Emerging Themes in Malaria Advocacy

Diseases rarely happens in silos, rather, they are affected by their network and environments, created or natural, and influenced by other concurrent diseases and lifestyle factors. The same is true for malaria. Malaria is in a delicate state, oscillating between the spectrums of elimination in entire countries and resurgence in others. Appropriately framing the malaria advocacy narrative can help drive malaria elimination efforts forward with a collaborative mindset. It is also important to keep in mind that building political will helps advance advocacy strategies to help support policy makers to increase government investments to end malaria. 

From the health and healthcare vantagepoint, specific intersectoral approaches include linking malaria with TB, HIV/AIDS, and UHC. This blends healthcare systems, supply chains, delivery of care and innovations of treatment. Priorities for procurement and supply chain management systems along with service delivery innovations continue to be at the crux of fighting malaria.

An environmental approach can also be taken that encompasses climate change to include the intersection of humanitarian responses to both natural and man-made disasters. These events change ecosystems that affect not only disease transmission rates but also the efficiency and effectiveness of healthcare delivery. Civil society also has a role to play to ensure that country investments in programs are held accountable, that progress is monitored, and that aid reaches the populations most in need.

Interwoven within each of these advocacy narratives is the need for continuous and reliable data monitoring as a means to demonstrate return on investment and economic development. Though reports and published data are needed, the power of live data can be used for specific program implementation in the areas that demand it the most. This is not to dissuade current reporting systems but rather to encourage the fluid sharing of data across borders to increase impact. The Global Fund continues to emphasize backing for health systems via technical support.

These umbrella themes can be seen as a way to promote over-arching policies that enable many disease efforts. By encouraging a broader viewpoint, we not only encourage collaboration but also open paths for resources both in funds and in infrastructure not previously linked. It is with this mindset that public health policies can weave in precise strategies for the fight against malaria.   

Exploring the Links Between Sustainable Business Practices and the Fight Against Malaria

The fight against malaria is evolving. The uptake of insecticide-treated bed nets, the scaling of spraying programs, and a greater focus on ensuring access to adequate testing and treatment resources has brought us to a cross-roads. The fight against malaria has saved over 6.8 million lives and the disease is in retreat in many geographies. In order to sustain the gains that we have made in the fight against malaria, the global fight needs to adapt to match the new face of the disease and its associated obstacles. Today, innovators are working to develop new tools and technologies to combat the growing threat of drug and insecticide resistance while programs are developing strategies to identify and treat cases of malaria amongst the most vulnerable.

Meanwhile, a confluence of other factors are continuing to complicate the fight against malaria: the World Bank reports that climate change may result in a 50% higher probability of malaria transmission in regions of South America, sub-Saharan Africa, and China by 2050.[1] Occurring in parallel, the increased urbanization and the proliferation of major agricultural operations across Africa are outpacing infrastructure, allowing excess runoff water to create the perfect environment for mosquitos to breed. Requiring employees to work outside at night-time, when malaria carrying mosquitos are more likely to bite, may result in increased transmission. Mining sites with standing pools of water can also lead to increased malaria outbreaks by providing a breeding environment.

Thus, we need to target malaria from all angles. Some companies have already taken the lead in advancing business practices to fight malaria. For example, South32, a mining and metals company headquartered in Perth, Australia is actively working to minimize malaria risk among its employees and operating communities in Mozambique. South32’s Mozal Aluminum Smelter team sprays areas with mosquito repellent and applies larvicides to standing water to eliminate malaria breeding areas. Additionally, they educate their employees on personal protection measures through readily available informational displays and seasonal awareness campaigns. Through these measures, and the provision of test and treat services for employees, the Mozal team saw a 58% reduction in onsite malaria cases over three years.[2] 

There is also an opportunity for local and global private sector actors to liaise directly with community farmers to provide capacity-building and education programs on sustainable agricultural practices for fighting malaria. For example, Nestle supports a “farmers school initiative” for farmers in the Ivory-Coast that meets every two weeks.[3] This type of effort has the potential to be hugely beneficial, as common community agricultural practices such as the use of irrigation during rice cultivation, the use of fish ponds for fish farming, and the storage of water in tanks for livestock all provide suitable breeding grounds for mosquitos. Further, farmers are at a high risk of developing malaria, which goes on to impact their productivity and ability to earn a living. One study in Nigeria amongst community farmers illustrates the opportunity to provide agricultural training aimed at malaria reduction: only 12% of respondents surveyed stated that mosquito bites transmit malaria, and observational research showed that agricultural practices that favor mosquito breeding were common.[4]

Ultimately, the links between business practices and malaria are significant and complex and will require collaborative action across disciplines. Agriculture companies, textile producers, oil and gas suppliers, industrial water operations, mining companies, and manufacturing centers of all sorts have a decisive part to play in the fight against malaria.

[1] RBM Partnership. “Climate Change and Malaria.” September 2015.

[2] International Council on Mining & Metals. “Mining with Principles.” Accessed 13 June 2019.

[3] Nestle. “Cocoa-Plan.” Accessed 14 May 2019.

[4] Oladepo O, Tona G, Oshiname F, and Titiloye M. “Malaria knowledge and agricultural practices that promote mosquito breeding in two rural farming communities in Oyo State, Nigeria.” April 2010.

BAAM Co-Hosts a Successful Event Alongside the 72nd World Health Assembly, in Partnership with the RBM Partnership, Unitaid, the President’s Malaria Initiative, and the World Health Organization

Photo of all the speakers( from left to right): Caroline Desrousseaux, Co-Chair of BAAM and Global Account Manager, Vestergaard, Mauricio Cysne, Director of External Relations, Unitaid, Dr. Hiwot Solomon, Director of Disease Prevention and Control, Federal Ministry of Health of Ethiopia, Lisa Goldman-Van Nostrand, private sector representative of the RBM Partnership’s Advocacy and Resource Mobilization Partner Committee’s Innovation & Access Workstream, Dr. Kenneth Staley, Global Malaria Coordinator, US President’s Malaria Initiative, Dr. Pedro L. Alonso, Director of the WHO Global Malaria Programme, Johannah-Joy Phumaphi, Executive Secretary, African Leaders Malaria Alliance (ALMA), Dr. .Abdourahmane Diallo, CEO, RBM Partnership to End Malaria, and Dr. Bala Mohamed Audu, Director of the Malaria Elimination Program, National Malaria Control Programme, Federal Ministry of Health of Nigeria.

The Business Alliance Against Malaria worked closely with Unitaid, the RBM Partnership, the President’s Malaria Initiative, and the World Health Organization to organize a panel discussion on deploying new tools to fight malaria. The event, entitled “Innovate + Collaborate + Scale = End Malaria,” took place alongside the 72nd World Health Assembly in Geneva, on 22nd May, and successfully attracted more than 150 attendees. Dr. Abdourahmane Diallo, CEO of RBM Partnership to End Malaria, moderated the panel comprising representatives of both the public and the private sectors, namely Ms. Johannah-Joy Phumaphi, Executive Secretary, African Leaders Malaria Alliance (ALMA), Dr. Bala Mohamed Audu, Director of the Malaria Elimination Program, National Malaria Control Programme, Federal Ministry of Health of Nigeria, Dr. Hiwot Solomon, Director of Disease Prevention and Control, Federal Ministry of Health of Ethiopia, Lisa Goldman-Van Nostrand, private sector representative of the RBM Partnership’s Advocacy and Resource Mobilization Partner Committee’s Innovation & Access Workstream, and Caroline Desrousseaux, Co-Chair of BAAM.

Dr. Kenneth Staley, Global Malaria Coordinator, US President’s Malaria Initiative and Mauricio Cysne, Director of External Relations, Unitaid, highlighted in their opening remarks the importance of partnerships in both Unitaid and PMI business models and the need to scale up innovations to make malaria diagnostic tools and treatments available to more people. Dr. Abdourahmane Diallo said that Ministries beyond the Ministry of Health should get involved, including the Ministry of Agriculture, Finance, and Infrastructure. This is important to note as it highlights that the Alliance’s efforts to expand its membership to non-pharmaceutical companies is also aligned with RBM’s perspective. He then introduced the panel with a first question to Ms. Johannah-Joy Phumaphi on innovation.

Ms. Johannah-Joy Phumaphi stressed that innovation is not only about science, but also about making medical products affordable and available to communities, and about making existing products more user-friendly.

The Director of the Malaria Elimination Program in Nigeria added that thanks to a national campaign of mass administration of a seasonal chemoprevention drug to children, Nigeria had been able to limit transmission in a heavily malaria-affected district and noted that a partnership with the Malaria Consortium enabled them to ensure that drugs were administered properly.

Dr. Kwafese, Director of Disease Prevention and Control, Ministry of Health of Ethiopia, said that Ethiopia aims to be malaria-free by 2030, and that the country has been very efficient in implementing malaria prevention programs. She commented that even though they faced a challenge with insecticide-resistant mosquitoes, this was overcome thanks to new chemicals. Today’s challenge is the storage and transportation of liquid insecticide to reach the entire country, presenting logistical difficulties.

Lisa Goldman-Van Nostrand highlighted that it is crucial to have compelling evidence before launching programs, and that creating dialogues with partners outside of the malaria space is desirable, in particular in the HIV and TB space to help see what models have been successful for them.

Continuing on partnerships, Caroline Desrousseaux said that the malaria market is still a risky one, as it is highly dependent on the malaria community to adopt new products developed by the private sector and integrate them into World Health Organization guidelines. Based on this observation, it makes a lot of sense to rely on partners to bring new products to the market. She then called on potential partners that might not be yet engaged in the fight against malaria to join BAAM.

Dr. Abdourahmane Diallo then opened the floor for questions, which focused on the role of prevention and models of cooperation. Ms. Johannah-Joy Phumaphi stressed that for prevention programs to work, communities must own local programs and develop capacity for integrated community case management and community education. She gave the example of ALMA, which has national councils led by key politicians, the private sector, NGOs, community leaders and works with parliamentary committees for malaria at district level to ensure that the “Zero Malaria Starts With Me” program is in the hands of the communities, which makes it well received by the population and therefore more effective.

Dr. Bala Mohamed Audu added that we must increase demand for such services, as he noticed that malaria treatments that require many visits to the hospital are not well followed by the patients, and that consequently demand is not there.

Audience remarks included a call for workshops and projects to foster products and prototypes between BAAM, Unitaid, and others. A representative of WIPO mentioned a coalition of businesses at WIPO focusing on malaria.

Caroline Desrousseaux said that it had been frustrating for the private sector to wait years for its innovations to reach to markets, but that partnerships like the one Vestergaard has with PMI and now BAAM create a sustainable ecosystem for innovation to work. She insisted that malaria is an energetic field where it is possible to innovate. Building on Caroline’s remark, Ms. Johannah-Joy Phumaphi stressed that we need smooth mechanisms to ensure that products are approved by the WHO and make it to markets as quickly as possible.

Dr. Abdourahmane Diallo concluded the panel by emphasizing that strengthening health systems overall is key since patients go to primary healthcare providers to be diagnosed, making the call for Universal Health Coverage very relevant for malaria.

Dr. Pedro L. Alonso, Director of the WHO Global Malaria Programme, recognized that the tools we have are not perfect, and that preventive actions can be heavy to sustain. He concluded that innovation is essential if we want to move forward. He closed the event by saying that the launch of the GSK malaria vaccine was made possible thanks to a massive partnership that involved an extensive research network in Africa and then implementation by Unitaid, the Global Fund, and GAVI for the pilot phase.

In conclusion, the event successfully highlighted examples of partnerships between the private and the public sector and made the case that the private sector has a central role to play in the fight against malaria. Again, we want to extend a big thank you to our BAAM-members Caroline Desrousseaux and Co-Chair Lisa Goldman-Van Nostrand for representing the Alliance and speaking about the importance of private sector innovations – both in health products, operating practices, and delivery models – to the fight against malaria.

Malaria in the Media: What We Talked About in 2018 And What to Expect in 2019

Last month, we undertook a media analysis, utilizing our in-house analytics software, to better understand the global conversation on malaria in 2018. Our analysis revealed three malaria-related topics that attracted a greater share of media coverage than others: new tools for malaria diagnosis, a potential malaria vaccine, and concerns over drug-resistant malaria. All three of these topics point to the public’s interest in innovative health product solutions for ending malaria—and, these three interest areas are very much in line with BAAM’s core priorities and key messages. Similarly, the Global Fund to Fight HIV, Tuberculosis & Malaria’s new investment case for its Sixth Replenishment also highlights the need for innovations in diagnosis and treatment. This alignment of messaging from major multilateral institutions with key topics of media and public interest point to a valuable opportunity for BAAM to underscore its commitment to advocating for transformative innovations in the fight against malaria.  

Conversation on malaria, predictably, spiked around World Malaria Day at the end of April. Based on analysis of the utilization rate of the word “malaria” and “paludisme” (the French word for malaria) on social media, we have put together a “heatmap” demonstrating where malaria attracted the most attention on social media across the year. The regions that have been the most actively talking about malaria in 2018 were North America, Western Europe, India, Indonesia, South America, China, African English-speaking countries as well as Nigeria and Ghana in West Africa.

For context, our in-house analytics software shows that the public health topics that enjoyed the most media attention (both traditional and social media) in 2018 were cancer, the opioid crisis, vaccines, marijuana legalization, and tobacco products. Malaria generated slightly less media buzz during these past two years, in comparison to 2016. Today, infectious diseases such as HIV and Zika, and non-communicable diseases such as heart disease and diabetes are capturing a larger share of media attention. Moreover, our issue analytics tool shows that most of the conversations around malaria emanated from influencers like the World Health Organization, MalariaNoMore, the Gates Foundation, The Lancet, and the Global Fund to Fight HIV, TB, and Malaria. Novartis and Bayer were the most vocal pharmaceutical suppliers in the malaria conversation in 2018, with ExxonMobil also publishing a significant amount of malaria-related content.

Graph showing the spike in mention of “malaria” and “paludisme” in social media on World Malaria Day, 25 April 2018. Data runs from 8 March 2018 to 31 December 2018.

Heat map showing media mentions of “malaria” and “paludisme” by country, from 8 March 2018 to 31 December 2018.

Find an overview of 2018’s “big three” malaria topics explained below.

New Diagnostic Tools for Malaria

At the moment, malaria cases are detected with biological tests that use expensive, non-portable machines, making the process quite costly, time-consuming, and occasionally just unfeasible in countries facing extreme shortages in human resources for health.

2018 was a productive year for innovations in malaria diagnosis. The most popular malaria topic in the media was dogs that can detect the disease by sniffing socks, with a diagnostic accuracy rate of 98%. Other non-invasive methods also gained traction in the media—for example, several outlets publicized the development of tools to detect malaria via saliva or even light. The “spit test,” using saliva, is faster and nearly as sensitive as traditional molecular diagnostic tests. The light test uses a red beam of light focused on a finger that detects changes in the shape, color, and concentration of red blood cells to see if they are affected by malaria and has an accuracy of 80%.

2019 could see wide-spread use of wearable technology using body temperature, as illustrated by our new potential BAAM partner, TermoTell. Artificial intelligence offers promising avenues to detect the malaria parasite by identifying infected cells more with accuracy and quicker than the human eye could, with the help of a simple phone app.

Timely, precise, and cheaper diagnostics are crucial as they can analyze more people and give a larger window for affected patients to get treatment—especially children. These tools could be revolutionary.

The WHO malaria vaccine

In 2018, the WHO launched the pilot phase of the RTS, S/AS01 malaria vaccine. WHO’s Malaria Vaccine Implementation Program will roll-out the vaccine in three sub-Saharan African countries – Ghana, Malawi, and Kenya—in 2019.

2019 will be a decisive year for the malaria vaccine. It will face challenges in terms of implementation—it requires no less than four injections—but vaccines are seen as a valuable long-term solution as insecticide resistance and drug resistance is on the rise.

Interestingly, alongside media conversations on the malaria vaccine, we also saw global chatter on “homegrown” and “lower-tech” solutions for fighting malaria. Some of these solutions, such as repellent soaps and creams, can be easily made and distributed locally.

Concerns over drug-resistant malaria

As with other disease areas, drug resistance is a key and growing concern within the malaria community. Studies have shown that drug resistant malaria tends to develop in lower risk regions such as South East Asia and South America. This global trend is pushing scientists to explore new ways to control the disease.

New drugs, such as a one-dose treatment to prevent the relapse of P. vivax malaria, and new suppository drugs for malaria treatment in children offer hopes of more efficient treatments. Still, drug resistance, more generally speaking, will remain a major topic on the global health agenda this year—not just for malaria but also within tuberculosis, sexual transmissible diseases, HIV, and food poisoning.

Overall, the global conversation around malaria has been focused on innovative mechanisms to treat or detect malaria—including better diagnostics, a potential vaccine, and genetically modified mosquitos. There is growing awareness and sense of urgency around malaria elimination, concern over the links between climate change and the spread of malaria-bearing mosquitos, and worry about mosquitos’ resistance to traditional insecticides. Despite these growing concerns, the data illustrates that malaria is, on the whole, slowly declining in the global conversation, making BAAM’s role more urgent and relevant than ever in amplifying the fight against malaria on the global stage.

Make-Believe Mosquitos

April 25th marks the day where the international community reaffirms its commitment to the fight against malaria. This year, we can celebrate the fact that our global investments in treatments and preventive measures have made a difference. As noted in the World Health Organization’s most recent World Malaria Report, 2017 saw an estimated US$ 3.1 billion invested in malaria control and elimination by governments of malaria endemic countries and international partners. We understand, at a theoretical level, the steps that we need to take to reach malaria elimination: reduce the ability of mosquitoes to bite people, treat every sick victim with curative drugs, and prevent any infected person from bringing new parasites into the area. Traditional methods include providing bed nets and drugs, building level roads, improving drainage techniques, installing safe water systems and constructing mosquito-proof housing.  Even with all these strategies, nevertheless, malaria persists.

But there is still hope. Biologists are developing a way of manipulating mosquito genetics that forces entire populations to self-destruct. The technique has proven so successful in laboratory tests that its authors believe malaria could be eliminated from large regions of Africa within two decades. The scientists alter the genes that disrupt the mosquito’s sexual development leading females to become infertile while the males are able to spread the debilitating gene to offspring. In lab settings, populations of mosquitoes can be driven to extinction within 11 generations and computer models show that wild populations could be decimated within about four years.

There have been previous attempts at genetic alterations, but these have failed as natural mutations over generations overcame the engineered changes--mother nature is a force to be reckoned with.  What is different about the newest DNA editing is that the DNA stretch that has been manipulated is vital to mosquito survival, thus at a low risk for naturally occurring mutations. 

Should this lab science become translated to “real life,” the fight against malaria conversation will shift from a technical or chemical solution to a social and diplomatic one. Releasing these edited, or “make-believe,” mosquitos into the wild comes with risks as they cannot be disabled or withdrawn; there might be unintended consequences. Though more testing has to be done and safety measures quadruple checked, the next hurdle could be regulatory and ethical approvals, as well as social acceptance.

The ethical debate needs to involve stakeholders living in malaria areas and should consider future generations and the environment. Caution should be at the center of the conversation but as should be the human cost of doing nothing.

Though no gene drive mosquitoes have yet been released in the wild, the future looks promising.

Partner Happenings

African Leader’s Malaria Alliance

ALMA supported the 32nd Ordinary Summit of the African Union where discussions revolved around the theme of “Refugees, Returnees, and Internally Displaced Persons: Towards Durable Solutions to Force Displacement in Africa”.  

ALMA has also been working on the 2018 scorecards reports. The Initiative’s aim is to reinforce the regional platform and create international synergy to eliminate malaria. Support for the initiative is strong and with the introduction of the sub-regional scorecard keeping track of progress will allow them to focus on the most vulnerable areas.  

Asia Pacific Leader’s Malaria Alliance

APLMA has been active in supporting various events and conferences. For example, they have helped advertise Unitaid’s call for proposals to develop better, more efficient treatments that will help bring about the end of malaria and encourage the M2030 awareness and fundraising campaign supporting malaria elimination in Myanmar.  

February was also an important month as APLMA convened a panel of senior officials in New Delhi to discuss the global fight to end malaria, outlining strategies to improve collaboration, increase investment and identify innovative approaches to eliminate the disease and stop drug-resistance. The event took place on the sidelines of the preparatory meeting for the Global Fund's Sixth Replenishment, hosted by the Government of India.

Additionally on the global front, Japan hosted the G20 Finance Minister and Central Bank Governors Deputy Meeting in Tokyo where universal Health Coverage (UHC) and the future of health financing were high on the agenda with focus on the fight against malaria and other communicable diseases. In fact, Japan will host the first ever joint session of Health and Finance Ministers in the G20 making this an opportunity to focus on the fight against malaria, and more broadly for health financing. APLMA is committed to supporting these seminal moments – to ensure a useful outcome and keep malaria elimination in Asia Pacific as a priority.

The President’s Malaria Initiative

PMI was recently part of a US leadership event that addressed U.S. supported successes and strategies in the fight against malaria. Other organizations in the effort include the Global Fund to End AIDS, Tuberculosis, and Malaria, the Bill and Melinda Gates Foundation; and UN Foundation’s Nothing But Nets. The briefing highlighted that since July 2018, PMI, the Global Fund and the Gates Foundation have been working to aggregate and homogenize each entities’ data and share it with countries while ramping up data collection efforts in order to more quickly and more precisely drive down the malaria burden with fewer resources.

More news worthy of mention is that PMI was featured for its work on malaria elimination and drug resistance in a broadcast of PBS NewsHour. As part of the Under-Told Stories Project, some of the segment focuses on a PMI-supported pilot program in Western Cambodia, as well as a rapid detection and reporting program to track and contain outbreaks, especially any cases that do not respond to drugs.

PMI is also launching several new initiatives to help transform data utilization. To that end, PMI will be reviewing program data quarterly instead of annually, has begun to develop a single integrated platform to house all data open to partners, and working closely with the Global Fund and Gates Foundation to adopt a set of common data definitions across donors to eliminate redundancies and maximize efficiency.

The Global Fund to Fight HIV, TB, and Malaria

At the kick-off meeting of the Global Fund’s Sixth Replenishment in New Delhi, leaders, global health organizations, civil society groups and people affected by the diseases vowed collective action to end the epidemics of AIDS, tuberculosis and malaria and accelerate progress toward universal health coverage.

Luxembourg has become the first country to pledge for the Global Fund’s Sixth Replenishment fundraising drive. Luxembourg is one of the Global Fund’s largest donors per capita, and the country has steadily increased its pledge each Replenishment cycle. Their commitment of EUR 9 million is an 11 percent increase over their previous pledge. The Global Fund is seeking to raise at least US$14 billion for the next three years to help save 16 million lives, cut the mortality rate from HIV, TB and malaria in half, and build stronger health systems by 2023.

The Global Fund has been also been busy with an audit if its multicountry grants process which are designed to accelerate the end of the HIV, TB and malaria epidemics and to strengthen health systems by tackling regional bottlenecks and cross-border issues. To date, multicountry grants have faced challenges in their implementation; 71% of the multicountry/regional grants selected for review by the OIG performed below expectation at the last progress update in December 2017. One particular challenge faced by multicountry grants is the inability of current regional data systems to provide quality and timely programmatic data, while another relates to the alignment of various country reporting standards to ensure regional data is available.