DPI/NGO Briefing

Towards the End of the Decade to Roll Back Malaria in Developing Countries

23 April 2009

Summary

Joyce Kafanabo, Minister Plenipotentiary at the Permanent Mission of the United Republic of Tanzania to the United Nations, began by noting that the population of the African continent continued to be highly affected by malaria, particularly economically. There were between 16 and 18 million cases of malaria each year, resulting in more than 100,000 deaths. The child mortality rate in Tanzania caused by malaria was 37% under the age of 5, 3% higher than the continent’s average. The Tanzanian government as a result had set 2025 as the year to eradicate the disease and would dedicate 3.5% of the country’s GDP to that effort. She explained that the Government had had great success eradicating the disease in Zanzibar through a series of prevention and early treatment efforts including residual spraying, making insecticide treated nets and treatment more available, and control and surveillance efforts. It hoped to replicate these efforts on the mainland. Ms. Kafanabo noted that a greater emphasis was being placed on prevention of transmission of the disease and treatment. However, there was a problem of having a major resource gap which the country was trying to address. Tanzania was the first country to lift all taxes and importation duties on insecticide treated bed nets with the hope of creating some savings. But essential to the efforts to eradicate malaria was the question of committed leadership and adequate resources. While the country was able to provide the leadership particularly at the highest levels of government (as their President was very committed to malaria eradication), the large resource gap remained. Through partnerships, like the Roll Back Malaria Initiative she informed that Tanzania had been able to make much progress towards meeting the 2010 goals. Furthermore, Ms. Kafanabo stressed the importance of diagnosis, but poor countries she noted, were unable to perform rapid diagnostic tests, which is one of the biggest challenges that they face. Ms. Kafanabo also emphasized that both prevention and an effective treatment infrastructure were needed for early diagnosis and treatment of those with malaria as well as preventing the unnecessary use of malaria drugs by those who did not have major symptoms. Tanzania, she explained was a poor country, but it was attempting to guarantee treatment particularly in the rural areas, by building a dispensary in every village and having a health care facility in every ward, as well increasing public education efforts. New advances in medicine, such as a specific malaria treatment for children which had recently tested as 97% effective, were also being employed. Ms. Kafanabo concluded by calling for strong, united and committed leadership in order to excel in all efforts to win the battle against the curable and preventable malaria disease.

Sansanee Sahussarungsi, Minister Counselor of the Permanent Mission of Thailand to the United Nations, pointed to the fact that Thailand was a co-sponsor of the UN General Assembly Resolution to Roll Back Malaria in Developing Countries from 2001-2010. Malaria was a disease that had gravely affected the Thai community, but in the past five decades, there had been a drastic reduction in deaths – from 268 per 1,000 cases in 1947 to 1.9 per 1,000 population cases in 1994. Thailand’s malaria control program had also adopted the global strategy for malaria of the World Health Organization (WHO). This global strategy included early diagnosis and prompt and effective treatment, vector control, timely containing of the disease thereby preventing epidemic spread, strengthening local capacity in particular the capacity of health care workers, collaborating with partners, developing a network of human resources and increasing malaria related research. To reach Thailand’s goal of reducing malaria cases by 50% by 2011, with morbidity under 0.5% per 1,000 people and mortality at 0.2% per 100,000 people, the Government had employed a number of strategies. There was a focus on building malaria clinics in endemic areas to encourage early diagnosis and early treatment, establishing community based clinics in broader communities, and setting up 300 malaria posts to improve surveillance and promote the distribution of treated nets. Vector control through an increase in the use of mosquito nets, active/non-active detection systems, microscopic diagnosis and treatment, and the creation of new management structures, such as a Bureau of Vector-Born Illnesses had been successful in reducing malaria deaths. Thailand had also made information materials available to educate the public. These publications were available in local languages, and included material on other mosquito-born diseases. Working to prevent malaria at the regional and international level, Thailand participated in joint action programs with Laos, Myanmar, and Cambodia organizing village health workshops to educate villagers, particularly in shared border areas, about malaria. Thailand also cooperated with ASEAN (The Association of Southeast Asian Nations) to ensure that mobile populations in the region had access to information on malaria, and worked with partners in Europe and Africa to organize training courses for healthcare workers on malaria prevention and treatment. Ms. Sahussarungsi also identified what she saw as challenges to the Thai success to date in its fight against malaria. A major problem was that of the multi drug resistant malaria, capacity building within the health service sector, and research. She also sounded the alarm that the effects of climate change could cause communicable diseases like malaria to re-emerge.

Allen Court, Special Advisor to the Secretary General’s Special Envoy for Malaria, noted that on World Malaria Day 2008, the Secretary General had called for universal coverage with preventive measures and universal access to appropriate treatment, a necessity in all healthcare facilities. Mr. Court pointed out that there were basically two types of malaria, falciparum malaria which was more prevalent in sub-Saharan Africa, and was the more deadly form of malaria and the more common version of the disease, vivax, is rarely fatal but was much more difficult to treat. Mr. Court pointed out that there was a direct relationship between meeting the Roll Back Malaria goals and achieving the Millennium Development Goals, since MDGs 4 and 5 which addressed decreasing child mortality and maternal mortality, were well below the global average in Sub-Saharan Africa. Describing malaria as a disease of poverty, Mr. Court pointed to a link between malaria and cognitive deficits in children which he said was confirmed in a recent study in the medical journal ‘The Lancet.” A January 2007 publication reported that 50% of cognitive deficit in children was due to either a deficit of iron or iodine. According to the report, despite the fact that the problem of iodine deficit had virtually ended with the advent of iodized salt, anemia [an iron deficiency] was still a problem. Anemia was a complication of malaria that led to 25% of cognitive deficits. Dr. Court predicted that of the children who suffered cognitive deficits only 1 in 5 would attain the academic standards of their unaffected peers regardless of teaching methodologies or the excellence of the school. On the other hand, he pointed to many areas of achievement in the fight against malaria including technological advances such as the production of long-lasting insecticide treated nets and new treatments, for instance Artemisinin therapies, which had had great impact in lowering mortality rates. Greater availability of Rapid Diagnostic Test Kits, had also led to a decrease in malaria and in addressing the problem of the potential over use of malaria drugs for those suffering from similar symptoms. The Special Envoy stressed that his focus was on advocacy and education since he had seen results on both these fronts. Advocacy efforts he noted had led to a commitment of $3.2 billion dollars from the World Bank and other partners to support efforts to eradicate malaria including the purchase of some 350 million bed nets needed to cover the needs in all endemic malaria regions. He reported that to date 140 million bed nets had already been delivered with another 240 million financed of the 280 million needed. Additionally, the number of drugs pre-qualified by the WHO to treat malaria had increased. These figures Mr. Court noted, pointed to the fact that the RBM partnership was very close to meeting its 2010 goal of full coverage. He appealed for an end to the senseless deaths from malaria and issued a call for joint concerted global effort to “go on to the victory.”

Dr. Melanie Renshaw, Senior Malaria Advisor at the United Nations Children’s Fund, (UNICEF) pointed out that UNICEF was the world’s biggest distributor of mosquito nets, providing support to malaria case management (particularly at home ), and supporting the delivery of malaria interventions, integrated with maternal and child health services. UNICEF also provided in county support to assist with monitoring and evaluation efforts, supply and logistics, technical assistance, and behaviour change communication. The Roll Back Malaria (RBM) partnership worked together to leverage funding, and was able to secure $3.5 billion from the Global Fund. The funding had led to rapid drug policy change by governments across the world to Artemisinin-based Combination Therapy (ACT) on an unprecedented scale. Mosquito net delivery was being scaled up through distribution during antenatal care, at child health clinics, in national campaigns, Child Health Days, and community-based allocations. Dr. Renshaw explained integration of malaria action plans into government efforts had supported the acceleration of the scale-up, improved the quality of the bed nets, increased the use of public health services and helped to establish health system capacity in many countries. She gave the example of Ethiopia which in 2004 faced the worst malaria epidemic in Africa. In 3 years, 20 million mosquito nets were distributed in the country and ACT treatments were rolled out to all health facilities, including 15,000 new health posts. By 2007, 66% of households owned at least one bed net. All these actions led to a more than 50% reduction in malaria deaths in Ethiopia. Dr. Renshaw expressed the view that the RBM Partnership was well on the way to closing the resource gap and meeting the 2010 target of attaining universal coverage. She stressed that in her view how to achieve this goal was well understood; wide scale implementation of mosquito nets and effective malaria treatment would reduce malaria mortality and help to achieve MDGs 4, 5 and 6 in Africa. However, this would also require additional resources and the continued commitment of the global community with just over 600 days left to achieve universal coverage. Dr. Renshaw concluded on an optimistic note that she was convinced this goal could be met.

Tara Gutkowski, Senior Manager, Community Relations, of the National Basketball Association explained that the NBA Cares partnership operated through 20 community partnerships. One of these partnerships included that of the NBA and a malaria advocacy group known as Malaria No More. Through this partnership, the NBA was able to help raise malaria awareness at events such as the 2006 World Health Organization Summit on Malaria and American Idol. These events served as ways to show ordinary viewers what they could do more to help eradicate malaria around the world. The NBA also partnered with Nothing But Nets in 2006 and raised $426 million and delivered 2.5 million bed nets in Africa. The effort was successful because of a simple message, ‘Send a net, save a life,’ and a transparent donation and delivery process. More than 60,000 individual donations had been made. The NBA also used other opportunities such as “arena nights” to highlight the problem of malaria. It also ran Public Service Announcements (PSAs), text message campaigns, and city-tours with NBA players to raise awareness of the disease and its effects world wide. Faith-based organized breakfasts, business lunches, and boot camps were platforms for NBA players to spread the word about eradicating malaria particularly in Africa. Ms. Gutkowski said the NBA’s success stemmed from its ability to provide a brand to the cause, and to use its star power to bring the issue to a higher level of public attention. She stressed that the NBA would continue to support global efforts to eradicate malaria, and partner with campaigns aimed at young people using new social media networks such as Facebook and Twitter to get the word out and involve as many people as possible.

Q&A Session
There were a wide variety of questions ranging from how to avoid unnecessary use of malaria drugs by those who may not have the disease, to the question of how could NGOs involve the NBA in some of the projects in Africa. Other queries focused on how to access hard to reach areas with education and information on prevention and treatment of the disease. Others asked whether there was help for children with cognitive problems as a result of malaria infections. Yet others enquired as to which factories in Africa produced bed nets. In response to why Tanzania was still having problems combating malaria, Ms. Kafanabo answered that Tanzania was a large country, and that it was expensive to continuously treat mosquito breeding sites as a means of vector control. Therefore reaching all areas of the country was difficult. There was also the problem that in some areas people were not using the mosquito nets either because they were poor, and especially in the face of the current financial crisis were less likely to invest in bed nets rather than more essential items; or simply because the climatic conditions such as the intense heat, made use of the bed net uncomfortable. Ms. Kafanabo stressed that bed nets were a new thing for the poor and for many they needed a bed to put the net on. She expressed the hope that through their malaria control program and village health days, the Government was hoping to create greater awareness of the problem of malaria throughout Tanzania. Mr. Court suggested that the lack of use of treated bed nets pointed to issues of behavior that needed to be addressed. He stressed that behavior change required open collective discussion and gave an example of community radio in Zambia where they were able to have on-line dialogue between fishermen who used the nets for fishing, and people in the village, on the importance of using bed nets to reduce the incidence of malaria. He noted that it should not be forgotten that malaria can be controlled not cured. He further noted that governments needed to keep in mind that they need to make large economic investments in malaria prevention efforts to reap the benefits of avoiding a reemergence of the disease within their countries. Ms. Renshaw in her turn noted that the world was closer than ever before to having a vaccine against malaria, but that until it was developed, countries should continue to distribute longer-lasting nets, use more effective insecticides, reduce malaria to hot spots and targets, maintain integrated health system approaches, continue to train health workers to recognize early symptoms and treat the disease, and most importantly assist with prevention efforts.

This Briefing was attended by over 170 representatives of NGOs, United Nations and Permanent Mission staff as well as interns from various Departments and NGOs.

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