Global malaria community embraces long-term goal of malaria eradication

By Laura Newman, MACEPA Senior Communications Associate

Bill and Melinda Gates field questions from the audience during the Malaria Summit

What a difference four years can make. During the second day of the Bill & Melinda Gates Foundation Malaria Summit, the world’s leading malaria authorities made a strong, united call to eliminate malaria, with the long-term goal of eradication. Progress in fighting the disease has been made in leaps and bounds during the last few years, giving the global community the confidence that these ambitious goals – first raised to a uncertain audience at the inaugural Malaria Summit in 2007 – can be achieved.

To many of these speakers, the idea of eliminating malaria is not just a goal – it is an obligation. Efforts to control the disease have greatly reduced malaria illnesses and deaths, but as long as the malaria parasite still exists, so does the threat that the disease may resurge. As Bill Gates said earlier in the day about the fight against malaria, “If you stop halfway, you don’t get half the benefit; you could end up with zero percent of the benefit. The progress counts only if we keep it going.”

This strong message of support for eradication speaks not just to the ability of the global community to reach consensus, but to the strength and maturity of the partnership itself. As Robert Newman, Director of the WHO’s Global Malaria Programme, said: “We have a changed mindset – we can achieve near-zero deaths from malaria.” With new tools and weapons in our arsenal, most notably the ongoing development of the RTS,S malaria vaccine that was announced Tuesday to be around 50% effective in young children, this goal seems more in reach than ever.

Eradication is understood to be a long-term goal, and maintaining political commitment and financing over the years will be a challenge.  Many speakers highlighted the need to set and achieve short-term interim goals, to help the global community benchmark high-profile progress towards elimination. Ongoing support for the Global Fund and maintaining national investments in global health were also highlighted as a key priorities.  Andrew Mitchell, Secretary of State, Department for International Development, United Kingdom, summed it up well when he said: “We need everyone standing by their commitments, and we need results.”

Using information systems to track a killer parasite

Using a mobile phone to transmit malaria burden data

By John Miller, MACEPA Senior Technical Advisor

As a country wages a successful battle against malaria, transmission of the disease decreases and it becomes more difficult—and more time-sensitive—to find and treat the remaining cases. In this phase, our definition of success must shift from lives saved to cases detected. While less dramatic than earlier steps, this is an important step forward on the path to eliminating the disease. In order to accomplish this, dynamic systems must be put into place to facilitate the flow of quality data.

National surveys like the National Malaria Indicator Survey are great for the big picture but they don’t help you understand challenges well at the local level. Yet, as malaria is reduced focusing on transmission becomes more critical, and therefore it’s vital to have timely access to localized information—actionable intelligence, if you will. But consistent reliable data is a huge challenge in many countries.

Take Zambia, for example. I presented a poster during the Gates Foundation Malaria Forum today that highlighted the country’s experience implementing a malaria rapid reporting system to track malaria cases.

As with many countries in Africa, Zambia’s health system is overburdened and understaffed. Figures from health facilities trickle in near the end of every month, but it can be many more months before that information is organized and shared. To strengthen the system, the national malaria control program has established a rapid reporting system that records the same malaria data—17 indicators on cases, blood tests, and medicine stocks—on a weekly basis, and those details are sent to a server by inexpensive, basic mobile phones. Officials at all levels of the health system are then able understand and respond to malaria in real time.

The information collected, those 17 indicators, is available to decision-makers in a built-data dashboard of charts and graphs.  A health official simply refreshes the Excel file on their computer and they can view what’s going on in an area down to the community level. A district health information officer, for example, can see their own data and make informed decisions to better target limited resources and time.

As WHO Director-General Margaret Chan aptly stated during her keynote address at the forum today, “Good malaria surveillance means knowing where the enemy lies.” Thanks to rapid reporting, Zambia has the malaria parasite on the run and won’t stop until the disease has been eliminated. Zambia can be a model for others in the region.

Vaccine RTS,S cuts malaria risk in half in young children, Phase III trials show

The initial results of the Phase III efficacy trial of RTS,S were announced during the Bill & Melinda Gates Foundation Malaria Summit today and have been published online, in the New England Journal of Medicine.

These results confirm that the RTS,S vaccine candidate reduces episodes of clinical malaria by half in children aged 5–17 months over the first year of follow-up, that this vaccine candidate has an acceptable safety profile and is immunogenic in children in this age category.

The efficacy trial, conducted at 11 trial sites in sub-Saharan Africa, showed that RTS,S reduced the risk of clinical malaria and severe malaria by 56% and 47%, respectively, among 6,000 children aged 5 to 17 months, over a 12-month period following vaccination. These first Phase III data are in line with results from previous Phase II studies. Furthermore, the widespread coverage of insecticide treated bed nets (75%) in this study indicated that RTS,S can provide protection in addition to that offered by existing malaria control interventions.

Says Anthony Fauci, Director, National Institute of Allergy and Infectious Diseases, National Institutes of Health, during the announcement of the results: ” The final challenge is to ensure the vigor and sustainability of the biomedical research efforts that will be required to eliminate and ultimately eraditcate malaria.”

Read the press release.

Bill and Melinda Gates urge continued commitment in the fight against malaria

Today, Bill and Melinda Gates each addressed attendees of the Malaria Forum, celebrating progress while urging the malaria community to remain vigilant in their fight.

“Eradicating malaria will take commitment. Not a commitment simply to reduce malaria deaths, or eliminate malaria from certain regions. Those are important milestones—but they are only milestones. A commitment to eradication means a commitment to intensifying the effort as fewer and fewer people get infected. It is counter-intuitive, but absolutely essential.

We understand the risks of declaring a goal of eradication. We understand the mistakes of the past and the obstacles of today. But your work gives us confidence and makes us optimistic.”

–Melinda French Gates, Co-Chair, Bill & Melinda Gates Foundation

Read transcripts of Melinda Gates’ keynote speech from today’s event.

Counting malaria out: Metrics of success

By Laura Newman, MACEPA Senior Communications Associate

During the first day of the Bill & Melinda Gates Foundation Malaria Forum, numerous statistics were shared that highlighted the incredible progress that malaria-endemic countries have made in fighting the disease in the last ten years. Among them:

• Deaths caused by malaria have dropped 38 percent, with 43 countries cutting the number of malaria cases in half.
• One million children’s lives have been saved from malaria.
• One-third of countries affected by malaria are now on track to eliminate the disease.
• Seven new countries have eliminated the disease, while ten are approaching near-zero deaths and nine are preparing to begin moving towards elimination.
• More than 300 million insecticide-treated nets have been distributed since 2008 in sub-Saharan Africa.

These figures stand in stark contrast to the bleak numbers that defined the malaria control landscape even just ten years ago.

During her keynote address, WHO Director-General Margaret Chan quoted the African Leaders Malaria Alliance, who said last month: “In Africa, we used to track malaria by metrics of despair: cases and deaths, wasted life and squandered opportunity. We tracked numbing statistics like the million Africans who died annually from this preventable disease a decade ago.”

As the numbers shared yesterday clearly demonstrate, we’ve come a long way in a short time.

What’s made this incredible progress possible? It’s due to the incredible leadership from the national malaria programs, a strong global partnership, and dramatic increases in funding and political commitments for malaria. We now have more comprehensive, better quality data that speak of success and a bright future.

We’ve moved from a “metric of despair” to one of hope.

What’s in a number anyway? Why does data matter? It helps us know where we been and where we need to go. Not only do these statistics provide benchmarks for success, they also provide important baselines for measuring impact and paint a clear picture of exactly how much malaria a country has, who is affected, and what resources are needed where.  The importance of rigorous data was underscored by many of the speakers during Monday’s events.

Looking forward, collecting data on malaria will only become more important as countries continue to reduce malaria transmission and move towards elimination.  Proper tracking of disease burden ensures that malaria no longer has the ability to “hide” from us – and that every last reservoir of infection will be found and eliminated.

Read the transcript of Margaret Chan’s keynote address.

Optimism and urgency at the 2011 Bill & Melinda Gates Foundation Malaria Summit

Children under age five are most vulnerable to malaria

By Duncan Earle, MACEPA Program Director

In 2007, the malaria community first gathered at the Bill & Melinda Gates Foundation to assess progress fighting the disease and to set a new challenge: eradicating malaria. At the time, this raised eyebrows—people wondered if it was possible. Today, the global community has set its sights on making this challenge a reality.

So how is this possible? We’ve made tremendous progress controlling malaria, and most of this progress has happened in the four years since the last Malaria Forum. We’ve seen the widespread scale-up of bednets and indoor spraying of insecticides, national malaria control programs are now leading the charge, and we’ve introduced the use of rapid diagnostic tests to confirm suspected malaria cases and help countries understand exactly how much malaria they have. Because of all of this, we’ve seen malaria illnesses and deaths decrease dramatically, and now one-third of countries affected by malaria on are track to eliminate the disease.

But looking ahead, we don’t just want to control malaria, we want to end it.

Now, we are coming together for a second time in Seattle to renew our commitments to eliminating and ultimately eradicating malaria. Recent experience among national programs across Africa shows us this is possible. We can eliminate malaria in Africa by ending transmission of the disease with tools available today and a focused strategy that evolves as progress advances. New strategies and tools, such as vaccines, will speed and strengthen these efforts.

Convening under the theme “Optimism and Urgency,” local experts, scientists, advocates, and people working in the field will discuss strategy, how we can better use the tools we have, and what new tools need to be developed to end malaria.

During the first panel, I spoke about Zambia, which is a great example of both the progress that can be made and just how fragile that progress can be. Zambia has seen an enormous drop in malaria in many parts of the country, cutting the malaria burden in young children in half in just two years thanks to an ambitious national program and stepped-up efforts to ensure widespread use of proven interventions. But they’ve also seen an uptick in cases in places where funding bottlenecks have led to delays in bednet distributions.

While Zambia’s story is largely a story of optimism, it carries important lessons for the global fight. The progress achieved in the country has helped create a roadmap for the community. The challenge now in Zambia is ensuring the reliable delivery of interventions and effective case management while tracking residual reservoirs of the disease as malaria cases dwindle and transmission occurs in smaller areas.  As Zambia works to eliminate the disease, and as transmission is reduced, the engagement of districts and communities in prevention and surveillance will become essential. So too will sustained political will and financing from the global community.

Zambia is an important example to reflect on as we set our sights on the future. Progress is possible, but fragile, without vigilance, sustained commitments, and a sense of urgency.  Stopping malaria illnesses and deaths is the only acceptable end to the fight, and we cannot settle for anything less.

New report shows one-third of countries making progress towards malaria elimination

The report, Eliminating Malaria: Learning from the Past, Looking Ahead, was launched today at the Bill & Melinda Gates Foundation Malaria Summit. Says report co-author Rick Steketee, Science Director, PATH Malaria Control Program: “We are building upon dramatic change that has happened in the last ten years – but the report shows this is not a given. Our ability to move forward towards elimination depends on navigating a fragile world.”

Read the report.

Kudos to Zambia on their joint efforts to roll back malaria!

Posted by Ahna Machan, Rotary Member

Our group of Zambian and U.S. Rotarians met with Dr. Mulakwa Kamuliwo (the acting coordinator of Zambia’s National Malaria Control Centre (NMCC)—and his team at NMCC.  There, we learned more about Zambia’s approach to malaria control:  one country-wide strategy, one coordinating body, and one monitoring and evaluation system.  This sounds so simple and so logical, but simple does not always mean easy—I knew that it was what made Zambia stand out among so many malaria-endemic countries and was likely the key to Zambia’s successes.  I also was reminded of the recent travails in the US in trying to pass health legislation reform that would make it easier for everyone to have access to health care. 

But at the NMCC, there seemed to be a real sense of teamwork as each person described their role, successes, and challenges.  Their collaboration and commitment stretched beyond a conference room in the capital of Lusaka into rural, malaria-endemic communities – those very vulnerable, high risk regions.  Several of the Zambian Rotarians asked questions about specific problems and possible interventions, such as using insecticide-treated bednets (ITNs) versus spraying and citing stagnant water pools they had noticed in their regions. 

The NMCC told us how they work in accordance with WHO guidelines and trained 600 community health workers (CHWs) who actively visit each home in these malaria-endemic villages.  Zambian Rotarians nodded as they had firsthand knowledge of working with these invaluable CHWs, particularly in the Copperbelt region. Several days earlier around World Malaria Day, the Zambian and Seattle (US) Rotarians had worked side by side with the CHWs, delivering ITNs and educating families about malaria. The community health workers explain how malaria is transmitted (by the anopheles mosquito), conduct rapid diagnostic tests to detect the presence of malaria (especially for pregnant women and children under five), prescribe appropriate treatment, and ensure that each home has at least one insecticide-treated bednet and knows how to use it to prevent malaria.  The NMCC hopes to train more health workers when they are able to attain more funding—and it was great to hear one of our Zambian Rotarians ask if they could be trained to become a CHW or if they could support more training for them! Dr. Kamuliwo welcomed this offer and encouraged them to keep in touch to develop a working relationship with the NMCC to become part of the team and help to carry out Zambia’s quest to roll back malaria by 2014. 

Zambia’s approach, including involving the participation of civil society, is becoming a model for other African countries.  So far, they have made great strides:  62% of the households have at least one bednet.  Yet, there is much more to be accomplished and Rotarians are joining forces across continents to help build public education, knowledge, and awareness of malaria in communities throughout Zambia.

Forging new friendships – with a purpose

Posted by Roy Mann, Rotary Member

Yesterday we traveled for five hours from Kitwe in the north to Lusaka in south-central Zambia. On board were Ben and Gena from PATH/MACEPA, my companions Jim and John from the Seattle Rotary delegation, and our nine new Zambian friends: Ndala and Varian from the Mongu club in Western Province; Webster from the Chipata club in Eastern Province; Fides, Rose, Akapelwa, and Bwembya from the Choma club in Southern Province; and David and Penias from the Livingston club also in Southern Province. Hard to believe we met only four days ago here in Lusaka, as strangers.

Along the way, bonds of friendship formed. We were entertained by a number of things: Ndala’s multitasking with not one but two cell phones, Akapelwa’s distinctive “Guinea fowl” ring tone, Varian’s infectious smile, Jim’s ready-print color photos, and Ben’s hearty laugh. We grew familiar with one another, even to the point of making coordinated “nature” breaks in the tall African grass next to the roadside. As Fides put it, “Rotary is friendship with a purpose”.

This same level of familiarity and trust makes Rotary a powerful force for change in the broader effort to achieve a malaria-free Zambia. Of the nine Zambian Rotarians on our bus, for example, seven tribal languages were represented—Lamba, Nyanja, Lozi, Lunda, Luvale, Bemba, and Tonga. Their knowledge of the village and community level uniquely positions them to assess local needs. Acting in partnership with the National Malaria Control Centre and MACEPA, Rotarians like these can increase access to treatment with the help of local community health workers and volunteers.

Seattle Rotary has “deeply touched our hearts”

Posted by Jim Moore, Rotary Member

On Sunday night we held a working dinner with representatives from nine Rotary Clubs.  Besides traditional Rotary fellowship, the main purpose of the dinner was to begin to specify the next steps that should be taken in implementing the Second Century Malaria Control and Eradication Project.  Though the hour was late and almost everyone had participated in a full schedule of events over the weekend, our fellow Rotarians got down to work—all of them.

Jim speaking at World Malaria Day in Mpongwe, Zambia

Rotary Club members, their skills, their connections, and their dedication to service are the key resource that would be brought to bear on the fight against malaria.  To be effective and have a sustained impact on malaria, Copperbelt-based Rotarians recognized that their projects must fit into the overall anti-malaria plan at the district and local levels.  Consequently, they should start with a cooperative session with District Health Management Teams aimed at identifying the gaps and local needs in the DHMT’s annual plan that can be filled by Rotarians.  Implicit in this concept of “gaps and needs” were villages units and entities such as schools and orphanages.  A Rotary Club could adopt one or more villages and/or entities for sustained anti-malaria actions including distributing insecticide treated nets, environmental management (draining stagnant water sources, cleaning water channels to promote flow, etc.), malaria education campaigns (media and curriculum delivery), diagnostic testing through community health workers, and indoor residual spraying—singly or in combination.

Pregnant mothers with bednets at Mpongwe Mission Hospital

It was more than heartening to hear the clarity and passion expressed by Zambian Rotarians about their roles in the fight to eliminate malaria.  At the end of the evening, Modestine Kaoma of the Mufulira Rotary Club rose to give visiting Rotarians and MACEPA/PATH staff a warm and emotional thank you.  “There are no words to adequately express how much we appreciate your leaving your homes in Seattle to come this long way to work with us and make our battle against malaria your battle too.  You have deeply touched our hearts.”