Malaria in 2013: progress,
challenges, and opportunities
APPMG
London, UK
23 April 2013
Robert D. Newman, MD, MPH
Director, Global Malaria Programme
newmanr@who.int
World Malaria Report 2012
Has international funding for malaria
reached a plateau?
Has international funding for malaria
reached a plateau?
Current core global malaria control
interventions
John Rae, Global Fund
WHO
WHO
WHO
Access to and use of ITNs in sub-Saharan Africa
Major decreases in deliveries of insecticide
treated nets (ITNs) over past 2 years
Proportion of suspected malaria cases attending public
health facilities receiving a diagnostic test
50 countries are on track to reduce malaria case
incidence by 75% by 2015: these account for
only 3% of total estimated cases
Estimated number of cases averted 2000 –2010
100 000 000
10 000 000
1 000 000
100 000
African Region
Other Regions
10 000
1 000
100
100 000 000
10 000 000
100 1 000 10 000 100 0001 000 000
Estimated number of cases 2000
Estimated number of deaths averted 2000–2010
Progress faster in smaller countries; greater number of
cases and deaths averted in highest burden countries
1 000 000
100 000
10 000
African Region
1 000
Other Regions
100
10
1
10
100
1 000 10 000 100 0001 000 000
Estimated number of deaths 2000
Source: WHO estimates
Majority of cases averted (52%) and lives saved
(58%) are in the 10 countries with the highest
estimated malaria burdens
Global changes in malaria death rate, 20002010
2010
2000
Malaria mortality rate estimates:
25% decline globally
33% decline in the WHO African
Region
over past decade
More than 1 million lives saved
Despite progress,
malaria remains an
enormous public
health problem:
219 Million cases
(uncertainty range:
154M to 289M)
and 660,000
deaths
(uncertainty range:
490,000 to
836,000) in 2010
Bonnie Gillespie / Photoshare
Malaria burden 2010: deaths by region & age
group
Malaria burden 2010: cases and deaths by country
80%
80%
WHO Global Malaria Programme:
core roles
Malaria Policy Advisory Committee (MPAC)
Provides independent
strategic advice and technical
input to WHO for the
development of policies
related to malaria control
and elimination
Global Plan for Artemisinin Resistance
Containment (GPARC): January 2011
Contain or eliminate artemisinin
resistance where it already exists
Prevent artemisinin resistance where it has not yet appeared
1
Stop the
spread of
resistant
parasites
2
3
4
Increase
monitoring
&
surveillance
to evaluate
the AR
threat
Improve
access to
diagnostic
s &
rational
treatment
with ACTs
Invest in
artemisini
n
resistance
-related
research
5 Motivate action and mobilize resources
Artemisinin Resistance Containment Areas
Tier I
Tier II
CHINA
MYANMA
R
Tier II (inactive)
VIET NAM
LAOS
THAILAND
CAMBODI
A
Importance of regional collaboration
Anopheles mosquito resistance to
insecticides: 64 countries and counting
GPIRM: Worldwide launch May 2012
A call to action: maintain
the effectiveness of
malaria vector control
Integrated Community Case
Management (iCCM)
•
•
•
Diseases: malaria, pneumonia,
diarrhea
Tools: RDTs, timers, ACTs, antibiotics,
zinc, ORS
Workers: different cadres in different
countries
UN Child Mortality Report 2010
Elimination: helping countries cross
the finish line
Elimination case studies
• 10 case studies planned jointly
with UCSF Global Health Group
• Four launched in October 2012:
Cape Verde, Mauritius, Sri
Lanka, Turkmenistan
• Six to be launched 2013:
Turkey, Philippines, Malaysia,
La Reunion, Tunisia, Bhutan
• To help NMCPs and other
partners considering malaria
elimination better understand
process and risks
Launch of T3: “Test, Treat. Track.” –
Namibia, World Malaria Day 2012
Surveillance: without it, we are
flying blind
Launched in Namibia by
WHO Director-General
on World Malaria Day –
24 April 2012
Malaria burden
fatal: ~660,000 per year
life-threatening
febrile
illness
asymptomatic
endemic areas
~10 deaths per year
in UK
UK, etc
Slide courtesy M. Molyneux
Malaria control & elimination
beyond 2015
Global strategy for the control and
elimination of Plasmodium vivax
Global technical strategy for malaria
control and elimination: 2016-2025
Roll Back Malaria Partnership: Global
Malaria Action Plan II
Future malaria R&D needs and projection:
what’s missing in the armamentarium?
 Transmission blocking tools
• Antimalarial drugs
• Vector control
• Vaccines
 Highly sensitive field-ready diagnostics
 Mass treatment or mass screening and
treatment options
 Safe, short course gametocytocidal drugs
 Optimum delivery systems
 Building capacity to use data for decisionmaking
Extrinsic Challenges
Malaria funding gaps by region, in billions
Asia
10%
• Biggest resource gap for 20142016 is in Africa: 90% of total gap
• Increased domestic funding
expected in Asia
Africa
90%
4.0
Africa
4.0
3.0
2.0
Asia
3.0
Gap 2014-16: $6.0B
2.0
1.0
1.0
0.0
2014
0.0
2014
2015
Domestic funding
Resource need
2016
External funding
Gap 2014-16: $0.6B
2015
Domestic funding
Resource need
2016
External funding
The greatest current threat to
continued success in malaria
control and elimination is
financial
32
Malaria cases 2000-2035: potential scenarios
600
Cases per 1000 population at risk
500
400
Scenario 1
300
Scenario 2
Scenario 3
200
100
1 Continue current coverage (country-specific LLIN coverage and treatment rates, and ACT coverage)
2 From 2012, scale up to 80% LLIN coverage and 80% treatment rate, latter all with ACTs
3 No further LLINs distributed from 2015 onwards; continue country-specific treatment and ACT coverage
-
2000
2005
2010
2015
2020
2025
2030
2035
1 Continue
current coverage
(country-specific
LLIN coverage&
andModelling
treatment rates, ,and
ACT coverage)
Azra Ghani, MRC
Centre
for Outbreak
Analysis
Imperial
College London & WHO
2 From 2012, scale up to 80% LLIN coverage and 80% treatment rate, latter all with ACTs
3 No further LLINs distributed from 2015 onwards; continue country-specific treatment and ACT coverage
Focused Screening and Treatment, Western Cambodia
Migrant and Mobile Populations
Photo: Eva
Christophel/WHO
Seasonal Cambodian migrant workers in Pailin, Cambodia
Climate change is happening
WWF-Canon / Jack Stein GROVE
Urbanization
Mumbai
Lagos
Panoramio.com
Panoramio.com
Infrastructure projects
www.alternet.org
Concluding thoughts
Reducing malaria transmission:
like draining a pond
Malaria Stratification: Lao PDR
Courtesy: D. Gopinath
Seasonal Malaria Chemoprevention (SMC)
Amodiaquine+SP: monthly treatment during transmission season
Children 3-59 months
Prevents ~75% of all malaria episodes
Prevents ~75% of severe malaria episodes
Why durable development matters for the
future of malaria control & elimination
Investment ► Control
Dis-investment ► Resurgence
Must not only continue to compress the spring, but
must also shrink the space within which the spring
can move
The risk of interrupted investment:
malaria resurgences
Cohen et al. Malaria Journal 2012 11:122
Post-2015 Development Agenda
Driving the malaria burden
downward: a cycle of innovation
Surveillance,
monitoring &
evaluation
Program
implementation
Basic and applied
research
Policy change
Product Development Partnerships (PDPs):
Driving force in developing new tools
Need to avoid false dichotomies
Africa vs. Outside of Africa
We need durable
progress in both
New tools vs.
Existing tools
We need both
Plasmodium falciparum vs.
Plasmodium vivax
We need both
Attacking the vector vs.
Attacking the parasite
We need both
Saving lives today vs. Eradication
tomorrrow
We need both
Focused Screening and Treatment, Western Cambodia