The Challenge of Malaria

Prof. Awa-Marie Coll-SeckExecutive Director of RBM Partnership

Donors Forum (co-organized by MMV & CRESIB)Barcelona, 15 March 2010Barcelona, 15 March 2010

A DECADE OF ROLLING BACK MALARIA: WHERE ARE WE?A DECADE OF ROLLING BACK MALARIA: WHERE ARE WE?

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Historic milestones in the fight against malaria (1998 2008)Historic milestones in the fight against malaria (1998-2008)•UN Secretary General's Special Envoy for malaria

1998 new funding 2008

•Call for universal coverage by 2010• President's Malaria Initiative

• World Bank Boosterfor countries

2002

2008

Launch f GMAP

2005of GMAP

2003RBM's

2000•MDGs•Abuja Summit

RBM's architecture was developed

1999

2007G8 pledgesSuccess inCountries ++

MMVGates Foundation

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Countries ++

More countries succeed in reducing malaria deaths and casescases

Malawi, Mozambique, Niger and Ethiopia: , q , g pmore than 40% decrease in under five mortality (UNICEF Sept 2009)

•Eritrea: 52% decrease in under five mortality (UNICEF Sept 2009)

Equatorial Guinea: 63% reduction in all-cause mortality in children under five since 2004

•Zambia: 66% decline in malaria deaths; reached the 2010 target of a more than 50% reduction in malaria mortality Rwanda, Sao Tome and Principe and the 50% reduction in malaria mortality compared to 2000 (WHO April 2009) island of Zanzibar achieved major

reductions in malaria mortality.

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CHALLENGES TO ACHIEVING THE 2010 TARGETS AND MDGsCHALLENGES TO ACHIEVING THE 2010 TARGETS AND MDGs

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Challenges at global levelChallenges at global level

• Funding gaps

Key strategic challenges

Funding gaps

• Keeping malaria high on the agenda

• Harmonization and alignment

• Strategic debates:

-horizontal vs. vertical approach-debates on DDT use

• ACT and insecticide resistance

N d f ti d h d t l

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• Need for continued research and new tools

Global international financing increases

(US$ million)

1.60

1 500

1,800

1,299.70

1,200

1,500

439.63

608.26701.26

600

900

249.11

0

300

02004 2005 2006 2007 2008 2009e

The Global Fund PMI World Bank Other USAID Others

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Global cost for malaria control and eliminationGlobal cost for malaria control and elimination

R&D will cost additional $US 750 to 900 millionR&D will cost additional $US 750 to 900 million a year

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Global research and development costs

7US$ billions Global research & development costs (~ $750M – $900M / year)

New vaccines, drugs, vector control and diagnostics

Global research and development costs

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7 New vaccines, drugs, vector control and diagnostics

4

5

2

3Global implementation costs (~ $5B / yr for next 10 yrs)Prevention: LLINs, IRS and IPTp

0

1

Prevention: LLINs, IRS and IPTpCase management: Drugs, diagnostics and severe case mgtCountry program costs: infrastructure / institutional strengthening, M&E, operational research, training and community health workers.

02008 2014 2020 2026 2032 20382010 2015 2020 2025 20352030 2040

Source: GMAP costing model

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Source: GMAP costing model

Estimated annual global resource needs for malaria control and current global malaria commitments from Global Fund, World Bank,

US dollars (billion)

and US-PMI

( )

9Source: Global Malaria Action Plan (RBM 2008), Global Fund, World Bank and US-PMI

More investment in R&D for malariaMore investment in R&D for malaria

4 consortia focus on developing new tools4 consortia focus on developing new tools

Vector control

Di iDiagnostics

DrugsDrugs

Vaccines

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Strategic debate: horizontal vs. vertical approach

Health systems strengthening and disease control are complementaryHealth systems strengthening and disease control are complementary and interdependent

Effective and sustainable malaria control efforts

DISEASE CONTROL

Effective and sustainable malaria control efforts depend on strong health systems

Strong health systems are needed to ensure sustainableStrong health systems are needed to ensure sustainable access to prevention e.g. IPTp through ANC clinics, effective diagnosis and treatment (ACTs)

M l i t l t th

HEALTH SYSTEMS

Malaria control programmes strengthen health systems

E hi i b ildi h iEthiopia: building a human resources capacity atcommunity level

Tanzania, Zambia, etc.: freeing overburdened health f iliti t t kl th lif th t i ill

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facilities to tackle other life-threatening illnesses.

Strategic debates: DDT useStrategic debates: DDT use

The Stockholm Convention on Persistent Organic Pollutants allows the use of DDT for disease vector control, within the recommendations and guidelines of WHO until locally effective and affordable substitutes are available

The ongoing debate on use among public health specialists and policy- makers

affordable substitutes are available.

g g g p p p yinfluences:

• the production and availability of DDT for vector control• countries' decision to deploy DDT

A need to secure:A need to secure:

Investment in research for alternatives

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Challenges at country level

Recent inputs

Challenges at country level

Recent inputs

• Meeting of African ministers in Geneva: May 2009

• Data from country roadmaps for 47 African countries and territories

• Partner publications• Information shared in key

meetings • WHO/ UNICEF dataWHO/ UNICEF data

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Challenges at country levelChallenges at country level

W k h lth t Low community awareness andWeak health systems Low community awareness andparticipation

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ACTs: distribution challengesACTs: distribution challenges

Relative Volumes of Antimalarials Distributed by Sector and Drug Type

90

100

•Anti-malarial mono-therapies still exceed ACTs in the private and

60

70

80public sectors.

•Malaria treatments are tl bt i d i l

20

30

40

50%currently obtained mainly

through the private sector.

•Almost 25% of all malaria

0

10

20

Public Private Public Private Public Private Public Private Public Private Public Private Public Private

Benin Cambodia DRC Madagascar Nigeria Uganda Zambia

•Almost 25% of all malaria treatments distributed through the private sector in DRC are oral

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First line ACTs Other ACTs Non-artemisinin monotherapies Oral artemisinin monotherapy

www.ACTwatch.info 11/20/2009

in DRC are oral artemisinin monotherapies. Source: ACTWatch

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Fluctuations in donor funding for countriesFluctuations in donor funding for countries

Total disbursements for malaria control – OECD database for selected countries 2003 to 2007

35

40

Angola

25

30AngolaBurkina FasoBurundiDem Rep Congo

15

20

Dem Rep CongoGhanaMadagascarSenegal

5

10

15 SenegalTanzaniaUgandaZambia

0

5

2003 2004 2005 2006 2007 2008

Zambia

Source: OECD database, analysis by MACEPA

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2003 2004 2005 2006 2007 2008

PARTNERSHIP INITIATIVES TO ADDRESS CHALLENGESPARTNERSHIP INITIATIVES TO ADDRESS CHALLENGES

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Uniting partners to overcome challenges

Targets: Innovative financing mechanisms

Uniting partners to overcome challenges

By 2010 : universal coverageBy 2015 : reduce deaths to near

zero

Access to GF resources: TA for country applications

zero2015 and beyond : sustain gains and

work towards elimination

Expansion of donors baseVPP, AMFm, SMS for life UAM, ALMAMalERAelimination MalERA

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OVERCOMING THESE CHALLENGES WILL HELP US REACH THE MALARIA TARGETS

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