Africa leading the fight against malaria as world faces up to climate change
World Malaria Day 2023
Joint Statement by H.E. Ambassador Margarida Rosa Da Silva IZATA, Head of the African delegation to the Unitaid Executive Board, and Dr Philippe Duneton, Executive Director, Unitaid
Cyclone Freddy, Mopeia District, Mozambique. Photo credit, Eldo Elobolobo, BOHEMIA project
Climate change, insecticide resistance, invasive mosquito vectors, and the growing threat of drug resistance are creating a challenging environment for public health efforts to control and eliminate malaria in Africa.
Africa carries by far the highest burden of malaria of any region, with an estimated 595,000 deaths in 2021, the vast majority of them among children under the age of five. About 70 percent of all malaria cases and deaths are concentrated in 11 countries, all but one of them in Africa.
The WHO has warned that the geographical footprint and intensity of vector-borne diseases such as malaria are set to grow with global warming. Scientists expect mosquitoes will reproduce faster as temperatures rise, increasing the likelihood of disease transmission.
Cities in coastal areas in Africa are becoming more vulnerable to frequent seasonal flooding, which also increases the risk of vector-borne diseases, and extreme weather events are on the rise. South Africa experienced torrential flooding on an unprecedented scale on its eastern seaboard in 2022. This year Mozambique received more than a year’s rainfall in four weeks.
Meanwhile, some areas face alternating floods and drought, which is accelerating migration to cities, where malaria outbreaks may become more common.
The spread of Anopheles stephensi, an invasive mosquito species that thrives in cities and can transmit both Plasmodium falciparum and Plasmodium vivax malaria parasites, is a new threat. The mosquito, which is native to South Asia and the Arabian Peninsula, has been detected in a growing number of African countries and is resistant to many insecticides in current use. Scientists are investigating links between climate change and the spread of the species.
The WHO considers the invasion of Anopheles stephensi to be a major potential threat to malaria control and elimination in Africa. If Anopheles stephensi establishes itself in Africa’s fast-growing cities, malaria cases could increase rapidly, and undermine the gains made in reducing the burden of disease.
As the impact of climate change evolves, other biological threats are causing concern. Mosquitoes that transmit malaria are developing resistance to the insecticides used to repel or kill them. In addition, there is growing parasite resistance to artemisinin, the main component of the best available medicines to treat malaria. Resistance first emerged in South-East Asia but is now increasing on the African continent. The urgency and potential implications of antimalarial drug resistance have generated a call to action within the global health community. In November 2022, WHO published a Strategy to respond to antimalarial drug resistance in Africa – a technical and advocacy document aimed at minimizing the threat and impact of artemisinin resistance.
Encouragingly, a spate of innovations, many of them funded by Unitaid, are meeting the challenges head-on and show potential to radically alter the landscape.
A top priority is to ensure the continued effectiveness of insecticide-treated nets and mitigate resistance. Insecticide-treated nets have been a mainstay of the malaria response for decades, and remain, as WHO states, an essential “pillar of malaria control.”
Unitaid is working on new vector control tools that are predicted to deliver a reduction in malaria by more than a quarter by 2030. Promising initiatives include new bed nets with different combinations of insecticides to counter mosquito resistance; spatial repellents that release chemicals into the air to prevent mosquitoes from biting humans within a given space; and treatment of humans and livestock with drugs that kill mosquitoes who bite them.
“A complex array of issues including climate change and insecticide resistance are bearing down on efforts to control malaria in Africa,” said Unitaid’s Executive Director, Philippe Duneton. “Unitaid is committed to ensuring widespread adoption of a new generation of vector control tools to ensure we have what it takes to beat the disease.”
Treatments to prevent malaria in pregnant women and children at risk of infection in the rainy season, as well as new malaria vaccines, are also gaining traction as years of pioneering work funded by Unitaid pays off. In its strategy to respond to antimalarial drug resistance in Africa, WHO lists chemoprevention and vaccines as key interventions. Although vaccine hesitancy or refusal remains a concern.
There is no time to lose. The evidence shows we are falling well behind ambitious WHO targets to reduce malaria case incidence and mortality rates by at least 75 per cent by 2025 and at least 90 percent by 2030, from a 2015 baseline.
Funding is less than half of what is required globally to stay on course to end malaria as a major public health threat.
In view of the tight funding constraints, we need to step up the pace of R&D, product introduction, and market-shaping activities. Overcoming barriers to accessing promising innovations will be critical to getting Africa back on a path to malaria elimination.
Unitaid is soliciting proposals and investment partners to mitigate antimalarial drug resistance in Africa and will soon launch a call for proposals to build effective delivery strategies for new vector control tools to catalyze adoption and address emerging threats.
Africa has a huge role to play in advancing the fight against malaria. “With Africa bearing such a heavy disease burden, there is a strong need for African leadership to tackle malaria, based on robust primary health care services and accelerated introduction of new products and techniques.,” said H.E. Ambassador Margarida Rosa Da Silva IZATA, Head of the African delegation to the Unitaid Executive Board.
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Global Fund and Unitaid Welcome WHO Recommendation for Insecticide-treated Nets With Dual Active Ingredients
GENEVA – The Global Fund to Fight AIDS, Tuberculosis and Malaria and Unitaid welcome WHO’s recommendation for the widespread use of a new class of mosquito net that uses two active ingredients – pyrethroid and chlorfenapyr. The new net has demonstrated approximately double the protection against malaria provided by the standard pyrethroid-only nets in areas where mosquitoes have already developed resistance to pyrethroids.
Randomized controlled trials in Tanzania and Benin over a two-year period demonstrated that the dual active ingredient insecticide-treated nets reduced malaria infections by approximately 50% among children between the ages of 6 months and 10 years.
Children and pregnant women are particularly vulnerable to malaria. According to the 2022 World Malaria Report, almost 80% of malaria deaths occur in children under 5. Most of the remaining deaths occur in children under 10 and pregnant women, especially in sub-Saharan Africa.
“This shows how we can accelerate impact by embracing innovation,” said Peter Sands, Executive Director of the Global Fund. “The issuance of guidance by WHO is critical to influencing broad uptake of the new nets and to combat growing insecticide resistance across Africa, where nearly all malaria infections and related deaths occur.”
“Widespread use of insecticide-treated nets is credited with nearly 70% of the reduction in malaria cases achieved in Africa in the first 15 years of this century,” said Dr. Philippe Duneton, Executive Director of Unitaid. “But as mosquitoes have grown increasingly resistant to the insecticides, the efficacy of this critical tool has dwindled. Unitaid is delighted to contribute to efforts to quickly add a powerful new tool to our malaria-fighting arsenal.”
Growing pyrethroid resistance in mosquitoes is likely to be a major contributor to the plateauing progress against malaria seen in recent years. With additional setbacks caused by disruptions and delays to services from the COVID-19 pandemic, the malaria response is in desperate need of new tools to kick-start progress.
The New Nets Project, a joint Unitaid and Global Fund-supported initiative with US$33 million invested from each agency, played a catalytic role in the introduction of the new nets, including market interventions to support affordability. Led by Innovative Vector Control Consortium (IVCC), the project – with its unique design of parallel collection of epidemiological and entomological data and cost-effectiveness studies – significantly reduced the timeline for entry of the new nets into the market and wide-scale adoption.
The respective national malaria programs were closely involved at each stage of the project. They invested the necessary leadership, resources, and technical expertise throughout the evidence-gathering stages of the project and will now be actively engaged in tailoring new tools and interventions to their unique contexts.
The New Nets Project, over four years between 2018 and 2022, has deployed over 35 million nets across the 14 countries that account for nearly 70% of all malaria cases and deaths worldwide, providing protection to more than 60 million people so far. The countries covered include Benin, Burkina Faso, Burundi, Cameroon, Côte d’Ivoire, Democratic Republic of the Congo, Ghana, Liberia, Malawi, Mali, Mozambique, Niger, Nigeria, and Rwanda.
Within the framework of the New Transition Initiative (2021-2024), the Global Fund continues to invest US$50 million in catalytic funding to support the transition to the new generation nets, help scale them up and, ultimately, achieve price decreases so that as many people as possible can benefit from them. An estimated 38 million nets will be distributed as part of this initiative.
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About the Global Fund
The Global Fund is a worldwide partnership to defeat HIV, TB and malaria and ensure a healthier, safer, more equitable future for all. We raise and invest more than US$4 billion a year to fight the deadliest infectious diseases, challenge the injustice which fuels them and strengthen health systems in more than 100 of the hardest hit countries. Since the beginning of the COVID-19 pandemic, we have invested an additional US$4.4 billion to fight the new pandemic and reinforce systems for health. We unite world leaders, communities, civil society, health workers and the private sector to find solutions that have the most impact, and we take them to scale worldwide. Since 2002, the Global Fund partnership has saved 50 million lives.
Information on the work of the Global Fund is available at www.theglobalfund.org
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About Unitaid
Unitaid is a global health agency engaged in finding innovative solutions to prevent, diagnose, and treat diseases more quickly, cheaply, and effectively, in low- and middle-income countries. Its work includes funding initiatives to address major diseases such as HIV, malaria, and tuberculosis, as well as HIV co-infections and co-morbidities including advanced HIV disease, cervical cancer, and hepatitis C, and cross-cutting areas, such as fever management. Unitaid is now applying its expertise to address challenges in advancing new therapies and diagnostics for the COVID-19 pandemic, serving as a key member of the Access to COVID-19 Tools (ACT) Accelerator, co-leading with Wellcome the Therapeutics Pillar and participating in the Diagnostics Pillar. Unitaid is hosted by the World Health Organization.
Nearly three-quarters of a million young lives saved as seasonal malaria chemoprevention marks 10 years since start of first pilots
Geneva, 2 March 2023 – Ten years after implementation of the first small-scale pilot program in Nigeria began, seasonal delivery of antimalarial medicines has saved the lives of 700,000 children under five and prevented 160 million infections. A new report published today highlights the coordinated global effort that contributed to this success. This includes Unitaid’s pivotal role, whose backing built the foundations for broad implementation and increased quality-assured supplies of the key preventive drugs needed to facilitate scale-up.
Seasonal Malaria Chemoprevention (SMC) relies on a mobilized team of community healthcare workers who deliver malaria prevention drugs to children monthly during the rainy season, reaching remote communities despite downpours, flooding, and washed-out roads. Although the World Health Organization recommended SMC in 2012, many believed that at-scale implementation would be too challenging to deliver meaningful reductions in malaria rates.
According to the report, despite many countries’ efforts to advance SMC pilots, the intervention struggled to garner momentum until Unitaid stepped in. The ACCESS-SMC project, implemented by the Malaria Consortium, demonstrated delivery at scale in seven countries, reaching a quarter of all eligible children at that time. That work proved community-delivery of SMC to be a feasible and cost-effective approach, preventing more than 88% of malaria infections among children at greatest risk.
Nearly all malaria infections and deaths occur in the African region, and 80% of deaths occur among children under five, who have not yet developed immunity to the parasite. SMC was initially targeted at countries in the Sahel region, where four months of heavy rain causes malaria infections to spike.
“Despite strong interest from countries in the years following the WHO recommendation, Unitaid saw that inadequate financing and supply challenges were standing in the way of realizing the full impact of seasonal malaria chemoprevention,” said Dr Philippe Duneton, Executive Director of Unitaid. “Working in collaboration with national programs and partners, we proved that SMC is not simply feasible, but highly effective in preventing malaria, and affordable to deliver at scale – paving the way for the massive uptake we have seen as a result.”
“The scale of seasonal malaria chemoprevention in 2023 speaks for itself. The catalytic funding, provided by Unitaid through the ACCESS-SMC program led by Malaria Consortium, enabled a transformative and sustained expansion of SMC across the Sahel region,” said Dr James Tibenderana, Chief Executive of the Malaria Consortium. “The unprecedented pace and scale were possible through the leadership of national malaria programmes, working closely with their sub-national structures and the commitment of health workers and communities. The success of SMC in the Sahel has spurred the expansion of the highly effective intervention to parts of East and Southern Africa, where we are working with national programmes in Mozambique, Uganda and South Sudan to introduce and scale SMC to suitable areas.”
Inadequate supplies of properly dosed, quality-approved medicines used in SMC presented a second significant barrier to wide-scale implementation. Through support to Medicines for Malaria Venture, Unitaid has worked to bring additional manufacturers to market and develop child-friendly formulations.
Today, a full four-month course of SMC costs less than US$4 per child. This was achieved through concerted efforts to increase demand, foster healthy market competition, and optimize delivery methods, resulting in a 20% reduction in the cost of delivery by the end of ACCESS-SMC in 2018.
Over the past decade, SMC coverage has surged, reaching a record 45 million children in 2021 compared to just over 1 million in 2013. The intervention is now a cornerstone of malaria control programs in 15 African countries, and its impact continues to accelerate.
Last year, the WHO expanded their recommendations to include children over five as well as additional regions where seasonal malaria transmission occurs. The new guidance is expected to see continued growth, protecting even greater numbers of children at serious risk from malaria.
About Unitaid
Unitaid is a global health agency engaged in finding innovative solutions to prevent, diagnose, and treat diseases more quickly, cheaply, and effectively, in low- and middle-income countries. Its work includes funding initiatives to address major diseases such as HIV, malaria, and tuberculosis, as well as HIV co-infections and co-morbidities including advanced HIV disease, cervical cancer, and hepatitis C, and cross-cutting areas, such as fever management. Unitaid is now applying its expertise to address challenges in advancing new therapies and diagnostics for the COVID-19 pandemic, serving as a key member of the Access to COVID-19 Tools (ACT) Accelerator, co-leading with Wellcome the Therapeutics Pillar and participating in the Diagnostics Pillar. Unitaid is hosted by the World Health Organization.
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Bed nets treated with new insecticide combinations reduced malaria infections by nearly half among children in Benin, according to new study
- New bed nets could put malaria efforts back on track to tackle rebounds in transmission observed across sub-Saharan Africa in the past few years
- Research funded by global health agencies Unitaid and the Global Fund through the New Nets Project has confirmed the high efficacy of a new type of bed net in reducing malaria
- Bed nets are a cornerstone in the malaria response and contributed significantly to the decline in malaria cases and deaths between 2000 and 2015 but growing insecticide resistance to existing products has led to diminishing rates of effectiveness
- Interceptor® G2 bed nets use a new insecticide for combatting mosquitoes, providing an urgently needed alternative to kick-start plateauing progress against malaria
- More than 60 million people are being protected by the new nets, with study results from Benin completing the evidence base necessary to inform a recommendation for scale from the World Health Organization
Geneva – Bed nets treated with a novel class of insecticide reduced malaria infections by 46% among children between the ages of 6 months and 10 years in a randomized controlled trial in Benin, as published in The Lancet this week.
The trial was conducted as part of the New Nets Project, a massive effort co-financed by global health agencies Unitaid and the Global Fund and led by the Innovative Vector Control Consortium (IVCC). The project responds to the critical need for updated tools to combat growing mosquito resistance across Africa, where nearly all malaria infections and related deaths occur.
Children and pregnant women are particularly vulnerable to malaria. According to the 2022 World Malaria Report, almost 80% of malaria deaths occur in children under five, and most of the remaining deaths occur in children under 10 and pregnant women.
“Insecticide-treated bed nets are a cornerstone of the malaria response and have played a key role in averting billions of cases of malaria over the past two decades,” said Dr Philippe Duneton, Executive Director of Unitaid. “But growing resistance is threatening our progress. Unitaid is extremely hopeful that these new bed nets will reignite the malaria response and reclaim the gains lost in recent years.”
“This new generation of mosquito nets, which reduces malaria cases in children under five by almost half [in a second consecutive pilot program], is a timely breakthrough which demonstrates the power of public-private partnerships,” said Peter Sands, Executive Director of the Global Fund. “The deployment of these highly efficient new nets at scale, together with other core malaria prevention tools like seasonal malaria chemoprevention, can help us protect people more efficiently and effectively and thus reverse recent setbacks in in the fight against malaria.”
Enormous reductions in the malaria burden in the early part of this century are credited in large part to the massive deployment and use of bed nets across Africa. However, as mosquitoes have grown increasingly resistant to the insecticides used in those products, efficacy has dwindled, and this has contributed to slowing progress against malaria.
With additional setbacks caused by disruptions and delays to services from the COVID-19 pandemic, the malaria response is in desperate need of new tools to kick-start progress.
The Interceptor® G2 bed nets used in the Benin study employ a new class of insecticides for combating mosquitoes – the first in more than 30 years. The nets serve a dual purpose: they create a physical barrier that protects those sleeping under them while long-lasting insecticides work to kill mosquitoes, dramatically reducing the number malaria cases in affected communities.
Over the two-year study, the Interceptor® G2 nets delivered significantly improved protection from malaria compared to standard nets. Notably, this research, led by the Centre de Recherche Entomologique de Cotonou and the London School of Hygiene and Tropical Medicines, provides the last piece of scientific evidence needed for the World Health Organization to issue updated policy guidance, which is critical to influencing broad uptake of the new tools in countries affected by insecticide resistance.
The New Nets Project is an innovative partnership initiative that is working to address evidence gaps and establish a sustainable market for new nets. The project is running operational pilots across a range of contexts to determine the cost-effectiveness of the new products to support their broad uptake and evidence-based deployment.
The New Nets Project has already deployed over 35 million nets across 14 countries that account for nearly 70% of all malaria cases and deaths worldwide, providing protection to more than 60 million people so far. The countries covered include Benin, Burkina Faso, Burundi, Cameroon, Côte d’Ivoire, Democratic Republic of Congo, Ghana, Liberia, Malawi, Mali, Mozambique, Niger, Nigeria, and Rwanda.
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Unitaid seeks to fund urgent measures to counter growing risk of antimalarial drug resistance in Africa
Proposals are welcomed until 11 August 2023
Geneva – The COVID-19 pandemic caused new setbacks in the fight against malaria, which had been experiencing plateauing progress even before the outset of the pandemic. Now, the latest World Malaria Report, published on 8 December, highlights the growing threat of resistance to a key compound used in the best available malaria treatments across Africa, where almost all malaria cases and deaths occur.
In response to this looming emergency, Unitaid is calling for proposals aimed at mitigating the threat of antimalarial drug resistance by diminishing reliance on the most widely used malaria treatment. These measures are also critically important to preserving the efficacy of a promising alternative antimalarial treatment candidate in the development pipeline.
The World Health Organization currently recommends six treatments for malaria that use artemisinin in combination with a partner drug. However, partial resistance to artemisinin is already emerging across Africa, threatening the efficacy of the medicines and increasing the risk of complete treatment failure.
One artemisinin combination therapy in particular is employed far more widely than any other across the continent. This treatment, called artemether–lumefantrine, is the only one used to treat malaria infections in 30 countries across Africa, despite alternatives being included in national policy guidance. It also makes up 80% of all the antimalarial treatments purchased through donor-funded procurement mechanisms.
However, the partner drug lumefantrine is also one of the two drugs used in the most advanced non-artemisinin-based treatment in the development pipeline, and the already growing threat of artemisinin partial resistance could trigger the rapid spread of lumefantrine resistance, derailing the potential new treatment.
Shifting reliance to alternative malaria treatments is critically important to preserving this life-saving malaria-fighting tool and futureproofing for coming innovations.
Unitaid seeks to fund interventions that will reduce dependence on a single treatment by diversifying markets, driving down costs, and addressing supply barriers to increase uptake of effective alternative treatments.
Proposals should place a priority focus on countries in Africa where artemisinin resistance has already been detected, where declined efficacy of artemisinin-based treatments has been observed, or where the risk of resistance is high, such as in countries with a high burden of malaria infections.
Find out more about this latest funding opportunity here
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A record 45 million children accessed seasonal malaria chemoprevention in 2021 thanks to Unitaid’s pioneering investments
Geneva – Unitaid welcomes the news published in the 2022 World Malaria Report that a record number of children were protected through seasonal delivery of antimalarial medicines in 2021.
This intervention, called seasonal malaria chemoprevention, reduces malaria infections by more than 70% among children who are at greatest risk of infection and death from malaria. Unitaid pioneered adoption of this preventive strategy through an enormous initiative that proved its effectiveness. The project also confirmed such delivery could be achieved at scale and significantly expanded the market to support broad implementation.
According to the World Malaria Report, approximately 95% of all cases and deaths from malaria occur in Africa. Children are by far the most affected, and those under the age of 5 account for nearly four out of five deaths. Almost all the remaining deaths occur in children under 10 and pregnant women.
Since Unitaid first invested, access to seasonal malaria chemoprevention has grown from approximately 1 million children in 2013 to nearly 45 million children across 15 countries last year. More than half a million children’s lives have been saved as a result.
The Unitaid-funded initiative alone reached 6 million children and covered more than 25% of the region’s needs at the time. This broad and successful demonstration sparked broader uptake, with a number of governments and scale-up partners quickly stepping in to implement it widely.
“Children continue to suffer the most serious consequences of the malaria epidemic. Last year alone, nearly half a million children in Africa died from malaria and countless more suffered severe illness. When Unitaid first invested to expand access to seasonal malaria chemoprevention, only 5% of eligible children were covered. To see 45 million children receiving life-saving prevention across the region today is an incredible achievement and a testament to the success of Unitaid’s model,” said Dr Alexandra Cameron, Senior Technical Manager at Unitaid.
At the outset, seasonal malaria chemoprevention was considered too complex to be feasible, given the challenges of reaching children in remote communities during the rainy season. Unitaid, in collaboration with the Malaria Consortium and partners, demonstrated how to successfully deliver antimalarial prevention on a wide scale, paving the way for broad implementation.
To further improve malaria prevention, Unitaid worked with Medicines for Malaria Venture to bring in additional suppliers of the key antimalarial used in seasonal prevention and supported the development of child-adapted formulations.
Increased medicine supplies were critical to enabling the scale of coverage seen today. And child formulations, which are easy-to-swallow, sweet-flavored versions of medicines, make treatments more effective by making it simpler for caregivers to administer drugs to young children.
As a result of Unitaid’s work, the cost of delivery of seasonal malaria chemoprevention fell by more than 20%, helping stretch available funding to benefit greater numbers of people.
Earlier this year, the World Health Organization updated its recommendations to support broader use of seasonal malaria chemoprevention among young children at high-risk, removing the original 5-year age cap. The new guidance is expected to see even greater numbers of children benefitting from this safe, high-performing, and cost-effective intervention.
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Executive Board approves Unitaid’s urgent action to confront antimalarial drug resistance in high burden areas
Geneva – Meeting at its 41st session, Unitaid’s Executive Board discussed strategic direction for future investments, and voted to approve a new area for intervention to counteract growing resistance to antimalarial medicines in high burden areas.
This new area for investment is one of many global health challenges Unitaid plans to tackle and it prepares to begin the first year of implementation of an ambitious new five-year strategy, which will focus on enabling access to critical medicines and tools across low- and middle-income countries.
In support of these efforts, the Board voiced political support for long-term financial engagement from major donors, recognizing that reliable funding is critical to successfully delivering on its goals.
The new strategy builds on a strong foundation developed over the past 15 years. Using its investments in HIV self-testing as an example, Unitaid showcased how it has rapidly expanded access to HIV testing across low- and middle-income countries working through strong multi-agency partnerships. Self-tests have not only transformed a key element of the HIV response, they have paved the way for simplified testing and greater autonomy to identify a range of other health conditions including COVID-19, hepatitis C, HPV and others.
“With the new year on the horizon, Unitaid is moving into an exciting new chapter in our history. I am particularly proud to see the Board’s decision to respond to the scourge of antimalarial drug resistance in high burden countries, specifically, resistance threatening the efficacy of WHO-recommended medicines, as a key threat to our ability to deliver quality case management in the future,” said Dr Philippe Duneton, Executive Director of Unitaid.
“On the eve of 2023, the board is enthusiastic about deploying our new strategy. For Unitaid, innovation is access. Also, we are more eager than ever to actively pursue our mission to expand the reach of the best health products for those who need them most. The challenges are and will continue to be numerous and demanding but we are confident Unitaid has the strategy and the skills to be up to it” said Marisol Touraine, Chair of Unitaid’s Executive Board.
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