Counting the Potential Consequence of COVID-19

It seems unavoidable that the COVID-19 pandemic will continue to pose severe challenges to programs that supply essential interventions in the fight against malaria. The intensity of changes to interventions and the resulting outcomes is still unpredictable. However, researchers have set out to better understand the potential changes in malaria morbidity and mortality to inform healthcare systems of potential consequences and at the same time advocate for greater attention to malaria eradication efforts.

In late September 2020, the Lancet published an article outlining the indirect effects of the COVID-19 pandemic on malaria intervention coverage, morbidity, and mortality in Africa. Using geospatial estimates the authors established baseline assessments for the anticipated malaria burden in Africa in the absence of COVID-19-related disruptions, and repeated the analysis with possible scenarios in which effective treatment with an antimalarial drug and distribution of insecticide-treated bed nets (ITNs) were reduced to varying extents. Study researchers then appraised resultant changes in malaria incidence and mortality. In a baseline scenario of undisrupted intervention coverage they estimated roughly 215 million malaria cases and 386 thousand deaths in malaria-endemic African countries in 2020. The worst-case scenario, in which mass ITN distributions are cancelled with decreases in effective treatment of cases with an antimalarial, the incidence of malaria would increase by 21·5%, giving way to 46.4 million additional cases. Mortality would double with an estimated 768.6 thousand deaths. The large increase in deaths is a result of the crucial role of antimalarial drugs in preventing progression to death in malaria-infected individuals. However, the true impact of malaria incidence will not be fully realized until future years and is dependent on countries’ epidemiological context and baseline intervention status.

Nevertheless, there is hope that internal health policy is nimble enough to mobilized needed resources to fill gaps to optimize the control and treatment of malaria. Aligning COVID-19 interventions with existing malaria strategies could help relieve pressure on health systems. Integration of malaria control efforts with the COVID-19 response in African countries is vital to prevent reversing important public health progress of past decades.

Malaria and Climate Change: A Complex Relationship

The relationship between malaria and climate is a complex one. While the exact climate-related health risks and impacts have yet to be fully understood, evidence does should that climate change impacts malaria transmission. Over the long term, rising temperatures and increases in rainfall could spread the disease to previously malaria-free zones. The suitable temperature range for the malaria parasite or the mosquito that transmits the parasite between humans is relatively well established by field and laboratory studies and forms the basis for current projections of the impact of climate change on malaria. Recent studies even found that malaria parasites need less time to develop at lower temperatures than previously thought, meaning that even slighter warming may be enough to heighten malaria risk. Surface water is equally crucial, as it provides habitat for the mosquitoes to lay their eggs. Nevertheless, different scenarios in which climate change remains under control, economic growth continues, and urbanization progresses offer some hope that the impact of malaria worldwide could still decrease in the decades to come. 

Climate change causes increasing global temperatures, extreme weather events and change in rainy seasons. As seen on the map below taken from the Global Fund’s Strategy Development Landscape Analysis for Malaria, the malaria burden is predicted to increase in contexts that previously did not have malaria, with low population immunity, and may decrease or disappear in tropical, previously endemic, regions. The map outlines the worst-case scenario with the ‘business-as-usual’ scenario where society does not make concerted efforts to cut greenhouse gas emissions, and in which the quantity of greenhouse gas emissions are therefore the highest.

In many places, malaria transmission is seasonal, with the peak during and just after the rainy season. Variation in climatic conditions, such as temperature, rainfall patterns, and humidity, have a profound effect on the longevity of the mosquito and on the development of malaria parasites within the mosquito and, subsequently, on malaria transmission. Malaria epidemics can occur when climate and other conditions suddenly favor transmission in areas where people have little or no immunity to malaria. They can also occur when people with low immunity move into areas with intense malaria transmission, for instance to find work, or as refugees.

WHO estimates that climate change will lead to 60,000 additional deaths per year due to malaria between 2030 and 2050, an increase of nearly 15% in overall annual deaths from this preventable disease, even when accounting for economic growth and health progress. It also projects that about 5% of the global malaria cases, or 21 million cases, would be attributable to climate change in 2030.

By 2050, climate change alone might expose some areas in South America, sub-Saharan Africa and China to a 50% higher probability of malaria transmission.

A recent study in Africa found that estimated geographic shifts in endemic and seasonal suitability for malaria transmission were observed across all future scenarios of climate change on the continent. The worst-case regional scenario of climate change predicted an additional 75.9 million people at risk from endemic exposure to malaria transmission in Eastern and Southern Africa by the year 2080, with the greatest population at risk in Eastern Africa. In general, the changes in malaria presence occur at the borders of current transmission zones. Once again, the largest changes are predicted in Africa.

However, malaria transmission is also strongly associated with GDP: in cases where temperatures and greenhouse gas emissions continue rising, urbanizations and economic development could offer some hope for either only modest malaria expansion, no further expansion, or even reduction or malaria disappearance in certain parts of South America and Asia. As urbanization is associated with economic growth, having increasing number of people living in urban areas would be beneficial in the fight against malaria, because they have fewer breeding sites suitable for the most effective malaria vectors, treatment is easier to reach and prevention measures such as insecticide-treated bed nets are more widely available.

The populations that are most vulnerable to climate change are also the ones that are most vulnerable to malaria. The link between climate change and health is getting increasingly noticed—in 2015, the Lancet launched a Health and Climate Change Commission, and health systems around the world have started to take some steps to be better prepared for extreme weather hazards, and businesses have become more engaged in the discussions around the climate-health nexus. Nevertheless, malaria has remained by the side of the road of these emerging conversations. There clearly is a need for a greater dialogue on how to grapple with the interlinked challenges of climate change and malaria elimination to identify strategies and opportunities for mitigating the impact of the disease—and ensure that it does not spread to new areas where populations are the most vulnerable physiologically, economically and socially.

Launching the Malaria Live Talks: Continuity through Crisis: COVID-19 and Malaria

We are excited to be launching the Malaria Live Talks, a series of webinars exploring how the coronavirus will impact ongoing efforts to combat malaria, with a first webinar to be broadcasted in the next few weeks. The first episode includes a rich discussion featuring Joy Phumaphi, Executive Secretary, African Leaders Malaria Alliance (ALMA), Rima Shretta, Honorary Visiting Research Fellow, University of Oxford’s Center for Tropical Medicine and Global Health, Patrik Silborn, Senior Director Resource Mobilization and Financing, Asia Pacific Leaders Malaria Alliance (APLMA), and Caroline Dessrousseaux, BAAM’s co-chair.  The event series is moderated by Eric Olander, Managing Editor and Co-Founder of the China Africa Project, who brings extensive experience in journalism with a focus on China’s engagement in Africa.

Partner Happenings Q2 2020

African Leader’s Malaria Alliance

On 11 May, three ALMA Chairs, His Excellency Uhuru Kenyatta, President of Kenya and Chair of ALMA, Her Excellency Ellen Johnson Sirleaf former President of Liberia and former ALMA Chair and His Excellency Jakaya Mrisho Kikwete of the United Republic of Tanzania issued a statement on behalf of the End Malaria Council calling for continued essential health services like malaria prevention and control, while responding to the COVID 19 global pandemic. H.E. Uhuru Kenyatta is the President of Kenya, the Chair of the African Leaders Malaria Alliance and a member of the End Malaria Council, said: “I am committed to working with fellow heads of state and government on a coordinated and harmonized response to COVID-19 that stamps out this pandemic while continuing to provide essential health services to our citizens. Nothing is more important than protecting our women, children and men from preventable and treatable diseases like malaria. These efforts will help us to sustain the significant gains that we have made driving down malaria cases and deaths over the past twenty years.” The statements of Her Excellency Ellen Johnson Sirleaf former President of Liberia and former ALMA Chair and His Excellency Jakaya Mrisho Kikwete of the United Republic of Tanzania of can be found here.

On World Malaria Day, Joy Phumaphi, Executive Secretary of the African Leaders Malaria Alliance, stepped up to say that “the response to COVID-19 is – and must be – all-encompassing. The worry is that efforts to protect against malaria may go off the radar, with huge implications for public health in Africa.” She added that ALMA has committed to supporting countries in the increased use of data and technology, which will drive impact and change. Her full statement can be found here.

The World Malaria Day 2020 Statement by His Excellency H.E. President Uhuru Kenyatta, Chair of ALMA, highlighted that “in many African countries, malaria is the leading cause of visits to health facilities and for poorer households these bouts of illness and expenditure on medication and treatment remain a challenge to financial growth and stability.” He added that “We should implement an integrated approach to controlling COVID-19 while maintaining malaria services as part of essential health packages”, as envisioned in Universal Health Coverage. He noted that efforts should focus on the following:

1.     Protect the gains in malaria control through prevention, treatments, and emerging interventions such as the malaria vaccine which is under phased implementation in Kenya, Ghana and Malawi.

2.     Boost African purchasing power and local manufacturing of critical medical supplies including regional partnerships and collaborations

3.     Increase youth engagement as our “Malaria Army” in deployment of interventions around community services, surveillance, health education and advocacy towards community ownership.

4.     Build on Technology Platforms and Data Capacity to combat COVID-19 and sustain the gains in the fight against malaria

His Excellency’s full statement can be found here.

Asia Pacific Leader’s Malaria Alliance

The Asia Pacific Leaders Malaria Alliance welcomed Dr. Sarthak Das as CEO, who took up office on 1 May 2020. Dr. Das brings twenty-five years of experience as a public health scientist, development practitioner, and global health policy advisor. As CEO, Dr. Das will look to strengthen regional collaboration and cooperation with stakeholders, a key component to supporting the Leaders’ commitments to ending malaria by 2030. More information about Dr. Das’s background can be found here.

 APLMA is looking at the interconnection between malaria and climate change. In April, the organization published a short piece highlighting that climate change is creating more suitable conditions for vector-borne diseases such as malaria. As a result, malaria is moving into new places where both people and health systems are not used to fighting the disease, and the periods when mosquitoes can reproduce and transmit malaria are also getting longer. This is particularly true in Asia-Pacific region. APLMA urges all countries in Asia-Pacific to act now, reminding us that climate change is not something that will hit us in the distant future. It is here now and it is already impacting health and livelihoods of communities across the globe. The article can be found on APLMA’s website here.

In light of the ongoing COVID-19 pandemic, APLMA and the Asia Pacific Malaria Elimination Network (APMEN) postponed upcoming events scheduled for April and May including Malaria Week 2020, the APLMA Senior Officials’ Meeting, and the APMEN Annual Meeting. These events should be rescheduled for later this year.

The President’s Malaria Initiative

On World Malaria Day, the President’s Malaria Initiative (PMI) released its 14th Annual Report to the Congress of the United States. The report explains the importance of continuing malaria programs during the COVID-19 pandemic, and highlights how the capacity and systems PMI help partner countries put in place to combat malaria also strengthen their ability to respond to other health threats. In its annual message, Ken Staley, MD, U.S. Global Malaria Coordinator celebrated the successes of the past year and underscored the need for continued investments toward our shared goal of malaria eradication. He explained that to mitigate the impact of COVID-19 on malaria programming, PMI has created technical guidance for its programs and is supporting partner countries to innovate and evolve their approaches to continue delivering proven malaria interventions during the COVID-19 pandemic. PMI also spearheaded the development of global guidelines for malaria interventions, and is working with the Global Fund, the RBM Partnership to End Malaria, and others to ensure robust and coordinated assistance for countries. In response to the supply chain impact of COVID-19, PMI has been working closely with the Global Fund to identify impacted products and orders, prioritize country needs, and work with suppliers to ensure countries continue to receive life-saving malaria products.

His full statement can be found here.

The Global Fund to Fight HIV, TB, and Malaria

The Global Fund released the primary version of its Strategy Development Landscape Analysis for Malaria. As it is now over half-way through its current Strategy, the Global Fund is starting the process of developing its next Strategy, which will commence in 2023. The next Strategy will need to set out how the Global Fund aims to contribute to achievement of the ambitious 2030 goals for HIV, TB, malaria, and health more broadly as set out in Sustainable Development Goal 3 (SDG 3).

The Global Fund is asking stakeholders for their input into what the focus and role of the Global Fund should be to best achieve these aims. Open consultation will run until 1st September 2020, and the 2023 Strategy will be approved in November or December 2021.

On 27 May, Peter Sands, Executive Director of the Global Fund made remarks to the 43rd Board Meeting of the Global Fund, which was held between 14-15 May 2020. He pointed that the COVID-19 crisis threatens to derail the fight against HIV, TB and malaria. He called for all of us to “engage in the broader debate about how to fight COVID-19 and mitigate its damage in countries which might be easily forgotten by the rest of the world.” His full statement can be found here.

The Global Fund’s response to the COVID-19 pandemic makes available up to US$1 billion through:

• Grant flexibilities: Through grant flexibilities, countries can use up to 5% of existing Global Fund grants to fight COVID-19 and mitigate the impact the pandemic has on HIV, TB and malaria programs. Funding approved for the COVID-19 response can be found here.

• COVID-19 Response Mechanism: Through the COVID-19 Response Mechanism, countries can access funding to reinforce the response to COVID-19, mitigate the impact of the pandemic on HIV, TB and malaria programs, and make urgent improvements in health and community systems. The mechanism has an initial allocation of US$500 million.

Malaria Vaccine in Sight

Malaria’s long history includes many attempts to defeat it. Quinine, a substance derived from the bark of the cinchona tree, has been known to be effective against malaria since the 1600s. After the role of mosquitoes in malaria transmission was understood, scientists focused on vector control. They hypothesized that that by killing the vector, they could halt the cycle of infection. Consequently, DDT and other insecticides came into view in the mid-1900s and have been topline deterrents ever since, along with bed nets and several different anti-malaria drugs. All these tactics have helped push toward the eradication of malaria. But, are there any steps left to take?

Just this month JCI Insights published a study giving light to a new genetically attenuated parasite that could give hope for malaria vaccine. In this study they report developing a genetically attenuated parasite (GAP) that stops late in the liver stage of human malaria caused by the mosquito Plasmodia falciparum. A vaccine developed with this new GAP would target the clinically silent phase of parasite infection in the liver and prevent blood stage infection. This would not only decrease mortality in especially vulnerable groups like children under the age of five, but also would serve to block the cycle of transmission.

To engineer this GAP, selected genes are deleted from the parasite’s DNA, allowing the GAPs to stop in the liver but not reach the blood stream. This “arrest” exposes the GAPs to the immune response that blocks infection. At this time only animal studies have been conducted, and translating these outcomes to humans may prove challenging, despite promising preliminary results. However, the scientists do believe that there is sufficient evidence to move the GAP vaccine candidate into early phase clinical trials.

At the same time the Lancet published findings from researchers investigating the safety and immunogenicity of Anopheles gambiae saliva vaccine. The shot is a peptide-based vaccine derived from salivary proteins tested in humans via performing randomized, placebo-controlled, double-blind, phase 1 trial enrolling 49 healthy adult participants. The idea behind the vaccine is to train the body’s immune system to recognize the saliva proteins and mount a response that would weaken or prevent an infection.

These studies showcase how research and development are at the core for the fight against malaria.

Taking Action Against Malaria in a COVID-19 World

Each year malaria sickens some 228 million people and kills 430,000, most of them in Africa, and most of them children. Spread by female Anopheles mosquitoes, malaria leads to fevers, lethargy, and chills. It can keep adults bedridden for weeks, take children out of school, and saddle families with crippling medical costs.

 During the COVID-19 pandemic, the malaria community must remain committed to supporting the prevention of malaria infection, illness and death through preventive and case management services, while maintaining a safe environment for patients, clients, and staff. Deaths due to malaria and its comorbidities (anemia, undernutrition, etc.) must continue to be prevented. We must not lose the gains we have won throughout the past two decades of the malaria fight. 

As outlined in BAAM’s position on COVID-19: “Keeping Malaria in Sight” and the BAAM Member COVID-19 Response Tracker we believe that we can and must take a multi-phased approach to first mitigate the impact of COVID-19 on the fight against malaria, and then build on those efforts to push closer to ending malaria for good.

Many global organizations are also funding focused responses to the pandemic. The WHO provided overarching principles as well as specific technical guidance for malaria interventions, including prevention of infection and disease, care and treatment of cases, testing, clinical services, supply chain and laboratory activities to take during the pandemic. Their data show that an overwhelming 769,000 deaths could occur this year, double that of 2018, due to disruptions in supply chains that affect bed net campaigns and access to antimalarial medicines. These figures represent those seen over two decades ago.

Furthermore, the Global Fund is at an important crossroads this year as it undertakes a mid-term review of their Global Fund Strategy 2017-2022 to assess the outcome and impact of investments in HIV, TB, and malaria in building resilient and sustainable health systems. Additionally, the Fund has launched its development process for its next strategy, scheduled to begin in 2023. BAAM members will have the opportunity to provide input into the strategy development process this Summer. Related to COVID-19, the Global Fund is engaging with key stakeholders to ensure the global response to the pandemic builds upon lessons learned from the historic fights against HIV, TB, and malaria.

The RBM Partnership has also mobilized workstream groups to help address the epidemic, and recently published their report “Monitoring and evaluation of malaria-related routine data during the COVID-19 pandemic”. Here they emphasize that routine disease surveillance will be critical for monitoring where malaria control, elimination and prevention of re-establishment efforts may be faltering during the pandemic as well as where COVID-19 may be spreading. Their recommendations include: 1) continuing to monitor key malaria (or malaria-related) indicators to assess where disruptions to access to care and to health service provision may be occurring, where malaria control, elimination or prevention of re-establishment may be faltering, or where COVID-19 may be spreading; 2) analyzing and interpreting indications where available; 3) understanding the context around the interpretation of these indicators; and 4) tailoring action to the observed trends.

 As BAAM, we know that malaria eradication remains achievable in the coming decades. However, much depends on whether this year ultimately represents a blip on the radar or reversal in our progress. Governments, civil society, and international partners all need to collaborate to face the delicate balancing act to keep both COVID-19 and malaria under control. If the scales tip, hundreds of thousands of lives could be at risk.

World Malaria Day 2020 Recap

Despite the COVID-19 pandemic, World Malaria Day, held on April 25th of this year, attracted a lot of activity on social media. As shown in the analysis below, mentions of malaria-related terms reached nearly 45,000 hits both this year and in 2019. This demonstrates that despite attention centered COVID-19, the malaria community is still able to come together and advocate for the eradication of this disease.

Figure 1: Spike in mentions of #malaria, #WorldMalariaDay, #palu, #paludisme, #ZeroMalariaStartsWithMe on social media between 11 April-10 May 2019.

Figure 2: Spike mentions of #malaria, #WorldMalariaDay, #palu, #paludisme, #ZeroMalariaStartsWithMe on social media between 11 April-10 May 2020.

This year, the United States, India, the United Republic of Tanzania, Kenya, Nigeria, Ghana, Indonesia, Japan, the United Kingdom, France, and Spain have been the most active in their mentions of World Malaria Day on social media.

BAAM also built on the RBM Partnership’s work to developed a suite of sample messages and campaign images to help promote #WorldMalariaDay and the Business Alliance Against Malaria.

These social cards linked with messages such as those shown below helps highlight the importance of maintaining robust health systems to manage and mitigate the impact of existing diseases like malaria, alongside emerging ones like COVID-19. In particular, the critical need for resilient health and surveillance systems in times where these systems are facing new challenges and grappling with long-standing deadly and dangerous foes such as malaria.

·      Robust health and surveillance systems alongside prevention and control interventions help ensure millions of the most vulnerable are protected from #malaria and new diseases like #COVID-19. #WorldMalariaDay

·      #COVID-19 has disrupted the production and supply of many #malaria commodities. Health systems need support to ensure that they can get the critical health products they need to maintain essential malaria services during the outbreak #WorldMalariaDay 

·      Addressing #COVID-19 should be a top priority. But on #WorldMalariaDay, we should urge leaders not to ignore other killers like #malaria since overburdened systems are a  threat to progress made to date on #malaria. BAAM members stand committed to play their part. https://www.malariabizalliance.org/

As we can see, social platforms are a powerful way to connect with others to build awareness, communicate authority within the malaria space, show authenticity, encourage engagement, and provide support.

Partner Happenings: Q1 2020

African Leader’s Malaria Alliance

The African Leader’s Malaria Alliance (ALMA) welcomes a new Chair, His Excellency President Uhuru Kenyatta, President of the Republic of Kenya. President Kenyatta is ALMA’s seventh chair and will serve for a two-year term, from February 2020 to February 2022. He takes over from His Majesty King Mswati III, of the Kingdom of Eswatini.

His Excellency President Uhuru Kenyatta had positive words as he took his new role: “I am honored to take over this role as ALMA Chair.  Significant gains have been made in the battle against malaria and progress needs to be accelerated. As we enter the decade to end malaria, I am committed to ensuring that we accelerate progress and end this ancient scourge! At the heart of Africa’s Agenda 2063: the Africa We Want, is improved health outcomes so that our people and economies continue to grow.”

Her Excellency Mrs. Amira El-Fadil, Commissioner for Social Affairs for the African Union Commission, as well as Dr. Abdourahmane Diallo, CEO of the RBM Partnership to End Malaria, both welcomed the new Chair. Dr. Abdourahmane Diallo said: “Leadership by African Heads of State is paramount if we are to reach the ambitious goal of a malaria-free Africa within a generation, and ALMA continues to be a key strategic partner of the RBM Partnership to End Malaria.  We look forward to continuing this collaboration and supporting His Excellency President Uhuru Kenyatta’s work to end malaria in Kenya and across the continent.”

BAAM is looking forward to keeping working with ALMA in 2020 and gives a warm welcome to His Excellency President Uhuru Kenyatta, President of the Republic of Kenya in his new role.

Asia Pacific Leader’s Malaria Alliance

M2030, an initiative by the Asia Pacific Leader’s Malaria Alliance (APLMA) and a group of leading businesses in Asia that use their brands to raise awareness and funds to fight malaria in the region, was launched in Japan on 18 December 2019. The launch took place around the third and latest roundtable “ZERO Malaria: What Can We Do from Japan?”, co-organized by Malaria No More Japan as part of their ZERO Malaria 2030 Campaign and the Asia Pacific Leaders Malaria Alliance (APLMA). The launch of M2030 Japan was led by M2030 partners Sumitomo Chemical, Dentsu, and Sompo Insurance Indonesia. Dr. Keizo Takemi, member of the Japanese House of Councillors and WHO Goodwill Ambassador for Universal Health Coverage, opened the event with a keynote speech highlighting the continuous need for political commitment and leadership, the need for Japanese companies to continue to innovate by improving on current technologies for malaria diagnosis, prevention, and treatment, and the need to increase access to malaria testing and treatment and of securing domestic funding to fight malaria.

Patrik Silborn, Head of External Relations at APLMA, announced the launch of M2030 Japan, and described how companies in Japan and throughout Asia can demonstrate private sector leadership for malaria elimination by joining the M2030 movement.

Ray Nishimoto, Executive Vice President of Sumitomo Chemical Co., Ltd, and Board Member of Malaria No More Japan as well as a member of the M2030 Champions Council, spoke about how Sumitomo Chemical continues to innovate to address challenges in malaria elimination. He said, "Experience shows there's no 'silver bullet' to end malaria. We need a combination of innovations to fight the disease from every direction."

Koji Kinoshita, Director of CSR at Dentsu, spoke about Dentsu’s role in raising awareness of the fight against malaria among those outside of the malaria community. He explained his company's role in the effort by stating, Dentsu Aegis Network (DAN) is a global media, digital marketing and communications network and a pioneering partner of M2030 “To eliminate malaria by 2030, we need to engage the general public. Advertising agencies like Dentsu can help with this."

Yuta Iboshi, Senior Deputy Manager for CSR at Sompo Holdings, highlighted how their subsidiary Sompo Insurance Indonesia is helping to protect people against malaria through the marketing of insurance for malaria and other tropical diseases. This insurance increases access to malaria treatment, which plays a key role in elimination. Additionally, Sompo Insurance Indonesia is a new M2030 partner, and is in the process of developing new campaigns for consumers and business clients to raise awareness and funds for malaria elimination in Indonesia.The event concluded with a roundtable discussion, where the following stakeholders were present: Dr. Shigeyuki Kano, Director of the Department of Tropical Medicine and Malaria Research Institute at the National Center for Global Health and Medicine; Dr. Ken Shibusawa, CEO Shibusawa and Company, Inc.; Catherine Ohura, CEO & Executive Director of Global Health Innovative Technology Fund; Dr. Hiroyuki Noda, Councilor, Office for Pandemic Influenza and New Infectious Diseases & Coordination Office of Measures on Emerging Infectious Disease, Cabinet Secretariat, Government of Japan.

The President’s Malaria Initiative

Dr. Ken Staley, Global Malaria Coordinator of the United States President’s Malaria Initiative, delivered a positive message as we entered in the first quarter of 2020. In particular, he welcomed a successful Global Fund replenishment and a $15 million funding increase for 2020 from the Congress and American taxpayers for the PMI to keep helping to mitigate the threat of insecticide resistance.  

2020 will also mark the 15th anniversary of the President’s Malaria Initiative. Dr. Ken Staley shared his vision for the year ahead, including leveraging the power of data to better respond to on-the-ground conditions and more precisely target interventions, continuing to prioritize reaching pregnant women and young children, expanding community health worker training and community-based interventions to reach more affected people, intensifying efforts to combat insecticide resistance and aiming for malaria elimination within the next 5 to 10 years in the Greater Mekong Subregion to further reduce the spread of antimalarial drug resistance.

The Global Fund to Fight HIV, TB, and Malaria

In December 2019, the Global Fund revealed the allocations for countries and regional grants across the world for its 2020-2022 cycle—allocations can be found here. The allocations include US$12.71 billion for country allocations and US$890 million for catalytic investments for the period beginning 1 January 2020 – 23% more than for the previous three-year period. Countries in Africa are receiving around US$2 billion more than in the previous period, and countries in West & Central Africa have the biggest increase – US$780 million. Worldwide, there are 32 countries with an increase of 40% or higher. Asia and the Pacific has been allocated more than US$ 500M for malaria programs.

Will the Wolbachia Work?

Late in 2019, Singapore’s National Environmental Agency opened a new facility with the aim of squashing dengue. This new facility is actually generating and intends to release around 5 million Wolbachia mosquitos per week once at full capacity.

But first, what is the Wolbachia mosquito?

Source: World Mosquito Program

Wolbachia is a natural bacterium present in up to 60% of insect species, including some mosquitos. The World Mosquito Program’s research has shown that when Wolbachia is artificially introduced into the Aedes aegypti mosquito – the primary species responsible for transmitting human viruses such as Zika, dengue, chikungunya, and yellow fever – Wolbachia can help to reduce the transmission of these viruses to people. They are now breeding Wolbachia-carrying mosquitos in partnership with countries to be released in areas affected by mosquito-borne diseases. So far, the evidence shows that dengue incidence is significantly lower in treated communities. Additionally, the Wolbachia strategy can be seen as a comparable approach to gene-editing mosquitoes, that after a few of their short generations go by, they are no longer able to reproduce and die out.

Circling back, Singapore is implementing this technique because of a surge of dengue cases last year, a surge that is projected to worsen due to higher than average temperatures; the continued climate change trend is likely to exacerbate the dengue situation in Singapore. Consequently, they are placing emphasis on breeding lab-created Wolbachia-infected male Aedes aegypti mosquitoes with females, so that the eggs will not hatch. Male Wolbachia-infected mosquitoes also do not bite. Wolbachia can be seen as a way to enhance, not replace, existing vector control strategies.

Are these strategies safe?

Three independent risk assessments have been conducted on the Wolbachia method. The results concluded that there is negligible risk associated with the release of Wolbachia-carrying mosquitoes and that contact with the Wolbachia bacterium does not affect people, animals, and the environment. The World Mosquito Program has received regulatory approval from relevant government bodies in all the countries where they are releasing Wolbachia-carrying mosquitoes and do so with the consent and permission of the communities.

What about malaria?

Though the effects of Wolbachia are not as extensive as in Aedes aegypti, a few studies in Anopheles did show that the presence of the bacteria negatively correlates with the plasmodium parasite; however the Wolbachia bacteria is not, at this time, vertically transmitted. Even though the focus of the Wolbachia methods is to attack dengue, the technology and overall ramifications also have important implications for the malaria community.

2020 Global Health Event Landscape – Identifying Hooks for Malaria

2020 will offer many opportunities for BAAM and the malaria community to make malaria more visible on the global stage, starting with the World Health Assembly in May and followed by the Kigali Global Summit on Malaria and Tropical and Neglected Diseases on 25 June 2020. The Kigali Summit will take place on the sidelines of the Commonwealth Heads of Government Meeting (CHOGM), to capitalize on the presence of the Heads of State of those countries who represent almost two-thirds of the global burden of malaria and neglected tropical diseases. The Summit will be hosted by the Ministry of Health of the Republic of Rwanda, and co-organized by the RBM Partnership to End Malaria and Uniting to Combat the NTDs, and will be supported by a wide range of partners, including the African Leaders Malaria Alliance, the Bill & Melinda Gates Foundation, the END Fund, Malaria No More UK and the World Health Organization (WHO). In particular, the Summit will call on world leaders to meet the Commonwealth Heads of Government Meeting 2018 pledge to halve malaria by 2023 and deliver the political and financial commitments of $1.5bn to end the scourge of neglected tropical diseases.

Dr Abdourahmane Diallo, Chief Executive Officer of the RBM Partnership to End Malaria said: “Commonwealth countries make up over half of all malaria cases and deaths globally. The Kigali Summit will be a crucial moment for leaders to take stock of the progress countries are making towards delivering on the Commonwealth leaders’ commitment made in London two years ago to halve malaria by 2023. There are 650,000 lives dependent on the achievement of this commitment and it is vital to the global elimination targets set for 2030. We will be urging leaders from across the Commonwealth, and beyond, to accelerate action to reach zero malaria.”

The Commonwealth brings together 54 countries, including Rwanda, South Africa, India and others around shared goals for development, democracy and peace. The group meets every two years. The Summit, focused both on malaria and tropical and neglected diseases alongside a Ministerial meeting, represents a great opportunity to bring malaria to the attention of Ministries beyond the Ministers of Health, as the Commonwealth Heads of Government Meeting will gather Ministers of Trade, Youth, Digital Economy under the overarching theme ‘Delivering a Common Future: Connecting, Innovating, Transforming’. It will also be an opportunity to illustrate that malaria is not only an issue in rural areas of affected countries. In the words of one member of the global malaria advocacy community, “There is a golden opportunity to see how we can strengthen vector control as malaria moves from a rural to an urban disease.”

Later in 2020, the malaria community will gather once again to the Meeting of the American Society of Tropical Medicine and Hygiene (ASTMH), this time in Ontario, Canada, between 15-19 November. Earlier, in September, the 75th United Nations General Assembly will bring together the global community to New York under a theme that is still to be determined.

At the same time, following discussions that started during the last BAAM retreat alongside the Global Fund Replenishment Conference in Lyon in October 2019 and thanks to the continuous collaboration between BAAM and the RBM Partnership, venues that are not traditional global health events will also be explored throughout 2020 as a means to making malaria more visible among new types of audiences. For example, the RBM Partnership will be present at the Global Summit on Agriculture & Organic Farming in Tokyo, Japan, on 17-18 August—a great opportunity to expose the agriculture community to the malaria risks the industry might create, for example through the culture of rice where pools of water are favorable to mosquito breeding. These meetings will also be a way to recruit new members in sectors beyond the pharmaceutical and chemical sectors.

BAAM is looking forward to strengthening its presence at global health events and elevating malaria in new industry sectors!