Malaria Control in Humanitarian Emergencies

Source: Médecins Sans Frontières

In recent years, a conflagration of humanitarian emergencies throughout the world has resulted in an incredible increase in the number of displaced persons. In 2018 alone, UNHCR reported a record 70.8 million people who had been forcibly displaced—this equates to 34,000 forcible displacements every day.

This increase in humanitarian emergencies and resulting displacement has implications for the spread of malaria. Forcibly displaced populations are often at greater risk of disease due to their high levels of mobility, poor living conditions, decreased access to health services, poor water access and management, and weakened immunity. For malaria, in particular, issues like camp site flooding can contribute to disease resurgence as it creates a breeding ground for mosquitos. Further, if displaced persons are seeking shelter in the bush, or arriving at transit centers, they likely do not have an adequate place to hang a long-lasting insecticidal net (LLIN), and prevention methods such as indoor residual spray are difficult to implement rapidly.

Malaria control programs, like other disease control programs, suffer from a lack of access to vulnerable displaced populations, low availability of health products, weakened health systems, and inadequate access to data. Further complicating matters, the socio-political landscape of humanitarian emergencies can result in a culture of fear and rumors that can hinder service delivery.

There are, however, strong examples of successful malaria interventions in humanitarian emergency contexts that can be instructive to informing future efforts. One example, in the Borno State of Nigeria, demonstrates how creative health service delivery mechanisms can help to disrupt malaria transmission. Severe food insecurity and famine, exacerbated by military conflict resulted in 1.4 million internally displaced persons, all in areas of hyper-endemic malaria. With a shortage of LLINs, and few options for standard vector control, UNICEF and WHO came together to undertake a Seasonal Malaria chemoprevention (SMC) campaign for children under the age of five. UNICEF agreed to deliver the SMC alongside their polio vaccination campaign, targeting 1,116,000 children in July 2017.

Source: UNICEF Nigeria

The RBM Partnership’s Vector Control in Humanitarian Emergencies Working Group, a subset of its Vector Control Working Group, is advancing efforts for cluster coordination and improved malaria interventions during humanitarian emergencies. Today, the existing World Health Organization Technical Guidance on the issue is in the process of being updated and re-written with the aim of transforming the guidance into a concise guide for effective malaria control responses in humanitarian emergencies. The guide will distill factors for success, building on lessons learned in humanitarian emergency settings.

Early findings suggest that successful malaria interventions aimed at displaced populations share the following attributes: a rapid response through the engagement of local actors, a concentrated effort among partners, continuous dedicated leadership, specific support for tracking key activities, the development of emergency preparedness plans, and the establishment of cross-level technical teams, inclusive of country representation.

We look forward to the launch of the guide later in 2020!

Partner Happenings: Q4 2019

African Leader’s Malaria Alliance

On the 11th of November in Geneva, country leaders, public health experts, scientists and researchers joined Medicines for Malaria Venture (MMV) to mark 20 years of innovation in malaria medicines and look ahead to the next generation of interventions for what remains one of the world’s deadliest diseases. Leaders of malaria-endemic countries across Africa and the Asia-Pacific pledged to accelerate malaria elimination through domestic funding and by creating an enabling policy environment for the introduction of new tools to boost innovation and access to medicines. His Majesty King Mswati III, chair of the African Leaders’ Malaria Alliance (ALMA) commented: “African leaders are racing to meet the target we set for malaria elimination by 2030. Increasing domestic resources for malaria so that we can scale-up and sustain universal coverage ad ensure medicines can be accessed by those who need them most is our top priority. We also commit to continue to address drug and insecticide resistance through investment in constant innovation and ensuring new solutions are made available. We commend all partners who have joined us on this critical journey, including MMV who is using data to identify gaps in innovation and developing new tools that will ensure we win this fight. I hope to be celebrating our countries eliminating malaria in the coming years. We will achieve a malaria-free Africa!”.

Asia Pacific Leader’s Malaria Alliance

APLMA attended Medicines for Malaria Venture (MMV) alongside African Leader’s Malaria Alliance. Dr Benjamin Rolfe, CEO, Asia Pacific Leaders’ Malaria Alliance adds: “In Asia-Pacific, we are making great strides against malaria – China has achieved nearly 3 years with zero indigenous malaria cases, Malaysia has reported no indigenous human malaria cases in 2018, and India reported a 24% fall in malaria cases between 2016 and 2017. Yet multi-drug resistance in the Mekong region due to Plasmodium falciparum, a deadly parasite found across the continent, is posing a threat to global health security. Now, it is more important than ever to ensure that citizens have access to innovative, effective medicines and scale-up efforts to defeat malaria. As we celebrate the progress made by MMV over the past 20 years, we reaffirm our commitment to increasing access to treatments for the disease and tackling resistance through the development of transformative medicines for malaria.”

At the beginning of November, leaders from 18 countries in East-Asia pledged their commitment to defeat malaria at the East Asia Summit in Thailand. In the Chairman’s statement, heads of government of all ASEAN nations, plus 8 more including India and China, reiterated their commitment to “the goal of a malaria-free Asia Pacific by 2030 and acknowledged ongoing efforts in the implementation of the Asia Pacific Leaders’ Malaria Elimination Roadmap.”

A November 2019 workshop in Hanoi convened by the Vector Control Platform in Asia Pacific (VCAP), co-led by Unitaid and APLMA, brought together representatives from Ministries of Health, Agriculture and Environment from 9 countries in Asia Pacific as well as regional and global health partners –including the World Health Organization (WHO), Australian Department of Foreign Affairs and Trade (DFAT), Innovative Vector Control Consortium (IVCC). The workshop was designed to build cross-ministerial and regulatory system support to introduce innovative vector control (VC) products needed to eliminate malaria by 2030. Country-specific presentations by Singapore, Thailand and Cambodia provided an overview of the regulation processes for vector control products in their respective countries. They highlighted the diverse range of regulatory practices in the region for vector control products and described challenges and opportunities for efficient regulation. Country discussions also stressed on the benefits of cross-Ministry collaboration to identify opportunities to accelerate introduction of new vector control products needed to eliminate malaria by 2030 in Asia Pacific. There were also discussions on mechanisms to streamline regulatory processes in countries, such as waiving the need for in-country product testing if already evaluated in a similar country context or though WHO-PQ: fast-tracking regulatory processes for high priority vector control products; and a harmonized regional regulatory process. As part of the workshop, IVCC also launched the publication of three new landscape studies for vector control products in Asia Pacific.

The President’s Malaria Initiative

The U.S. President’s Malaria Initiative (PMI) welcomes the publication of the report from the Lancet Commission on Malaria Eradication, which concludes that malaria can and should be eradicated by the year 2050. Dr. Staley said: “This report will be incredibly valuable for the global malaria community, and I’m honored to have played a part in it. Not only will it help guide our collective efforts to create a world free of malaria, it will bring renewed purpose, urgency, and dedication to the task.”

The Global Fund to Fight HIV, TB, and Malaria

At the Board’s 42nd meeting in mid-November, one month after a successful Sixth Replenishment that secured pledges of over US$14 billion for 2020-2022, Board members expressed appreciation for the collective efforts that led to such a strong mobilization of resources, calling it a compelling affirmation of commitment toward achieving greater social justice all over the world. The Board of the Global Fund to Fight AIDS, Tuberculosis and Malaria approved funding decisions for ambitious investments over the next three-year period to significantly increase impact against HIV, TB and malaria and to build resilient and sustainable systems for health.

Additionally, several Board members also welcomed plans announced by the Global Fund’s Executive Director to establish a Youth Council to facilitate greater engagement of young people in finding solutions, since people under 25 are disproportionately vulnerable.

The Comic Relief - GSK Partnership welcomes the World Malaria Report and Universal Health Coverage Day with a new progress briefing

Tackling malaria and achieving Universal Health Coverage (UHC) are mutually reinforcing goals. Earlier this month, the World Health Organization launched its annual World Malaria Report, providing a comprehensive overview of the prevalence of malaria worldwide. The report revealed that, despite significant declines since 2000, the rate of progress in tackling malaria globally has plateaued for a third year running. Pregnant women and children in Africa continue to bear the brunt of this epidemic, with children under the age of five accounting for two thirds of global malaria deaths in 2018. As a result, global targets are at risk of being missed and the report highlights the need for accelerated action across all malaria endemic countries. This same month, the global health community came together to mark World UHC Day, reaffirming the ambition that every person—no matter who they are or where they live—should be able to access the quality health services they need without facing financial hardship. The timeliness of these two milestones serves as a reminder to us all of the importance of sharing learnings across the health sector to help build on progress made to date.

In 2015, Comic Relief and GSK announced the Fighting Malaria, Improving Health partnership to fight malaria and improve health of people living in Ghana, Mozambique, Sierra Leone, Tanzania and the Greater Mekong region. We believe that strengthening local and national health services is one of the most effective ways to combat malaria and offers the added benefit of increasing the overall resilience of the health system – which is also key step on the path to UHC. Once malaria's spread is controlled, it’s devastating impact will be diminished. This, in turn, can lead to better overall health for people living in poverty and whole communities will have the chance to thrive.

By tackling malaria through health systems strengthening, the Fighting Malaria, Improving Health partnership is helping to drive progress towards achieving UHC and the wider agenda of the Global Goals. This level of ambition demands that organizations come together and work in partnership. In this spirit, Comic Relief and GSK are working together in new and innovative ways to tackle malaria and strengthen local and national health systems, while also contributing to driving progress towards UHC. A new briefing, available here, launched by Comic Relief and GSK last week on World UHC Day, outlines how Fighting Malaria, Improving Health aligns to the below key principles of the UHC agenda:

- Ensuring no one is left behind;

- Upholding quality health care through a strengthened workforce;

- Building better surveillance and information systems;

- Political leadership within and beyond health; and

- Working in partnership and moving together.

An Eye on RAI

The story of malaria in the Mekong region today is one of optimism and urgency. Optimism because the five countries in the region, Cambodia, Laos, Myanmar, Thailand, and Vietnam are in the fight together and are aiming to eliminate the most dangerous strain of malaria by 2025. And, the fight is urgent, because the parasite that causes malaria is evolving and becoming drug resistant.

UNOPS is the regional principal recipient in collaboration with Global Fund partners whom responded to this emerging threat by creating the Regional Artemisinin-resistance Initiative (RAI) with $115 million in grant funding for the period of 2014-2017. Their aim is to eliminate malaria in this geographical region. RAI’s regional steering committee breaks down the barriers between funders, researchers, and communities at risk for malaria. Together they identify gaps, challenges, and fruitful programs. For example, they identified health centers as an effective place for funding investments. Functioning health centers with well-trained staff sow benefits beyond malaria prevention. They also support a network of volunteers that reach people where they live and work, thus promoting prevention activities such as sleeping under mosquito nets, and providing testing and treatments, without the need for a brick and mortar clinic.

RAI Grant Map

As a result of their success, they expanded with a second phase, the RAI2-Elimination (RAI2E) program, with $243 million in grant funding for the period of 2018-2020. The RAI2E continues support for malaria service coverage for remote populations in border areas and other at-risk populations, as well as case management through health volunteers and strengthening of national surveillance systems.

As of June 2019 they have tested 23.3 million people for malaria, distributed over 19.5 million long-lasting insecticidal nets, trained over 33,000 volunteers, and treated over 660,00 people for malaria. The numbers of cases have fallen by over 70% since 2012 and deaths have fallen over 90%.

The RAI2E also has a new private sector advisory network: The Regional Steering Committee (RSC). The RSC collaborates with the Principal Recipient, national country coordinating mechanisms (CCMs), Global Fund, local funding agenda and technical partners to provide strategic direction and oversight to the RAI grant. The RSC also works closely with the World Health Organization through the support of the Emergency Response to Artemisinin Resistance Hub (ERAR), based in Phnom Penh, Cambodia.

Some of the main responsibilities of the RSC are to ensure that grant implementation is focused, fast and flexible based off of access to high quality data enabled by real partnerships. They also aim to create political leverage and joint funding platforms through linking with regional Asia Pacific organizations while complementing the role of national CCMs. Members range from leaders in health ministries, departments of health, and other private sector organizations such as banks, foundations, departments of foreign affairs, and health product suppliers.

Overall, though RAI’s focus is regional, its impact is global as it stops the spread of drug-resistant malaria through multisectoral collaborative support.

BAAM Engagement Alongside the Global Fund’s Sixth Replenishment Conference

BAAM Co-Chairs Caroline Desrousseaux, Vestergaard, and Sherwin Charles, Nando’s, were invited to represent the voice of BAAM at the “Innovation & Access Roundtable: Increasing Access to Innovations in the 6th Global Fund Replenishment Period” organized by the RBM Partnership on the 10th of October in Lyon. Both of our representatives emphasized the need for public organizations to develop partnerships with the private sector. Roundtable participants also highlighted that advancing multi-sectoral discussions, especially between manufacturers, other industrial partners, and international donors could serve to advance innovation in the malaria space and boost access to the newest malaria treatments. The discussions successfully convened stakeholders from across the malaria community, including the RBM Partnership, the WHO, the Global Fund, IVCC, UNITAID, BMGF, Global Health Institute, MMV, Stop TB, UNICEF, FIND, and UN Foundation. Representatives from the private sector included Vestergaard, Nando’s, Bayer, Mylan, Abbott, Cepheid, Fosun Pharma, Sanofi, Sumitomo Chemical, Johnson & Johnson, GSK, Gilead, Novartis and Merck|MSD.

Meeting participants identified two key areas for future consideration: 1) de-risking research and development and 2) providing price guarantees. Within research and development, roundtable attendees noted that companies ought to work closely with public institutions—especially on those efforts related to the development of malaria and tuberculosis vaccines and diagnostics—with an emphasis of aligning on expectations form the initial development stage. On the issue of price guarantees, participants largely agreed that public institutions should be in “constant dialogue” with companies throughout the health product pricing process and that companies ought to ensure that appropriate resources are allocated for market approval at the national level. Adding to the conversation, WHO representative David Schellenberg agreed that institutions have a role to play in aligning research and development expectations, and noted that the WHO is working to develop a standardized approach for the development of product profiles.

BAAM representatives also participated in a number of other events alongside the Global Fund’s Sixth Replenishment Conference. On October 9th, Sherwin Charles, CEO of Nando’s and of Goodbye Malaria, spoke at the event “Global Fund as a catalyst for regional malaria elimination: Applying lessons learned to the Sahel”. On the same day, the event “Step up the fight: how private sector commitments to innovation will support the Global Fund to end Aids, tuberculosis and malaria by 2030”, organized by the Global Fund and the French Business Council for Africa, welcomed speakers from Microsoft Healthcare, Viiv Healthcare, Orange, Mastercard, Google Cloud, Societe Generale, Sanofi and Thompson Reuters Foundation.

From left to right: Tara Nathan, Executive Vice President, Humanitarian & Development, Mastercard, Peter Lee, Corporate Vice President, Microsoft Healthcare, Bruno Mettling, Chairman, Middle East & Africa, Orange, Tariq Shaukat, President, Google Cloud at the event “Step up the fight: how private sector commitments to innovation will support the Global Fund to end AIDS, tuberculosis and malaria by 2030” on 9th October 2019 in Lyon, France.

During the event, business executives from a range of sectors announced new partnerships with the Global Fund. Google Cloud, Mastercard, Microsoft, Orange, Pharmaccess, the Rockefeller Foundation, and Zenysis are among the technology companies that committed to harness data and digital technology to tackle malaria, tuberculosis, and HIV. The Coca-Cola company announced an additional 20 million USD in in-kind and financial support to the Project Last Mile, a project with the Global Fund and the Bill & Melinda Gates Foundation that leverages Coca-Cola’s logistical, supply chain management and marketing expertise to support African governments in delivering lifesaving medicines and supplies. Societe Generale and India Health Fund/Tata Trusts also announced projects to enhance gender equality and tuberculosis research, respectively. Manchester City announced a partnership with the Global Fund to promote behavior change and disease prevention targeting the youth in Tanzania. Thompson Reuters Foundation will partner with the Global Fund to support its innovative “Breaking Down Barriers” initiative to raise awareness around barriers to health, while ViiV Healthcare committed up to 3 million GBP through its “Positive Action” programs to improve access to health for young girls and adolescents. More details on these initiatives can be found here.

Overall, the Global Fund met their target and raised 14 billion USD, including more than one billion USD coming from the private sector. Private sector donors included the Bill & Melinda Gates Foundation with the biggest donation of 760 million USD, followed by Product (RED) with 250 million USD. Other private sector donors include Comic Relief, Rotary Australia World Community Service, and Rotarians Against Malaria, and the Tahir Foundation, among others.

The private sector was involved in more conversations than ever before with malaria as a central topic on the agenda. This year’s Global Fund Replenishment opened new doors for advancing the discussions between the private and public sectors.

Partner Happenings : Q3 2019

African Leader’s Malaria Alliance

South Africa launched its national Malaria Elimination Strategic Plan for South Africa (2019-2023) at the beginning of August during the fifth Annual Southern Africa Malaria Research Conference in Pretoria. The Strategic Plan seeks to achieve zero malaria transmission by 2023. The South African Scorecard for Accountability and Action was launched during the meeting to help the country track performance against key indicators and take action to address areas of under-performance. Ms. Joy Phumaphi, ALMA Executive Secretary, congratulated the country on the Strategic Plan: “Ending malaria is a key building block to healthier and fulfilling lives. To achieve the South African National Development Plan 2030’s vision for economic prosperity we need increased investments in malaria and the broader health development agenda. Investing in health is investing in human capital development which is a precursor for inclusive economic growth and transformed societies.” South Africa has seen a significant reduction of the number of malaria cases the past ten years, with government funding contributing to the successful trajectory despite ongoing financing resourcing challenges. Their Strategic Plan is aligned with the Catalytic Framework to End AIDS, TB and Eliminate Malaria in Africa by 2030, the Africa Health Strategy (2016-2030) and the Global Technical Strategy for Malaria (2016–2030).

Ahead of the Global Fund Replenishment Conference to take place in Lyon, France, on 9-10 October, ALMA has been working with the African Union Commission to ensure support from African countries to the Fund but also to domestic investments in health on the Continent. At the last Replenishment, the Republic Benin, Ivory Coast, Kenya, Namibia, Nigeria, Senegal, South Africa, Togo and Zimbabwe each made contributions to the Global Fund.

Asia Pacific Leader’s Malaria Alliance

The M2030 initiative, which brings together the business community, consumers and health organizations in the fight against malaria, announced new partnerships and initiatives. Shopee, the leading e-commerce platform in Southeast Asia and Taiwan and pioneering partner of the M2030 movement, announced that it had raised US$30,000 as a result of its malaria campaign that ran between May and July. The funds will support NGO Population Services International in the implementation of its malaria programs in South -East Asia. Moreover, City Mart Holdings, the top retail chain in Myanmar, joined the M2030 campaign in July. The company has installed posters in many store locations to educate its customers on the importance of malaria elimination. Stores are also selling donation cards at checkout registers, enabling customers to give directly to malaria elimination programs in Myanmar.

Additionally, the fourth Asia Pacific Leaders Malaria Alliance Senior Official’s Meeting took place at the beginning of June. Senior Officials reaffirmed their commitment to the goal of a malaria-free Asia Pacific by 2030, supporting in particular the call for a five-year progress review for the 2030 goal, as foreshadowed in the Roadmap, to refocus Leaders’ attention on addressing the toughest remaining challenges. They emphasized cross-border cooperation efforts between the government, the military, and civilians in India, Indonesia, Thailand, and Cambodia. The Senior Officials also raised concerns over the increasing resistance of parasites to artemisinin combination therapies in the region and recommended monitoring the situation and increasing collaboration on data sharing in this regard. This is particularly important as the Senior Officials noted that external funding will become scarcer and that domestic financing will be absolutely key to maintain malaria programs. They also highlighted the importance of engaging new actors in the fight against malaria, including the private sector. Finally, the Senior Officials welcomed whole-of-government responses from many countries and reiterated its support for the Asia Pacific Malaria Elimination Network (APMEN).

The East Asia Summit Foreign Ministers’ Meeting took place on 2nd August in Bangkok, where the Ministers reiterated their commitment to the goal of an Asia-Pacific free of malaria by 2030, noting that they will release a five-year progress report to APLMA in 2020 to evaluate the ongoing efforts of countries as part of the Malaria Elimination Roadmap for the region.

Finally, APLMA has been emphasizing the importance of quality medicine to fight malaria and of monitoring the disease as drug-resistance is spreading, ahead of the Global Fund’s Sixth Replenishment Conference.

The President’s Malaria Initiative

Through a PMI initiative, the U.S. Agency for International Development (USAID) had awarded US$36 million in new funding for PMI partner countries to strengthen their malaria information systems and build capacity in malaria surveillance, monitoring, and evaluation. The award will supplement the USAID-funded MEASURE Evaluation project for five years.

PMI also shared statements from the U.S. Government on malaria during May’s World Health Assembly, where the U.S. government reiterated its support to the WHO Global Technical Strategy for Malaria 2016-2030, and emphasized the need to combat drug-resistance and insecticide resistance especially in Africa.

The Global Fund to Fight HIV, TB, and Malaria

The Global Fund is preparing for its Sixth Replenishment Conference that will take place in Lyon, France, on 9-10 October. It published its Funding Request Materials for the 2020-2022 Funding Cycle, which updates the allocation-based funding model for the upcoming Conference. Materials will be provided in English, but also in French and Spanish starting in September.

On 30 July, artists and athletes released an open letter to 7-year-olds promising to end AIDS, tuberculosis and malaria epidemics by 2030. The public is invited to sign this call-to-action to step up the fight against these three deadly diseases ahead of the Replenishment Conference.

Finally, the Global Fund celebrated the increase of 16 percent over the U.K.’s contribution compared to the previous Replenishment. This increase means that the U.K. government now matches up to the 100 million of investment from private sector organizations, so the aim is also to encourage stronger private sector engagement during the upcoming Replenishment cycle. Takeda Pharmaceuticals was the first company to make an early pledge to the Global Fund, making a commitment of approximately USD 9 million.

Malaria Investment Case Sneak Peek The BAAM Investment Case for Malaria: Raising the Profile of the Private Sector in the Fight Against Malaria and Making the Case for Increased Engagement

The Business Alliance Against Malaria is excited to confirm the launch of an Investment Case Report on 9 October alongside the Global Fund’s Sixth Replenishment in Lyon. The report will be presented during the side-event – “The Global Fund as a Catalyst for Regional Malaria Elimination: Applying Lessons Learned to the Sahel” – that will be co-hosted by APLMA, the UN Foundation, Malaria No More, Speak Up Africa, ALMA, and CS4ME.

Drawing from global health data, economic research, and sector-specific case studies, the report makes a compelling case for increasing private sector investment in the fight against malaria.

The report begins by setting the stage and depicting the critical juncture we find ourselves in. This includes the ongoing campaign to eradicate malaria and identifies the reasons why progress has stalled in recent years, highlights the key gaps, challenges and shortfalls the global health community will face in combating the disease in the future and explains why greater private sector involvement is urgently needed.

The second section of report reviews the ways in which businesses benefit from investing in malaria programs. Building on a wealth of academic research and case studies, the report shows that investing in malaria initiatives offers direct economic benefits to businesses operating in malaria-endemic regions, boosts regional and global economies, and creates exciting new markets opportunities around the world. It also highlights the breadth of creative solutions spearheaded by industry leaders, including: transformative product innovations, collaborative cross-sector partnerships and groundbreaking initiatives that fully leverage the expertise and assets of the private sector.

We also investigate in detail several case studies from six critical sectors, offering insights into how each one is impacted by malaria and showcasing how select private sector actors have responded to the challenge of malaria in creative ways and have created shared value for their employees, communities, and stakeholders, as well as their businesses. Ultimately, we hope this report will persuade more businesses to join us in the fight to defeat malaria.

Business Alliance Against Malaria: 2019 Progress Update

BAAM is the leading alliance of businesses committed to the elimination of malaria within our lifetime; and, through its close relationship with the RBM Partnership, BAAM is a vital part of the network that binds together the malaria community. As we enter the final quarter of 2019, we wanted to take a moment to take stock of the Alliance’s accomplishments to-date.

We started the year with a ratified Memorandum of Understanding between BAAM and the RBM Partnership to End Malaria. Several joint activities were planned to align both BAAM’s and the RBM Partnership’s work plan. These included BAAM-representative participation in the RBM Partnership’s Advocacy & Resource Mobilization Partner Committee and our collaborative joint World Health Assembly side-event: Innovate + Collaborate + Scale = End Malaria, which included a panel discussion on deploying new tools to fight malaria.

The Alliance has also made progress on internal initiatives and governance work—for example, in August, the Alliance issued its first set of invitations to start-ups and small organizations to join BAAM’s “Innovator’s Circle”. The reasoning behind the creation of this initiative is that the fight against malaria is evolving and requires fresh thinking from innovative organizations of all sizes. In order to sustain the gains the global community has made in the fight against malaria, meet the needs of key and vulnerable populations, and grapple with drug and insecticide resistance, we need to invite as many creative and entrepreneurial players to the space as possible. Thus, in light of the changing nature of the fight against malaria and acknowledging that the fee structure has proven a challenge for small start-up innovators in the past, the Business Alliance Against Malaria has launched a new mechanism for malaria innovators to engage with the Alliance: the BAAM Emerging Innovators Circle. Should you be interested in further details on the program, or if you know of an organization or entrepreneur that might be a good candidate for membership, please reach out to the Focal Point team!

Additionally, we are evolving our malaria investment case report to showcase how malaria affects economies and health simultaneously. Case studies from multiple sectors will be highlighted demonstrating how malaria prevention strategies are good for business. Further details on the report can be found later in this newsletter.

We also underwent elections this past quarter and are thankful and appreciative of Ms. Caroline Desrousseaux’s leadership! We welcome Caroline on to a new term as Chair of the Business Alliance Against Malaria.

BAAM has several exciting milestones to anticipate between September and the close of 2019--the Alliance will be participating in the RBM Partnership’s Country/Regional Supporting Partner Committee (CRSPC) National Malaria Control Program Managers and Partners Meeting, an important sub-regional meeting to help advance malaria control and elimination goals in Eastern and South Africa. The meeting is being held in Lusaka, Zambia from 16 to 19 September, and will bring together national malaria control program managers and their teams, as well as other key players in the field of malaria at national, regional, and global levels, to identify challenges and to share best practices and lessons learned. BAAM will be a focal point in the agenda with a high-level presentation of the private sector’s appreciation of collaboration married with a cocktail and dinner. We aim to increase the awareness and benefits of engaging the global fight against malaria, in particular through membership with BAAM.

Another important upcoming milestone is BAAM’s annual retreat which will take place on October 8th in Lyon, France alongside the Global Fund’s Sixth Replenishment conference. The retreat represents a valuable opportunity for BAAM members to come together in-person to spend dedicated time discussing policy priorities and positions, and strategic objectives to guide the development of the Alliance’s 2020 workplan. Further, by holding the retreat alongside the Replenishment conference, the Alliance will maximize members’ opportunity to participate in high-profile policy and advocacy conversations with leaders from multilateral and bilateral health and development agencies, governments, civil society, and the broader private sector.

As seen in the pledge map below, this Replenishment cycle is showing increased funding among many nations. Part of The Global Fund’s striking progress is achieved through their unique partnership model in which private sector and non-governmental partners play a vital role.

BAAM will also be co-hosting a side-event, in partnership with several leading organizations in the malaria community, alongside the Replenishment titled “The Global Fund as a Catalyst for Regional Malaria Elimination: Applying Lessons Learned from the Sahel.” The event will take place on 9 October, and is being co-organized with: APLMA, the UN Foundation, ALMA, Malaria No More, Speak Up Africa, and CS4ME.

BAAM has set an energetic trajectory for the remaining quarter of 2019 and beyond – as members of the global community engaged in the fight against malaria, we thank you all for being a part of it!

Addressing Drug-Resistant Malaria: Integrated Approaches Offer a Promising Path Forward

A recent article from The Lancet reveals that drug-resistant strains of the malaria parasite are emerging in Southeast Asia, rendering many malaria treatments increasingly inefficient and ineffective. Most worrying for the global health community, are the WHO-recommended artemisinin-based therapies, used to treat the majority of malaria cases, that have been found to fail in an increasing number of cases, leading to fears that drug-resistance could spread to India and Africa.

Some studies have suggested that genetic mutations in mosquitoes could lead to the proliferation of multidrug-resistant malaria parasites. This rapid genetic evolution is a great threat. In the greater Mekong region, which includes Cambodia and Laos, it is well-known that drug-resistance has been on the rise for a decade. This was emphasized in a randomized study - one of the two studies discussed in The Lancet – where researchers observed an overall failure rate of a two-drug combination therapy of up to 50 percent in the region going as high as the alarming rate of up to 90 percent failure in some districts. This discovery was incidental and occurred while the researchers were testing the efficacy of a new triple-drug combination--the two-drug combination was simply supposed to serve as the control group for the study. As early as 2014, Cambodian officials switched back to older medication protocols, as treatment failures of the artemisinin-based combination therapy (ACT) of dihydroartemisinin-piperaquine had already been documented. Due to this powerful trend, Thailand and Vietnam have started to move away from these ACT treatments, even though they are recommended by the WHO.

In order to tackle the ever-growing threat of drug-resistance, the malaria community needs to embrace a holistic and integrated approach that leverages new health products and tools alongside community monitoring approaches and digital solutions.

For example, approaches such as the efficient tracking of malaria patients, precise monitoring of mosquito populations, and a sharp focus on improving malaria diagnostics are promising avenues for curtailing the spread of drug-resistant parasites. More accurate and timely data of all kinds are needed in the malaria space in general, as highlighted in the World Health Organization’s 2018 Malaria Report. Integrated management can be implemented in malaria programs by leveraging digital tools to track mosquitoes and malaria patients. These tools are  crucial in the current context of possible resurgence in the number of malaria cases and the increased drug-resistance of the disease. Developing diagnostic solutions that are affordable, accessible, and reliable is another important piece of the puzzle – this is why the Business Alliance Against Malaria is making it a point to boost innovation in the malaria space through its Innovators’ Circle.  This aligns with the United Nations General Assembly’s agenda where there is no doubt that anti-microbial resistance and drug-resistance remain high on the global health agenda.

Partner Happenings

African Leader’s Malaria Alliance

During the 32nd Ordinary Session of the Assembly of the African Union in Addis Ababa, Ethiopia, it was requested that the 55 Member States “work towards an enabling environment and ensure the availability of affordable, effective, safe, next-generation malaria commodities through regulatory harmonization and support for local production including innovative initiatives to increase availability and scalability”, with the support of ALMA, the RBM Partnership to End Malaria, the African Union Commission and other partners.

This result is the 2018 African Union Malaria Progress Report, which was presented by Prime Minister Ambrose Mandvulo Dlamini of the Kingdom of Eswatini on behalf of His Majesty King Mswati III in front of African Heads of State and Government. The report provides an update of the “Zero Malaria Starts With Me” campaign’s successes and highlights the importance of cross-border coordination, public-private partnerships, and community engagement.

To achieve the targets set out in the Catalytic Framework to End AIDS, TB and Eliminate Malaria in Africa by 2030, the report recommends Member States to enhance sub regional collaboration with the Regional Economic Communities of Africa. It also highlights that the ALMA Scorecard for Accountability and Action remain an important tool that countries use to track performance against key indicators. To date, 39 countries have rolled out national and subnational malaria control and adopted the scorecards that can be used to improve local regulatory frameworks to track the innovation of new commodities, in particular to address insecticide resistance.

Furthermore, on 31 May 2019, His Majesty King Mswati III of the Kingdom of Eswatini, also ALMA Chair, launched the End Malaria Fund in his country as part of the “Zero Malaria Starts with Me” campaign. Goals of the campaign are to eliminate domestic transmission of malaria in the country by 2022; to sustain elimination thereafter through surveillance, testing, and case management; and to support malaria elimination at the sub-regional and regional levels. Eswatini business leaders committed to support the Fund, to which His Majesty King Mswati III committed around 352 thousand dollars as seed funding, with the goal of closing the USD 5 million funding gap to meet the targets of the national malaria strategic plan.

Asia Pacific Leader’s Malaria Alliance

On 25 April 2019, Shopee, the leading e-commerce platform in Southeast Asia, moved into the second phase of its partnership with M2030. The campaign dictates that for every dollar spent, Shopee will donate 1 dollar to defeating malaria in Asia. The company will also launch an interactive game called “Mosquito Smack” to raise awareness about malaria in the region. Patrik Silborn, co-founder of M2030 and Head of External Relations at APLMA, highlighted the importance of businesses in the fight against malaria: “Partnering with Shopee has allowed us to tap into their extensive network of users across the region, and to get more people onboard our fight against malaria. It is heartening to work alongside homegrown businesses who are invested in changing the course of history in this region.”

On the same day, APLMA and the World Economic Forum announced the M2030 Champions Council. The Council will drive corporate leadership to eliminate malaria in Asia and is composed of CEOs and Presidents of well-known businesses in Asia-Pacific.

Additionally, the updated APLMA Leaders’ Dashboard 2018 was launched in Bangkok in April 2019, where the 3rd APLMA Senior Officials Meeting took place. It was developed in collaboration with the WHO and senior government officials from malaria-endemic countries alongside the Dashboard Experts Reference Group. The Dashboard encourages governments to act to eliminate malaria in the region by 2030 with a particular focus on near-term collective actions.

The President’s Malaria Initiative

PMI and the Global Fund are supporting the joint campaign by the governments of Gambia and Senegal to distribute 11 million mosquito nets to fight the high cross-border transmission of malaria. The launch of the campaign took place in Senegal at the border with Gambia to symbolize the commitment of both countries. This bilateral international cooperation is a part of the Senegambia Malaria Elimination Initiative Agreement that they had signed in December 2018.

This is the first time that two countries synchronize mass net distributions on each side of an international border. The campaign will deliver around 10 million long-lasting insecticide-treated nets in Senegal, and 1 million in Gambia with the financial and technical support of PMI and the Global Fund.

The Global Fund to Fight HIV, TB, and Malaria

The Board of the Global Fund held its 41st Board Meeting in May in Geneva, Switzerland, where it approved its Allocation methodology for 2020-2022, and its catalytic investments for the same period, though dependent on the amount of funds it will receive at the upcoming Replenishment.

The Global Fund target for its next Replenishment, which will take place in Lyon, France, on 10 October 2019, is 14 billion US dollars. The first private company to make a financial commitment was Takeda Pharmaceutical Company Limited on 3 June with nearly 9 million US dollars.

Another highlight is that on April 25th the Thai Foundation Dhanin Tawee Chearavanont became the first private sector partner to support the Global Fund in its largest regional initiative to eliminate drug-resistant malaria in the Greater Mekong region. As such, the private family foundation will give 2 million US dollars over two years to support the Global Fund’s Regional Artemisinin Resistance Initiative (RAI). The contribution will focus on detecting more of the malaria cases in the region, and on tracking hard-to-reach, mobile and migrant populations that live along the border of the country.