Malaria and Neglected Tropical Diseases - Q2 2023

BY

Since the turn of the millennium, global partnership and sustained investment have significantly impacted the fight against malaria, preventing 2 billion malaria cases and saving 11.7 billion lives.

Today, however, low coverage of existing tools, emerging biological threats, funding shortfalls and the ongoing impact of Covid-19 are brewing a perfect storm for malaria, putting progress at risk. In 2021, there were 241 million malaria cases and about 620,000 malaria deaths.

Recent research and development investments have produced the most robust pipeline of malaria interventions in over a decade. Still, many challenges are holding countries off track from achieving the 2030 global malaria targets.

On World Malaria Day, the RBM Partnership to End Malaria calls for countries and global stakeholders to invest, innovate and implement for a zero-malaria world.

Bridging critical global funding gaps to deliver zero malaria

Despite considerable efforts from the malaria community, the global funding gap for malaria is increasing, exacerbated by a shortfall in funding secured at last year’s Global Fund Replenishment.

To reach global malaria targets, available resources must be used efficiently, and leaders must urgently deliver bold investments in malaria control to bridge the funding gap and accelerate progress. This needs sustainable and predictable health financing for universal health coverage (UHC) and

Invest, innovate, implement: it’s time to deliver zero malaria

a shared vision for primary healthcare investments that impact public health priorities.

Innovation must continue at pace for improved solutions

Biological threats in recent years have endangered malaria control and elimination efforts, putting progress at risk.

The ability of the Anopheles mosquito — and the malaria parasite it transmits — to constantly evolve has given rise to emerging drug and insecticide resistance, reducing the efficacy of existing tools.

Meanwhile, many proven interventions await to be tailored and targeted to those who need them most. We must continue accelerating innovation and delivering transformative tools and improved approaches to end malaria.

Scale up and urgently deliver malaria control programmes

As countries, global communities and partners work tirelessly to hold the line against malaria through inclusive, multisectoral responses to the disease, it’s time to scale up robust national malaria programmes to deliver lifesaving tools to those in need.

As the global malaria community comes together this World Malaria Day, we must continue to invest in malaria elimination; innovate to develop and tailor new tools and approaches; and implement national strategies to accelerate progress against this age-old disease.

This World Malaria Day, the global malaria community calls for urgent action and further investment to deliver zero malaria.

WRITTEN

Dr Corine Karema Interim CEO, RBM Partnership to End Malaria

Biological threats in recent years have endangered malaria control and elimination efforts, putting progress at risk.

“Prevention is key, and researchers are making progress in developing effective tools for all ages.”

“Nearly 77% of malaria deaths were among children under five.”

against malaria

The fight against malaria has stalled in some countries. A mix of new and existing tools and approaches can help eliminate and eradicate this preventable but deadly disease.

The world must take a more proactive approach to fight malaria, insists Simon Bland CBE, CEO of Global Institute for Disease Elimination (GLIDE), a United Arab Emirates-based organisation focused on eliminating infectious diseases of poverty. After all, malaria is preventable but accounts for 80% of all deaths in children under five in Sub-Saharan Africa.

Global fight against malaria

Climate, natural disasters and conflict displace millions of people into zones where malaria is highly prevalent, creating major challenges for humanitarian response.

Global coordination can offer improved support to displaced populations in malarial regions. Millions, particularly in Sub-Saharan Africa, face an increased threat from malaria after being displaced by changing weather conditions or conflict.

Displaced populations

Humanitarian experts believe a more coordinated, continuous and adaptive approach between countries and emergency agencies is critical in addressing these challenges.

Joseph Lewinski, Multisectoral Malaria Platform Lead with Catholic Relief Services (CRS), says: “The world is living with a large level of displacement, with 110 million people displaced and many of these in malaria-endemic areas.” CRS is an NGO working in the malaria sector in 12 countries.

Lewinski adds: “We have seen an increasing amount of displacement from natural causes through weather-related events and climate as well as through civil strife and conflict, leading towards internal displacement and refugees flowing out of countries.” He cites the recent cyclone in Malawi with local populations displaced by flooding.

Prevention commodities

A challenge lies in aligning systems designed for routine malaria care. Lewinski continues: “We also have challenges with getting the right malaria prevention commodities like bed nets or other prevention tools to distribute to displaced populations.

“Changing weather patterns are creating further challenges when it comes to mosquito breeding and transmission and our ability to effectively control that.”

Malaria tools

With ecological changes creating malarial issues, Lewinski emphasises the importance of improved coordination between humanitarian response partners. He points to their recent work co-hosting roundtable discussions with Red Cross, Alliance for Malaria Prevention and the UN Foundation to examine how cluster system partners can mitigate ongoing challenges.

Coordination between private and public sectors and affected communities is critical to developing strategies that better serve displaced populations. “These include shelters with insecticide on them; changing the dimensions of bed nets; and improved indoor residual spraying,” he says. Another step is around prepositioning commodities to enable better and quicker responses to emergencies.

Blended transition

CRS and its partners are working with the vaccination/immunisation sector to better understand where displaced populations are missing out on routine services. One project with USAID Bureau for Humanitarian Response is piloting delivery of nets through water, sanitation and hygiene (WASH) services they provide.

Multisectoral coordination can ensure a more blended transition from emergency response to the development phase and a collaborative approach in funding, with the flexibility to mitigate effects of the climate crisis on stable communities that become displaced.

Lewinski stresses that countries must learn from one another’s experiences to plan for — and respond to — emergencies in the future.

Written by Mark Nicholls

In recent years, a certain amount of complacency has set in. “Great progress was made just after the turn of the millennium,” notes Bland. “The UN had launched its Millennium Development Goals (MDGs) and more global investment was going into health. As a result, we saw the malaria curve falling.” But progress stalled long before Covid-19 muddied the waters.

This is not to underplay some impressive successes or ignore the 40 countries that have been granted malaria-free certification from the World Health Organization (WHO). These include El Salvador, Algeria, Argentina, Paraguay and Uzbekistan. Additionally, there was the development of the world’s first malaria vaccine — RTS,S — hailed as a game-changer.

Link between climate and infectious disease

However, significant challenges remain. “For instance, we’re going to need different tools and approaches to tackle a species of Anopheles mosquito now appearing in Africa, which is more urban and bites during the day,” says Bland. “Resistance to therapies and insecticides is increasing — so we need new therapies; new insecticides; and new, rapid, accurate diagnostics that can diagnose several diseases at once.”

There is no silver bullet for this, he admits. “We must use the tools we have and keep developing and rolling out new ones to re-energise the global programme towards the elimination and ultimate eradication of malaria.”

Worryingly, the climate crisis and extreme weather events could hamper these efforts because, as the world gets warmer, more countries may prove to be amenable habitats for mosquitoes carrying disease-causing parasites. With COP28 taking place in the UAE in November, GLIDE has been contributing to building the field of knowledge about climate and infectious diseases. This includes launching a second iteration of its Falcon Awards for Disease Elimination, supporting research into the subject. Ultimately, eliminating malaria requires joined-up thinking, says Bland. “No one can do this in isolation. If we work together to eliminate this disease from affected countries, that will be a cause of real celebration. We hope to support, promote and accelerate more celebrations over the next decade.”

INTERVIEW WITH Simon Bland, CBE CEO, Global Institute for Disease Elimination (GLIDE)

INTERVIEW WITH Joseph Lewinski Multisectoral Malaria Platform Lead with Catholic Relief Services (CRS)

WRITTEN BY Tony Greenway

Paid for by Global Institute for Disease Elimination

Why we need greater coordination to fight malaria in displaced populations

Inaction is unacceptable: how we can re-energise the fight

Find out more at glideae.org

©Oscar Medina

©Jjumba Martin/CRS

Strategy, persistence and innovation: how we aim to beat malaria

For millennia, humans have been locked in a strategic game of chess with a formidable opponent—malaria. With hundreds of thousands of lives at stake each year, we can’t afford to lose.

When we make a move, malaria makes countermoves that challenge our best defences. As seen recently, one mosquito species, Anopheles stephensi, is literally on the move, bringing the disease to new environments in Africa.

Like chess, many pieces are on the board in the malaria fight. Drugs treat the disease; insecticides kill the mosquitoes that spread it; and vaccines are emerging to prevent infection. Yet, the tools we have today will not be enough to end malaria. Fortunately, game-changing tools are within reach, thanks to decades of investment in innovation and leadership from endemic countries.

New bed nets are saving lives

In the battle against mosquitoes, new bed nets using insecticide mixtures have proven more effective in preventing disease than standard nets, especially in areas with insecticide resistance. The World Health Organization recently recommended widespread deployment of these nets, which are already saving lives in communities.

Promising tools ahead

Prevention is key, and researchers are making progress in developing effective tools for all ages. Monoclonal antibodies are showing promise, as early-stage findings indicate a low-cost, single-dose antibody treatment could

protect children and, eventually, adults. Additionally, innovators are leveraging recent advances in vaccine technology to create a more-effective, longer-duration, all-ages malaria vaccine.

What if we could stop malaria transmission altogether?

Researchers are exploring gene drive — an innovative genome editing technology — to modify mosquitoes and prevent them from transmitting the disease.

A comprehensive strategy

Successfully ending malaria will require new tools but also improved systems, access to care and partnerships centred on malaria-endemic communities. More sophisticated monitoring systems, including genomic surveillance, are transforming how we track resistance and malaria transmission. This, paired with improved case management in communities, provides malaria programmes with a more holistic and nuanced picture of how and why malaria is spreading — which will inform tailored response and care within countries.

Malaria continues to challenge us, but we can gain the upper hand. As our opponent makes new moves, we must adapt our strategy and outsmart it with the tools we have now, while rapidly bringing new ones to the game. By investing in innovation today, we can beat malaria at its own game for good.

WRITTEN BY Philip Welkhoff Director, Malaria, Bill & Melinda Gates Foundation

WRITTEN BY Helen Jamet

Deputy Director for R&D, Malaria, Bill & Melinda Gates Foundation

Prevention is key, and researchers are making progress in developing effective tools for all ages.

Public-private partnership: the entryway for malaria elimination in Equatorial Guinea

With intensive year-round transmission, malaria has been a leading health problem for the people of Equatorial Guinea. Sustained partnership efforts offer hope for a future without malaria.

Equatorial Guinea is made up of its mainland and insular regions, including Bioko Island. MCD Global Health (MCD) and its partners celebrate year 20 of implementing the Bioko Island Malaria Elimination Project (BIMEP). This award-winning public-private partnership is committed to eliminating malaria on Bioko Island as the first step toward national elimination.

Reducing the malaria burden on Bioko Island

Since 2004, the BIMEP has contributed to improvements in the health and wellbeing of the island’s residents. It has:

• Reduced the percentage of children (between ages 2 to 14) with malaria by 66% from 2004 to 2022.

• Reduced the prevalence of severe anaemia in children under 5 by 93% (from 15% in 2004 to 1.1% in 2022).

• Reduced the mortality rate of children under 5 by 63% from 2004 to 2018.

• Eliminated two of the four main species of mosquitoes that carry malaria on Bioko Island: Anopheles funestus and Anopheles gambiae s.s.

• Reduced the rate of transmission of the parasite by the vectors by 97%.

• Advanced the knowledge base related to best practices and challenges for malaria control and elimination through 71 peer-reviewed scientific journal publications.

These accomplishments and more are attributed to a data-driven, adaptive and comprehensive approach to malaria control and elimination consisting of integrated vector control. This includes using a combination of indoor insecticidal spraying of walls in homes, distributing and hanging insecticidetreated nets, and larviciding, as well as the timely and effective diagnosis and treatment of malaria cases.

“Our robust, real-time data collection and analysis has been the basis for adaptive decision-making that has enabled the project to modify interventions to changing conditions while maximising our impact,” says Guillermo García, deputy director for international programmes.

Beginning to eliminate malaria on Bioko Island

The project began in 2004 as the Bioko Island Malaria Control Project when “the Government of Equatorial Guinea, Marathon Oil and its partners and MCD came together with the common goal of eliminating malaria from Bioko Island,” says Philip Liverpool, general manager, Marathon EG Production Limited.

“Over the last two decades, this unique public-private partnership, which is one of the longest-lasting malaria control projects in recent history, has changed thousands of lives across Equatorial Guinea through its dramatic strides in malaria control and elimination,” he adds.

Contributions to national health

“The strong and enduring partnership has also helped strengthen the capacity of the Ministry of Health in not only leading malaria control but its health system more broadly,” remarks Dr Christopher Schwabe, CEO and president of MCD.

In addition to substantial investments in workforce development for the National Malaria Control Programme, the BIMEP has contributed to health systems strengthening by supporting the national health information system, helping develop district health plans and systems and establishing a National Institute of Public Health.

With its partners Swiss TPH and Sanaria Inc., the BIMEP also established the Baney Reference Laboratory and the country’s first infrastructure to carry out clinical trials, with three malaria vaccine trials completed to date.

“The award-winning BIMEP is one of many examples of how Chevron is contributing to improving healthcare delivery in communities where we operate,” says Bernardo R. Cuaresma, vice president of Noble Energy EG Ltd. “We are proud to have been part of a project that has made significant improvement toward the eradication of malaria in Equatorial Guinea.”

Despite challenges, the continued commitment of and investments from the Government of Equatorial Guinea and the private sector have sustained progress toward the country’s goal of ultimately eliminating malaria.

MCD Global Health (MCD), previously known as MCDI, is a nonprofit public health organisation working in over 50 countries around the world. To learn more, visit mcd.org

WRITTEN BY Guillermo A. García Deputy Director for International Programmes, MCD

WRITTEN BY

Dr. Christopher Schwabe CEO and President, MCD

WRITTEN BY Philip Liverpool General Manager, Marathon EG Production Limited

WRITTEN BY Bernardo R. Cuaresma Vice President, Noble Energy EG Ltd.

How British-backed malaria vaccines are helping to move progress forward

This year, World Malaria Day falls during World Immunisation Week, highlighting the collective action needed to protect people from vaccine-preventable diseases, including malaria.

Malaria is one of humankind’s oldest and deadliest diseases, stealing futures and diminishing both national and individual potential, with a child still dying every minute from this treatable and preventable disease.

New hope with malaria vaccines

With the international community’s attention focused on COVID-19 in recent years, combined with rising biological and environmental threats and not enough funding, progress in the malaria fight has not only plateaued but is at risk of reversal.

However, the latest pipeline of innovative malaria prevention tools, including vaccines, offer renewed hope for the future. British-backed science is helping to lead the way on the international stage with two promising vaccine candidates — RTS,S developed by British-based GSK, and R21 from the Jenner Institute at the University of Oxford.

Positive impact of malaria vaccines

RTS,S has been in the making for over 30 years and was the first-ever malaria vaccine recommended by the World Health Organisation (WHO). The vaccine is now a crucial part of a wider toolbox of interventions including next-generation insecticide-treated bed nets and innovative malaria medications.

Even greater effectiveness has been seen when RTS,S is used on top of seasonal malaria chemoprevention, which involves giving children malaria prevention medication monthly during the malaria season.

As of this year, a staggering 4.5 million RTS,S vaccine doses have been administered to more than 1.4 million children, potentially saving tens of thousands of children’s lives each year. With many children still left unprotected from malaria, the vaccine has also been shown to reach children not covered by other malaria interventions.

Delivering vaccines to meet demand

This milestone year, Gavi, the Vaccine Alliance will begin the rollout of funded doses to three pilot countries — Kenya, Ghana and Malawi and at least an additional country by 2024. However, there is not enough supply of RTS,S to meet demand, which is where the Oxford University R21 vaccine could play a significant role. Awaiting full vaccine trial results, the WHO will evaluate R21 for recommendation. If approved, R21 will greatly increase the supply of malaria vaccines and help drive down the cost.

With British-backed science at the forefront of the malaria fight, the future is bright but requires continued UK support for the global institutions that deliver the vaccines and new products to the children that need them, including the Global Fund to Fight Aids TB and malaria; and Gavi, the Vaccine Alliance.

Investing in new drugs to combat parasitic worm infections

Lack of investment in developing drugs against parasitic worm infections results in limited treatment options and a growing threat of drug resistance. Combining or repurposing drugs can help overcome this problem.

Strategies to fill the anthelmintic pipeline

Anthelmintic drugs are crucial in the fight against parasitic worm infections — which affect over 1.5 billion people worldwide — particularly for those living in poverty. These drugs treat infections caused by different species of parasitic worms including whipworms, hookworms and roundworms — the three main soil-transmitted helminths that can cause debilitating diseases.

WRITTEN BY Jennifer Keiser Associate Professor and Head of Helminth Drug Development, Swiss Tropical and Public Health Insitute (Swiss TPH)

Challenges in treating parasitic worm infections

The current pipeline of anthelmintic drugs is insufficient to meet the global demand for effective treatments. This is partly because parasitic worm infections have been neglected by the pharmaceutical industry, as there are few incentives for drug development given the low profitability. To treat soil-transmitted helminth infections, albendazole and mebendazole are currently used; but both drugs have limitations and demonstrate low efficacy against whipworm infections. However, no new anthelmintic has been developed in four decades.

Another challenge is the threat of resistance to existing drugs. This is particularly concerning given the limited number of drugs available and the fact that resistance can develop rapidly in response to the widespread use of these treatments, as observed in animal health.

One promising area of research we are working on at the Swiss Tropical and Public Health Institute (Swiss TPH) is testing new combinations of existing drugs. They have the potential to target multiple species of helminths given their broader spectrum of activity. Additionally, drug combinations can increase efficacy and reduce resistance. Another area of research is the repurposing of veterinary drugs for human use. Several veterinary drugs might be an attractive starting point for treating infections in humans. For example, emodepside — an anthelmintic drug used for dogs and cats — is undergoing clinical testing with promising results. Repurposing could provide a cost-effective way to expand the pipeline of available treatments.

Only one piece of the puzzle

Investment in the anthelmintic pipeline is critical to reducing the burden of disease and preventing drug resistance. By combining existing drugs or repurposing veterinary drugs for human use, we can help to ensure that effective treatments are available to those who need them — and that they remain effective for years to come.

New drugs are only one piece of the puzzle. To truly reduce the burden of these diseases, an integrated approach is needed, which includes improved water and sanitation infrastructure, education and behaviour change.

No new anthelmintic has been developed in four decades.

Dr Astrid Bonfield CEO, Malaria

Photo: Emmanuel Museruka

The time is now: how innovation and investment can tackle malaria in Africa

Africa, the continent bearing the heaviest burden of malaria, is on a time-sensitive mission to intensify efforts to eliminate the devastating disease once and for all.

The African Union (AU) Malaria Progress Report 2022, presented at the AU summit in my capacity as the Chair of the African Leaders Malaria Alliance (ALMA), reveals that progress remains stalled, with most member states off-track to achieve the AU’s goal of eliminating malaria by 2030.

Malaria across Africa

The World Health Organization’s World Malaria Report 2022 indicates that in 2021, Africa accounted for 96% of all malaria cases (238 million) and 98% of all malaria deaths (603,877). Nearly 77% of malaria deaths were among children under five, undermining Africa’s collective social and economic development and hindering the achievement of Agenda 2063. Despite strong political will, efforts must be accelerated to increase domestic resources and foster shared responsibility and global solidarity.

Reaching zero malaria

This year’s World Malaria Day theme, ‘Time to Deliver Zero Malaria: Invest, Innovate, Implement,’ underscores the urgent need for action and further investment to achieve zero malaria. It highlights maximising the impact of current investments by expanding existing interventions and calls for celebrating research community efforts and encouraging more investment in transformative tools.

Significant investments are required to increase coverage of key interventions and achieve the ambitious goal of eliminating malaria by 2030. In 2022, the global community’s pledge of $15.7 billion to replenish the Global Fund fell short of the $18 billion target. This, along with existing resources, is insufficient to fully support malaria programmes, particularly as member states face global inflation, supply chain disruptions and other economic challenges.

Resources and strategies

Upon assuming the ALMA chairmanship, I prioritised a four-point agenda emphasising multisectoral advocacy, action and resource mobilisation to close funding gaps; harnessing data for accountability and action; engaging a robust continental youth corps; and enhancing regional and cross-border coordination in the fight against malaria. Mobilising additional resources, including from the domestic private sector, remains crucial for increasing access to long-lasting insecticide-treated nets, indoor residual spraying and rapid diagnostic tests, as well as supporting the development and rollout of new tools. This will save 20 million more lives and result in economic gains from a healthier population, ultimately ensuring a healthier and more equitable world.

To date, 12 countries have launched or announced End Malaria Councils and Funds (EMCs and EMFs), with another 13 in progress. Several have integrated EMCs into national strategies as the primary mechanism for mobilising multisectoral advocacy, action and resources and accountability. Moreover, 27 countries have launched their ‘Zero Malaria Starts With Me’ campaigns, cueing the remaining countries among the 47 impacted by malaria to urgently activate their campaigns.

WRITTEN

Investing in malaria

Investment in new approaches and innovations, such as digital technologies for real-time data collection and analysis to guide evidence-informed decision-making, is also integral to the fight against malaria.

Africa utilises digital technologies and shares data and best practices through the Africa Scorecard Hub, promoting accountability and action across 16 member states. Additionally, over 40 African countries are implementing malaria and other health scorecards; and the continent is strengthening engagement through regional economic communities to coordinate malaria response efforts and prioritise the disease on the regional development and financing agenda. A continental ‘Malaria Youth Corps’ has been mobilised to increase youth engagement and resource commitments for malaria elimination.

The time to defeat malaria is now. Ending malaria has a high return on investment, and these investments will strengthen the capacity and resilience of health systems to respond to future epidemics and pandemics. Malaria is a pathfinder for pandemic preparedness and response. By focusing on investment, innovation and implementation, the global community can unite to eradicate malaria, save lives and ensure a healthier and more equitable world for all.

Image provided by African Leaders Malaria Alliance

Ending malaria has a high return on investment, and these investments will strengthen the capacity and resilience of health systems to respond to future epidemics and pandemics.

BY Umaro Sissoco Embaló President of the Republic of Guinea Bissau and Chair of the African Leaders Malaria Alliance