will be developing two advocacy tools: The Policy Roadmap and the Commodity Tracker. The aim is to increase the visibility of radical cure options among senior officials and policy makers and to promote timelier introduction and scale up of these treatment regimens to achieve elimination targets. The Policy Roadmap provides a high-level overview of the policy and related processes required to accelerate access to innovative malaria commodities. The Commodity Tracker outlines the different milestones and related policy decisions required to accelerate access to innovative malaria products and maps it as a timeline against the country's elimination goal.

A thematic brief about the link between malaria and climate change in Asia Pacific highlights that climate change could wipe out the gains against malaria in the region. A quantitative assessment by the World Health Organization (WHO) estimated that climate change may cause an additional 60,000 malaria deaths between 2030 and 2050 even when accounting for economic growth and health progress. It also projects that about 5% of the global malaria cases, or 21 million cases, would be attributable to climate change in 2030. Asia Pacific is particularly vulnerable for the four following reasons: 1) The region’s geography makes it highly susceptible to rising sea levels, other weather-related events, and climate change; 2) The region has disproportionately high burden of vector-borne diseases; 3) Low income populations mainly in tropical/subtropical countries are likely to be most affected; and 4) Several countries in Asia-Pacific region are facing the double burden of infectious and non-communicable diseases.

The President’s Malaria Initiative

Dr. Ken Staley, Global Malaria Coordinator of the United States President’s Malaria Initiative (PMI) shared a blog post discussing that projections about COVID-19 to significantly disrupt prevention campaigns and access to antimalarial medicines and malaria deaths could double in 2020 and wipe out decades of hard-fought progress aren’t destiny. He explains that many life-saving malaria prevention efforts have been adapted to safely continue during the COVID-19 pandemic—with PMI-supported bed net, indoor residual spraying (IRS), and seasonal malaria chemoprevention (SMC) campaigns on track to protect tens of millions of people from malaria. Critical work is also underway to minimize the impact of COVID-19 on the delivery of routine malaria and other health services.

The Global Fund to Fight HIV, TB, and Malaria

News from the Global Fund have revolved around the need to protect decades of progress against HIV, TB and malaria. The Global Fund has approved a total of US$736 million to support the COVID-19 response across 104 countries and 12 multicounty programs. Their latest COVID-19 Situation Report shows that countries are using 35% of the funds under the COVID-19 Response Mechanism for adapting HIV, TB and malaria programs to safeguard progress. Additional data shows that malaria is the least impacted disease in terms of service delivery disruption, with moderate levels of disruption. Levels of disruption to national stocks of HIV and TB medicines remain high, with 10% of countries reporting shortages of HIV medicines and 9% for TB medicines. 4% of countries report shortages for malaria medicines.

The Global Fund’s Results Report shows that 160 million mosquito nets were distributed to protect nearly 320 million people from malaria for three years in 2019. To protect people from malaria, the Global Fund worked with partners to reduce the cost of an insecticide-treated mosquito net to less than US$2 and the cost of antimalarial treatment dropped to US$0.58 in 2019 – savings that helped purchase more than 14 million extra nets and treat more than 24 million additional people for malaria. However, the reductions in malaria mortality rates and number of malaria cases have slowed markedly, and cases of malaria in pregnant women and children remain high. This year, the report calls to urgently invest to protect decades of progress against HIV, TB and malaria that are being derailed as a knock-on effect of the COVID-19 pandemic.