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Joy Phumaphi Executive Secretary, ALMA “African health systems are already weak; COVID-19 is a major threat” Page 4 Dr Scott Filler Malaria Team Leader, The Global Fund “A renewed effort to end malaria has never been so vital” Page 6 Olivia Ngou Global Coordinator, CS4ME “Empowered community and civil society are game-changers in health responses” Online
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Fighting malaria in times of global crises With COVID-19 spreading across the globe, straining national health systems and challenging families, communities and countries, there has never been a more important time to uphold our commitment to end malaria, says Dr Abdourahmane Diallo, CEO, RBM Partnership to End Malaria and former Minister of Health, Guinea.
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Ebola increased malaria-related deaths by
7,000 among under-fives in West Africa Consider the following: the 2014-2016 Ebola outbreak in West Africa led to 7,000 additional malaria-associated deaths among children under five in Guinea, Liberia, and Sierra Leone. Moreover, frontline health workers were disproportionately affected by Ebola, just as they are by COVID-19.
Ensuring safe delivery of life-saving malaria services must therefore be our top priority. Robust health systems will be our primary line of defence, and with outbreaks like COVID-19, it is crucial that we ensure that our health systems are strengthened, not compromised. As some countries have recognised, investment in malaria elimination is an investment in broader health systems, long-term productivity and economic growth.
Improved nets, tests, medicines and political support have achieved progress-to-date
Progress-to-date has only been possible thanks to increased political commitment and investment, and future progress now relies on sustaining these key drivers of success. Another key driver of progress has been the development of new, transformative tools, such as longlasting insecticide-treated mosquito nets and rapid diagnostic tests. Last year, three countries introduced the world’s first malaria vaccine, which provides partial protection against malaria in young children. New malaria medicines have also been introduced to prevent and treat the disease.
Ugandan progress offers hope in malaria fight
INTERVIEW WITH
Dr Dorothy Echodu CEO Pilgrim Africa
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ince the early 2000s, we have made tremendous gains against malaria, setting us on the path towards a malaria-free world later this century. Current investments in malaria are saving almost 600,000 lives and preventing nearly 100 million cases a year. However, we still have a long way to go, with malaria still among the leading causes of child mortality in Africa. And, as long as malaria exists, it threatens the poorest and most vulnerable, and has the potential to resurge in times of public health crises – like the one facing us now. In addition to bearing the heaviest burden of malaria, the world’s most vulnerable populations are also at risk of being hit the hardest by an outbreak, as they’re often last in line to receive appropriate testing and treatment for existing and emerging diseases.
WRITTEN BY: Dr Abdourahmane Diallo CEO, RBM Partnership to End Malaria and former Minister of Health, Guinea
As some countries have recognised, investment in malaria elimination is an investment in broader health systems, long-term productivity and economic growth. The need for action
Today, we find ourselves before an ever urgent need to fast-track the availability of effective and innovative tools that can be used to save lives and stay on top of emerging resistance of both the malaria-carrying mosquitoes and the parasite itself. Finally, as we have seen from the dramatic spread of COVID-19 in recent months, diseases don’t respect borders.
Today, 49 countries are within reach of malaria elimination. We must work together to ensure that overburdened health systems do not result in increased malaria transmission in countries that are approaching zero malaria cases. Efforts to fight malaria have been a hallmark of global cooperation of the early 21st century. More than ever, we must unite to protect our hard-won gains against malaria and effectively address existing and emerging threats to global public health.
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Uganda has achieved a remarkable reduction in malaria transmission by focussing on high burden areas. The challenge now is to maintain momentum amid the COVID-19 crisis
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etween 2017 and 2018, the number of malaria cases in Uganda fell by 1.5 million due, in part, to a renewed focus on tackling the disease in high burden areas. Dr Dorothy Echodu, CEO of Pilgrim Africa, an NGO based in Uganda and the US, is the architect of one successful effort to dramatically reduce malaria transmission in Uganda. “The poorest 20% of citizens bear 10 times the disease burden of the wealthiest 20%,” she notes. “We will never eliminate this disease until we focus on the poorest, most difficult geographies.” Perfect storm of poverty and ideal conditions for mosquitoes This extraordinary progress can’t be taken for granted. Uganda faces a complex array of environmental and social challenges.
The wet, humid climate provides an ideal breeding ground for mosquitos, while widespread poverty hampers access to prevention, testing and treatment. “And there is a psychological challenge,” explains Echodu. “Our communities sometimes have a 70% infection rate. It’s hard for people to imagine life without the constant realities of malaria. Changing this mindset is critical.” Combined, layered strategies lead to success Complex challenges require a coordinated response. Pilgrim Africa developed a novel approach that layers traditional control methods to help disrupt the entire malaria transmission cycle, generating significant reductions. As Echodu explains: “The key now is scaling this effort.”
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Going digital with malaria net distribution
We are on the right track to end malaria. We’ve developed tools that can rapidly identify people infected with the disease, effective medicines to cure those who are sick, and preventive approaches to stop infections before they occur.
T WRITTEN BY: Bruno Moonen Deputy Director for Malaria, Bill & Melinda Gates Foundation
Hundreds of millions of people are still infected with malaria each year.
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“Distributing bed nets is great, but it’s only part of a comprehensive approach. Adding proactive case management in the same communities affords greater protection. Additional tools to control mosquitos may be needed, too.” Together with Uganda’s Ministry of Health, Pilgrim Africa led a 2008-09 trial of another layered initiative – combining indoor residual spraying (IRS) with mass drug administration. This combined approach led to an 80% drop in malaria cases. With partners they recently conducted a longer study to further investigate this synergy. And, because IRS can be too expensive for ongoing use, current research examines the effectiveness of combining pyrethroid-PBO bed nets, a cheaper alternative, with proactive community case management in areas where IRS must be withdrawn. All the findings are relayed to the National Malaria Control Division in Uganda to help shape a scaled, sustainable national response.
Community volunteers are essential When it comes to innovation, new technology often claims the limelight, but community health volunteers play a pivotal role in integrated health campaigns and on-the-ground malaria testing. In many Ugandan communities, they carry out critical, life-saving work. Unfortunately, such workers are a low priority when it comes to distribution of personal protective equipment. Pilgrim Africa has been quick to address this. “With help from our key partners, we were able to obtain masks, gloves and soap for hundreds of health workers.” says Echodu. With protocols in place, these local champions have been able to continue anti-malaria efforts while assisting the Ministry of Health with COVID-19 response. “In rural communities, where malaria thrives, there isn’t the access to media and communication that we’re used to in urban centres. The best way to exchange health information is person-to-person,” confirms Echodu,
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he interventions we use to prevent malaria – including long-lasting insecticide-treated bed nets – are among the most effective in our toolbox and have contributed to a reduction in deaths from the disease by more than half since 2000. We have also started to scale up a new generation of bed nets that will offer even greater protection and help contain the spread of insecticide resistance. Yet, despite having more advanced prevention tools than ever before, hundreds of millions of people are still infected with malaria each year. In the West African country of Benin, around one in six people was infected in 2018, even though health authorities routinely conduct bed net distribution campaigns throughout the country. Faced with this situation, the government of Benin was determined to develop a better system for protecting people. A new initiative launched earlier this year does just that, while providing a powerful reminder that some of the most impactful innovations in public health can be among the most straightforward.
Gates Foundation. Together, they worked to digitise the entire process, creating a new system to more accurately and efficiently reach families with life-saving bed nets. First, health workers go door to door, gathering information from every household on the number of people living there and the number of bed nets needed. Then, using mobile devices, health workers add this information to a comprehensive database. Under the original plan, each household would have received a voucher to redeem for the bed nets they need at a distribution centre. Faced with the threat of COVID-19, the government of Benin mobilised rapidly to adjust their approach, shifting to a door-to-door distribution strategy to ensure the nets reach those who need them, without increasing their risk of contracting the novel coronavirus. With the information now digitally accessible, health workers will be able to quickly identify households that might have been missed and follow up accordingly.
Pencil and paper record-keeping is not accurate enough Until now, Benin’s malaria programme has relied upon a pencil and paper system for recording bed net distribution. This system was dwarfed by the scale of the task at hand: distributing millions of nets requires complex population estimates, thousands of frontline workers and careful documentation to ensure each household receives what it needs. Any gap or delay in distribution meant a gap or delay in coverage, and an increased risk of malaria infection. To find a solution, leaders across Benin’s government – from the Ministry of Health to the Office of the President and even the Bureau of Statistics – teamed up with Catholic Relief Services and the Bill & Melinda
The new digital system will do more for the people of Benin than save lives from malaria. It’s an important step toward a more sophisticated health system driven by timely and accurate data, one better equipped to address existing challenges like neglected tropical diseases and meningitis, and emerging ones like the COVID-19 pandemic. To end malaria for good, we have big needs to address: increased funding, strengthened political will and rapid innovation to develop transformational tools for the endgame. Benin’s new distribution system is an example of what’s possible when we’re alert to the solutions right in front of us – identifying them and acting on them can save lives and move us closer to a world without malaria.
underscoring the importance of an active volunteer presence. Uganda’s progress shows what can be achieved when combined efforts are focused on high-burden areas. Pilgrim Africa hopes that further research and innovation will help guide investment toward effective programmes. “Lives depend on it,” says Echodu. Written by: Kate Sharma
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A digitised system will be more reliable for tackling future – and present – conditions
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Malaria no more No mother should have to lose her unborn baby to malaria.
Don’t forget malaria during COVID-19
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Before we had any malaria preventative treatment for pregnant women at WRITTEN BY the maternity clinic, Rosemund Awumi we saw too many Community Health Nurse, stillborn births and Maternity, Abokobi Health Centre, Accra. miscarriages, and it was heart-breaking. Preventative treatment of malaria in pregnancy is saving lives in Ghana; we hear from Rosemund Awumi, a Community Health Nurse for Maternity at Abokobi Health Centre, Accra.
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ince 2004 the situation has changed a lot. Supported by the Ghana Health Service and the NMCP [National Malaria Control Programme], we have been providing intermittent preventive treatment of malaria in pregnancy, using sulfadoxinepyrimethamine or IPTp-SP. This treatment is available for free across Ghana, it’s universal, and it is saving many lives. It really is making a huge difference in the community here.
The response to COVID-19 is – and must be – all encompassing. The worry is that efforts to protect against malaria may go off the radar, with huge implications for public health in Africa.
WRITTEN BY: Joy Phumaphi Executive Secretary, African Leaders Malaria Alliance
In Ghana, universally available malaria treatment while pregnant is saving lives The first dose of SP is taken 16 weeks into pregnancy then three or more doses spaced one month apart until delivery. Essentially, the medicine reduces placental plasmodium parasitaemia and improves birth outcomes so, put simply, it helps to prevent mothers miscarrying or having to endure stillborn births. If a woman contracts malaria during pregnancy there is also a big risk of their developing baby being born with low birth weight, foetal anaemia, dangerously low immune systems, and in rare cases, sustained brain damage. As well as the SP therapy, as with any malaria prevention, we still recommend using ITNs [insecticide treated nets] and repellents. Another of our complementary activities to support malaria prevention is the seasonal destruction of mosquito breeding sites in the communities using insecticides. We can end malaria within a generation, this is one step further towards that mission We are all striving for elimination, from one end of the country to the other. We know how destructive it is on every level. I do believe that it is feasible, at the rate of progress we are making and with real, long-term support from all sectors, not just health. The medical staff here are all very committed to what they are doing, and we work hand in hand with the community, every step of the way. We are more hopeful than ever that, if we keep fighting, we can beat our old opponent malaria for good one day.
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ince the Abuja 2000 Political Declaration on Roll Back Malaria, global efforts have dramatically reduced the global malaria burden. Unprecedented partnerships and high-level political alliances such as ALMA demonstrated shared responsibility and regional as well as global solidarity, enabling the scale-up of effective interventions and better data for evidence informed policies and programmes. While more countries are close to elimination, the progress made in Africa is fragile and can easily backtrack. A seasonal outbreak has the potential to reverse progress made in decades. Africa suffers a disproportionate share of the global malaria burden: 94% of deaths and 93% of the cases, with pregnant women and children under five in sub-Saharan Africa being the majority of the victims. African health systems are already weak; COVID-19 is a major threat As COVID-19 ravages the globe, weak health systems are under real threat in Africa. While COVID-19 is wreaking visible economic damage even in the most developed societies, its impact on health systems in Africa promises to be devastating, affecting all social protection mechanisms across African countries. The highest malaria burdened countries – the majority of which are in Africa – cannot cope with millions more malaria infections. Women and children are the most affected by malaria with more than two thirds of deaths being children. In addition, children’s learning ability is compromised when they get malaria, thus affecting their future contribution to the development of their communities and Africa’s potential for growth. The COVID-19 pandemic has the potential to significantly increase malaria deaths and cases, and add
pressure on less-resilient health systems and limited human resources for health. WHO estimates that, without access to malaria prevention and treatment, deaths due to malaria could double in 2020, from the 380,700 in 2018 to 760,000.
Zero Malaria Starts With Me.
We must not lose the past 20 years’ progress in reducing cases of malaria Now, more than ever before, it is vital that the malaria endemic countries and the world work together to protect gains painstakingly made in reducing malaria cases and deaths over the past two decades. This requires coordinated action that will keep frontline health workers and communities at risk of malaria safe from COVID-19, minimise disruptions to supply chains and malaria services, as well as ensure funding is not diverted away from malaria programmes. Keeping malaria high on the development agenda is now more urgent than ever before. Also critical is ensuring funding commitments are maintained, including commitments that have already been made by Heads of State, governments and national End Malaria councils. ALMA has committed to supporting countries in the increased use of data and technology, which will drive impact and change. We need to harness the demographic dividend of our youth who can act as catalysts and drivers of investments in drugs, technical innovation and researchers to win the fight against malaria. The Zero Malaria Starts with Me campaign endorsed by the AU, ALMA Chair and Heads of State and Government emphasises the power of the people and the urgency to defeat malaria with global solidarity and shared responsibility. Zero Malaria Starts With Me.
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Moustarida, age three, is one of more than four million children under five in Niger alone to receive seasonal malaria chemoprevention (SMC). During the rainy season, when malaria strikes the most, community health workers dispense SMC to protect young children from the disease. This cost-effective, targeted intervention can reduce cases by more than 50%. Effective control of diseases like malaria frees health systems to manage other demands and prepare for future threats. But malaria cases are rising in some countries after years of decline; history has shown malaria’s ability to resurge even after years of successful control. As the leading international funder of the malaria response, the Global Fund is investing in new tools, data generation, partnerships and innovations – including piloting new mosquito nets to combat insecticide resistance in Africa. I M AG E A N D C O N T EN T P R OV I D ED BY T H E G LO BA L F U N D
COVID-19 could cause malaria deaths in Africa to double INTERVIEW WITH
Malaria deaths in sub-Saharan Africa could double due to COVID-19, warns World Health Organization.
T Abdurazak Mohamed Managing Director of the charity, African Development Trust
Written by: Kate Sharma
Read more at africandt.org
he World Health Organization (WHO) is urging countries in Africa to press on with prevention, diagnosis and treatment of malaria. However, new COVID-19 restrictions are making the task on the ground impossibly hard. There have been reports that campaigns to distribute insecticidetreated bed nets (ITNs) have been put on hold as have initiatives to spray homes with insecticide. “COVID-19 has totally interrupted everything on the ground with curfews and movement restrictions,” confirms Abdurazak Mohamed, managing director of the charity, African Development Trust. Mohamed goes on to explain that messaging regarding what to do if you present COVID-19 symptoms, such as fever, are also hampering efforts. Within an African context, fever is much more likely to be a symptom of malaria then COVID-19, but many individuals are not than seeking a diagnosis for malaria.
In some situations, patients with fever are only being screened for COVID-19 and not malaria at all. Further strain on overburdened healthcare systems WHO have developed guidelines to ensure that other health initiatives don’t get sidelined as countries rally to respond to COVID-19. But there is no denying the strain that already overburdened healthcare systems are under. Mohammed explains: “It’s very scary. Many countries are shifting budgets from other areas, such as managing malaria, to fight COVID-19. In Somalia we took two children who were sick with malaria to the hospital and it was difficult persuading the managers of the hospital to treat them.” In the worst-case scenario, where the distribution of ITNs is suspended, insecticide spraying curtailed, and access to effective antimalarials reduced by around 75%, WHO estimates deaths could reach 736,000 in sub-Saharan Africa – twice the number recorded in 2018.
Countries will be plunged further into poverty The impact could be catastrophic. Mohamed isn’t just concerned about the number of deaths, he also fears that decades of development work could be undone, and millions plunged further into poverty as a result. “Malaria and poverty are interrelated. We need to manage malaria if we are to alleviate poverty across the region,” he states. Sub-Saharan Africa continues to bear the greatest global burden of the disease – accounting for 93% of cases and 94% of all deaths. COVID-19 may know no boundaries, but as developed nations struggle to cope with cases and mend broken economies, Mohamed is concerned that the poorest of the poor will be forgotten once more.
In some situations, patients with fever are only being screened for COVID-19 and not malaria at all.
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The malaria season is coming – we must continue to protect children at risk As anxiety around the COVID-19 pandemic is felt around the globe, the voices of those at risk of malaria ring in parallel - voices that often go unheard.
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ccording to the World Health Organization (WHO), malaria takes a child’s life every two minutes. The vast majority of incidence and mortality occur in subSaharan Africa, where health systems are fragile, and any extra burden placed on scarce resources could be the difference between saving or losing lives.
WRITTEN BY: André-Marie Tchouatieu Associate Director, Access & Product Management, Medicines for Malaria Venture (MMV)
P H OTO : J B R U S S EL
Protecting young children from malaria In the Sahel sub-region of Africa, 60% or more of total malaria cases occur during the four to five month rainy season between July and November.1 During this period, seasonal malaria chemoprevention (SMC),2 a WHO-recommended strategy, is used to protect young children from malaria. The intervention requires the administration of doses of a child-friendly medicine once per month (over three days) for the duration of the season and has been proven to prevent malaria in children under five by approximately 75%.3 Recent progress has been remarkable in the scale-up of this intervention. In a UNITAID-funded project,4 seven countries in the Sahel region received support in piloting and increasing the reach of SMC. By project end, coverage had more than doubled from 2.6 million children in 2014 to over 6.5 million in 2016. Medicines for Malaria Venture (MMV) supported the project by strengthening and diversifying the supply of medicines to meet the growing demand for SMC. In 2018, SMC coverage ensured protection for up to 20 million children. Currently, MMV is supporting the scale-up of the intervention in 13 countries.
I M AG E A N D C O N T EN T P R OV I D ED BY T H E G LO BA L F U N D
INTERVIEW WITH
Dr Scott Filler Malaria Team Leader, The Global Fund
A shortage of funding Despite major progress, there remain challenges to the implementation of SMC. Although key funding partners have remained committed and increased their support, the intervention is out of reach for many eligible children, particularly in Nigeria, Chad and Guinea Bissau: about 10 million children do not yet benefit from SMC due to a shortage of funding. The lack of resources also constrains the potential for expansion of SMC to older children between five and ten years of age, who remain unprotected. COVID-19 and SMC In addition, the COVID-19 pandemic has brought new obstacles, threatening both the supply of critical medicines and the ability of national and regional authorities to coordinate adequate supply and coverage. The intervention also relies heavily on the impressive determination of community health workers who walk miles from village to village each day, to ensure that children receive their preventive medicine treatment. Unfortunately, safety measures to cope with COVID-19 include social distancing for the protection of villagers and health workers alike; these measures will make deployment that much more daunting. The WHO Global Malaria Program recently published new guidance including measures that can be taken to reduce the risk of health workers being infected with COVID-19 during the delivery of community-level malaria control interventions in order to address these challenges.5 To realise the maximum benefit that can be provided by SMC, more country-based funding is needed, not only to expand access to the over 10 million children who remain at risk and without protection, but to ensure that, during this time of uncertainty, SMC can continue to save young lives. References 1 Cairns, Matthew et al. Estimating the potential public health impact of seasonal malaria chemoprevention in African children. Nature. 2012. 2 MMV website. SPAQ for Seasonal Malaria Chemoprevention (SMC). 2019 3 WHO website. Malaria, Seasonal malaria chemoprevention (SMC). 2017. 4 The project is called ACCESS-SMC and more information can be found at access-smc.org. 5 WHO website. Tailoring malaria interventions in the COVID-19 response. April 2020.
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It is time to unite to fight against malaria In the face of the current COVID-19 pandemic, a renewed effort to end malaria has never been so vital.
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n the past few years, progress toward The Global Fund is responding quickly eradicating malaria has levelled by making up to US $1 billion available to off, according to the World Health help countries fight COVID-19, mitigate Organization. the impacts on lifesaving malaria Even more worrying are reports that the programmes, and prevent fragile health disease is on the rise in some high-burden systems from being overwhelmed. countries. “We need to adapt things like mass “A lot of this is driven by the fact that mosquito net distribution,” says Filler. the populations affected by malaria are “We’re also working on messaging to growing fast, while we’ve seen financing ensure patients with symptoms do seek plateau,” explains Dr Scott Filler, Malaria care and that the healthcare providers Team Leader at the Global Fund. and patients are protected.” Throw into the mix a global pandemic, and it’s easy to see Malaria eradication can why efforts need to be benefit the economy stepped up if we are Malaria is a disease to defeat a killer that that not only takes the lives of more disproportionately As the world grapples to than 400,000 every affects people in single year – more deal with COVID-19, there poverty, but also than half of whom are perpetuates poverty. are lessons to be learnt children. Filler believes that, despite the gloomy from previous disease Learning from our fiscal outlook, now is outbreaks. mistakes the time for investors As the world grapples to be bold and consider to deal with COVID-19, there are lessons to the wider economic benefits of defeating be learnt from previous disease outbreaks. this deadly disease. During the Ebola crisis of 2014-2016, Talk of vaccines, genetic engineering and health services in West Africa were new drugs being developed in the near disrupted, malaria campaigns put future should add encouragement. on hold, and many individuals too “In the next three to five years we’ll see fearful to seek treatment. things come to the table that will expand As a result, a massive increase in Malariaour toolbox,” continues Filler. “But that related deaths was reported. “More people takes investment.” died from malaria than from Ebola,” says The goal of eradicating malaria within Filler. a generation is still achievable. If the COVID-19 crisis has taught us anything, Adapting interventions quickly it’s that we live in an interconnected While the disease is complex, effective world and sharing resources, expertise tools are available and they are working. and finances will bring results. Since 2000, the number of malaria-related deaths has halved. However, without further support, these huge gains Written by: Kate Sharma could be lost.
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We can’t pause the fight against malaria To defeat malaria, we need to invest in strong, integrated healthcare systems at the heart of nations with the greatest burden.
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hile the World Health Organization urges countries to continue their core malaria prevention, testing and treatment activities in the midst of COVID-19, there have been reports of initiatives being suspended in some countries. But we shouldn’t have to choose which battle to fight. “If we want to push forward, we can’t work in silos anymore – we need integrated healthcare systems,” explains Dr Sabine Dittrich, Head of Malaria and Fever at the Foundation for Innovative New Diagnostics (FIND).
Thousands of lives lost to malaria during global pandemics We saw the disastrous impact of neglecting malaria in the wake of Swine influenza in 2009, Ebola in 2014 and Zika virus in 2015, when thousands more lost their lives to malaria than the disease outbreaks themselves. We need to learn from our mistakes, which is why experts are urging global collaboration and investment in healthcare systems that can provide more coordinated care.
COVID-19 is disrupting vital supply chains
INTERVIEW WITH
INTERVIEW WITH
INTERVIEW WITH
INTERVIEW WITH
Jeffery Smith Chief Operating Officer, APLMA
Dr Sabine Dittrich Head of Malaria and Fever, FIND
Dr Philippe Duneton Executive Director a.i., Unitaid
Dr Nick Hamon CEO, IVCC
aplma.org
finddx.org
unitaid.org
ivcc.com
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Research and development Malaria continues to outwit many of the tools in our current arsenal. Research and development is vital to bring new medication, improved vector controls and better diagnostics into play, but COVID-19 threatens to slow that process too. “We’re currently modelling what the impact will be if production of these new chemistries is delayed by a month, or even a year. The prospect is scary,” continues Dr Nick Hamon CEO at the Innovative Vector Control Consortium (IVCC).
Strong leadership is key We know from experience that strong leadership can make a significant difference in these areas. In 2014, heads of state at the East Asia Summit made a commitment to work toward the elimination of malaria in the region by 2030. That commitment was backed up by a regional road map and national investment. Countries such as Thailand harnessed sophisticated technology to map the disease and monitor supply chains and budgets so resources could be deployed to areas of greatest need. In Cambodia, innovation in insecticide treated clothing for outdoor workers has also reaped benefits – with the country reporting no malaria deaths since 2018.
Collaborating to fight disease Putting activities to eradicate malaria on hold could have devastating consequences for a disease that already kills 405,000 people each year and infects 228 million. If we are to protect lives, malaria initiatives can no longer be viewed in isolation. No one should be forced to choose between fighting malaria or fighting COVID-19. By building a more integrated approach to healthcare in countries with the greatest malaria burden, benefits will be reaped across the board. “If you strengthen entire healthcare platforms – you can cope with multiple diseases,” confirms Hamon, from IVCC. Action is certainly needed right now to ensure that current malaria initiatives stay on track. However, as the world wakes up to the central role healthcare plays in all aspects of life, now is the time to renew efforts to strengthen those systems and push harder to eradicate malaria. Written by: Kate Sharma
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What happens on the ground is directly influenced by activities further up the supply chain – and those chains are being tested to the limit. Manufacturing, research and testing have all been impacted by COVID-19, and import and export restrictions are disrupting deliveries. Such delays won’t just result in stagnation of activity on the ground. As Jeffery Smith, CEO of the Asia Pacific Leaders Malaria Alliance (APLMA) warns: “This could open the door for substandard products.” Poor quality bed nets and sprays are certainly nothing new. They put lives at risk and also accentuate the problem of insecticide resistance, which threatens to reverse the huge global gains made in the last 20 years. These concerns highlight the importance of strengthening national regulatory authorities and also reinforce the need for innovation. “The model we’re using is to bring innovation to scale and increase access,” explains Dr Philippe Duneton, Executive Director a.i. of Unitaid, a global development agency engaged in finding innovative solutions in global health. “You need a comprehensive approach. It’s a combination of prevention, testing and treatment, and we need to find the best weapons and combine them.”
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Advancing promising science to fight the scourge of malaria Developing effective antimalarial medical interventions can be a lengthy, high-cost, high-risk process. A financing instrument is available to support SMEs and potentially speed up the development of vaccines, diagnostics and therapeutics.
M
alaria continues to kill around 750 children under the age of five every single day. One thing is certain, says Holm Keller, Managing Director of the EU Malaria Fund, if malaria was endemic in Europe, the US, or any other country in the so-called ‘developed’ world, an effective vaccine and alternative treatments would have been found by now. Developing a vaccine for a disease, such as malaria, is high-risk and hugely expensive, which is why big pharmaceutical companies largely avoid doing so. “On average, vaccine development costs €1 billion,” notes Keller. “So, even if a pharma company successfully brought a malaria vaccine to market, it still wouldn’t repay their investment.” What’s needed is a way to de-risk development into novel pharmaceuticals. Hence the creation of the EU Malaria Fund, a public-private partnership between the European Union, international organisations, corporations, and organised civic society. The EU Malaria Fund is managed by IBB Group, the public promotional bank of the Federal State of Berlin. General Partner of the EU Malaria is EMM EU Malaria Fund Berlin Managementgesellschaft mbH. The EU Malaria Fund has been initiated by kENUP Foundation.
Engaging biotechs and balancing risk “The Fund is a minimally invasive, non-dilutive financing instrument,” explains Keller. “It invests in a number of small or medium-sized biotech companies (SMEs), with the stipulation that malaria has to be part of their platform.” Investing in a portfolio of research projects (currently 11 companies with 27 independent projects) balances risk and increases the chances of success. The Fund does not aim to bring the innovations to market directly, however. Instead it supports SMEs until certain proof-of-concept milestones are reached, thus demonstrating the value of the novel product and highlighting the potential of these SMEs to the large multinational pharma companies, which may eventually wish to acquire the company and bring the products to market themselves. Indeed, this type of platform funding is a way to engage smaller biotechs that would not normally engage in the development of products to prevent, diagnose or treat malaria. “Plus, it allows easy transfer of ideas from academia because, finally, there’s a way to advance promising science beyond grant funding,” says Keller. “It’s an instrument that may yield important results and could potentially be leveraged in other disease areas where there is a similar market failure.”
WHO welcomes the creation of this innovative and much-needed funding mechanism for the fight against malaria. The EU Malaria Fund will bring vital new resources to develop tools to tackle a disease that continues to kill over 400, 000 people every year.” Dr Pedro Alonso Director, WHO Global Malaria Programme
PAGE INTERVIEW WITH
Holm Keller Managing Director, EU Malaria Fund
Written by Tony Greenway
The fight against malaria has stalled, we need to invest now. The EIB is fully committed to the EU Malaria Fund.” Dr Werner Hoyer President, European investment Bank (EIB)
As Siena is a world-renowned lifesciences hub, Fondazione MPS has been supporting scientific research on drugs, vaccines and treatments to achieve sustainable development in the world. Fondazione also appreciates that the Malaria Fund will support the research for defying the COVID-19 and it’s proud that Siena will take an important part in this project.” Read more at controlmalaria.eu
Carlo Rossi President , Fondazione MPS
Working together for successful anti-malarial development By pursuing a number of independent projects in the malaria field, the EU Malaria Fund hopes to increase the chances of discovering second-generation vaccines and therapeutics.
T
he catastrophic COVID-19 pandemic has given the world a new appreciation of vaccines and therapeutics, says Holm Keller, Managing Director of the EU Malaria Fund. “COVID-19 has increased awareness of infectious diseases,” he says. “It’s critical these diseases are dealt with for the good of public health, starting with the biggest killers. And malaria is one of the biggest.” This is why the €280 Million Fund is working with a portfolio of smalland-medium-sized companies that are developing a wide range of promising anti-malarial projects. Currently, the Fund is pursuing 27 scientifically independent development projects, 21 of which are malaria related. The remaining six are non-malaria related and focus on other under-served infectious diseases, such as COVID-19.
These are included because the Fund invests in SME’s platform technologies, which explore multiple – rather than single – product candidates. Investing in a variety of candidates to increase chances of success “Of the 27 projects, 19 are vaccine candidates, seven are therapeutics and one is a test,” says Keller. “The thinking is that, by supporting 21 malaria related projects, we are significantly more likely to discover one working antimalarial medical intervention.” To further increase these chances, it’s important to fund a range of products and platform approaches including vaccines, monoclonal antibodies, alternative new treatments and diagnostics. Therefore, investment is being directed towards a diversity of new, scientifically sound hypotheses to give additional financial support to the most
promising of approaches. Active conversations are ongoing with a number of big pharmaceutical companies that are interested in acquiring the SMEs in the Fund’s portfolio. Keller is therefore optimistic that this could be a turning point in the fight against malaria. “I believe that, in three to five years, we could have two second generation malaria vaccine candidates,” he says. “That’s a situation the world has never enjoyed before. In the malaria community, we’re aware that the Fund’s contribution is small — but it may be an ingredient that makes a lot of difference.” Written by Tony Greenway