Une nouvelle initiative permettra d’améliorer la prévention du paludisme chez les enfants de moins de deux ans dans toute l’Afrique grâce à une intervention recommandée par l’OMS, mais encore sous-exploitée

  • A safe, effective, and affordable intervention for preventing malaria in infants (IPTi), has been recommended by the WHO since 2010, yet access remains limited.
  • The initiative seeks to maximize the benefits of the antimalarial intervention by increasing the number of doses administered and extending coverage beyond the currently recommended 9 months to protect children in their first two years of life.
  • Through a country-led, co-design process, the project will develop scalable IPTi delivery models and generate compelling evidence to catalyze wide-spread roll-out of this life-saving intervention in high-burden countries across Africa. Four countries, Benin, Cameroon, Côte d’Ivoire, and Mozambique will initially be targeted by this initiative.

Geneva / Washington, DC, 15 September 2021 – To kick-start progress against malaria and improve child health in Africa, a new initiative, funded by Unitaid and led by Population Services International (PSI), will support widespread adoption of an effective but underutilized prevention method that could avert 6.7 million cases of malaria and anemia in children under two by 2030.

Intermittent Preventive Treatment of malaria in infants (IPTi) with sulfadoxine-pyrimethamine (SP) is a safe, affordable, and effective intervention shown to reduce rates of malaria and anemia in children under one year of age by 30 percent and 21 percent respectively. The World Health Organization (WHO) recommended IPTi for use in 2010, yet the intervention has not been widely adopted in Africa.

With a US $35 million investment from Unitaid, the Intermittent Preventive Treatment in infants – Plus (IPTI+) project will develop scalable models of IPTi+, an innovation on the WHO-recommended IPTi, that expands the number of preventive doses of SP administered to children and extends coverage of IPTi through a child’s second year of life. Over the life of the project, the IPTi+ project will administer an estimated 2.5 million doses of SP for IPTi+ protecting over half a million children under two years of age from malaria and anemia.

Brought to scale, IPTi+ will help reignite progress against malaria in the Africa region, where 94 percent of all malaria cases and deaths occur each year. Progress in reducing malaria rates has plateaued in recent years and the COVID-19 pandemic has caused additional setbacks and interruptions to malaria efforts across the continent.

IPTi+ targets a crucial population: children under the age of five accounted for nearly 70% of the estimated 409,000 malaria deaths globally in 2019. Children under two years of age are among the most vulnerable to malaria; half of child deaths from malaria (54%) are estimated to have occurred in children under the age of two.[1]

“We cannot afford to leave any effective tool unused in our fight against malaria, or we will see our hard-won progress slip away. Unitaid is pleased to announce this major effort to reach hundreds of thousands of young children with IPTi+ – a highly effective but greatly under-utilized intervention for malaria prevention. This latest investment rounds out Unitaid’s work to innovate on all the current antimalarial interventions and improve access we can reignite the fight against malaria and drive down the burden of disease,” said Dr Philippe Duneton, Executive Director of Unitaid.

Widespread adoption of IPTi has faced challenges including misperceptions about the effectiveness of the recommended drug, sulfadoxine-pyrimethamine, a lack of evidence on its efficacy in areas of moderate to high resistance, and a lack of enabling policies. As administration of IPTi can fall within the remit of child health, malaria, and immunization programs, unclear delineation of responsibilities has also contributed to unsuccessful adoption.

The IPTI+ project will address these challenges at a country and global level to accelerate adoption and scale-up of IPTi+ with sulfadoxine-pyrimethamine.  At the country-level, the IPTi+ project will facilitate a country-led co-design process to design IPTi+ models specific to each country in Benin, Cameroon, Côte d’Ivoire, and Mozambique. These four countries represent diverse health systems, malaria transmission, SP resistance, routine health service access, and implementation of other seasonal antimalarial interventions.

“PSI is proud to be working with the Ministries of Health in Benin, Cameroon, Cote d’Ivoire, and Mozambique, as well as county-level and global malaria partners, and the London School of Hygiene & Tropical Medicine, to accelerate adoption and scale-up of IPTi+. PSI and our partners will engage and convene communities and stakeholders to co-design country-specific IPTi+ models that overcome known barriers to uptake; shape mixed health systems to bring IPTi+ closer to Sara, PSI’s archetypal consumer, and her family; and generate evidence on the impact of IPTi+,” said Karl Hoffman, President and CEO of PSI.

To ensure scalability of the IPTi+ models being developed, Unitaid is also expanding the scope of an existing and complementary grant, implemented by the not-for-profit product development partnership Medicines for Malaria Venture (MMV). In addition to collaborating with the IPTi+ Project to deliver existing formulations of SP, MMV will work with selected African manufacturers to support local production of properly dosed, dispersible, and quality-assured formulations of SP that are suitable for children to future-proof supply of the medicine.

The project will collect evidence on impact, cost-effectiveness, and feasibility of IPTi+ across variable settings to inform scale-up in target countries and beyond. In addition to piloting implementation models in the four focus countries, the IPTi+ project will generate policy, economic, and suitability evidence on IPTi+ in three additional countries.

“In the past five years, annually, there have been approximately 4 million malaria cases and 400,000 hospital admissions for malaria in children under 5 years in Cameroon. To address this, we hope that introducing IPTi+, in addition to the use of long-lasting insecticide nets, will enable us to further reduce the malaria incidence and hospital admissions contributing to healthier and happier families. The National Malaria Control Program is excited to work with the IPTi+ Project and two renowned public health institutions, PSI and LSHTM, to introduce and increase access to IPTi+ and ensure accurate monitoring and evaluation of IPTi+ in Cameroon,” said Dr. Dorothy Fosah Achu, Permanent Secretary, National Malaria Control Program, the Ministry of Public Health, Cameroon.

PSI will coordinate the project co-design and implementation in collaboration with Ministries of Health and country teams. The London School of Hygiene & Tropical Medicine (LSHTM) will lead research that will generate evidence to inform country and global-level adoption and scale-up of IPTi+.

[1] Malaria deaths among children under age 2 as a proportion of malaria deaths among children under age five estimated from Global Burden of Disease 2019 data.

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/AIDS, malaria, and tuberculosis, as well as HIV co-infections and co-morbidities such as 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. Unitaid is hosted by the World Health Organization. www.unitaid.org

About Population Services International (PSI)

Population Services International (PSI) is a global nonprofit organization focused on encouraging healthy behaviors and delivering affordable health products and services around the world. We bring innovation to scale through our presence in 40+ countries and a network of over 10,000 health clinics and pharmacies. PSI takes a business approach to saving lives, designing effective, scalable, and sustainable solutions to the world’s biggest challenges in healthcare.

About the London School of Hygiene & Tropical Medicine (LSHTM)

The London School of Hygiene & Tropical Medicine (LSHTM) is a world-leading centre for research, postgraduate studies and continuing education in public and global health. LSHTM has a strong international presence with over 3,000 staff and 4,000 students working in the UK and countries around the world, and an annual research income of £180 million. LSHTM is one of the highest-rated research institutions in the UK, is partnered with two MRC University Units in The Gambia and Uganda, and was named University of the Year in the Times Higher Education Awards 2016. Our mission is to improve health and health equity in the UK and worldwide; working in partnership to achieve excellence in public and global health research, education and translation of knowledge into policy and practice.

Media contacts

Hervé Verhoosel, Unitaid, Geneva | verhooselh@unitaid.who.int | tel. +44 77 29 618 634

Maggie Zander, Unitaid, Geneva | zanderm@unitaid.who.int | tel. +41 79 593 17 74

Christine Vargas, PSI, Washington D.C. | cvargas@psi.org  | tel. +1 202 235 1875

Transforming IPT for Optimal Pregnancy (TIPTOP) Project and Output 1 of the Supply Side Grant, End-of-Grant Evaluation Report

Lancement d’un nouveau partenariat pour accélérer l’élimination du paludisme récidivant à P. vivax qui menace environ 2,5 milliards de personnes dans le monde

  • The Partnership for Vivax Elimination (PAVE) will support endemic countries in achieving their Plasmodium vivax (P. vivax) malaria elimination goals.
  • PAVE will advance the development of quality-assured, child-friendly treatments for relapse prevention, and generate and consolidate evidence to support malaria-endemic countries in developing and implementing new strategies to eliminate P. vivax malaria.

Geneva/Seattle, 14 July 2021 – The new Partnership for Vivax Elimination (PAVE) launching today, will support countries in the elimination of P. vivax – a complex and persistent type of malaria that poses a risk to more than one-third of the world’s population.

As part of PAVE, Medicines for Malaria Venture (MMV), PATH, Menzies School of Health Research, and Burnet Institute will work with in-country partners to conduct feasibility studies looking at the best way to use different P. vivax relapse treatments and diagnostics at different levels of the healthcare system in endemic countries including Brazil, Ethiopia, India, Indonesia, Papua New Guinea, Peru and Thailand.

PAVE will also continue to support countries, including Cambodia, Colombia, Lao PDR, and Vietnam, with market analytics and readiness planning for new tools and approaches as they seek to optimize P. vivax case management according to World Health Organization (WHO) guidance and accelerate progress towards their malaria elimination goals.

PAVE is led by MMV and PATH and combines a new investment of USD 25 million from Unitaid with work under existing grants from the Bill & Melinda Gates Foundation, the UK Foreign, Commonwealth and Development Office (FCDO) and MMV core funding.  Consolidating these projects under PAVE will ensure coordination of efforts and clear communications with partners around the world. Recognizing that even more work is needed, PAVE will provide a vehicle for advocacy to bring further attention and resources to the challenge of eliminating P. vivax malaria.

Accounting for between 5.9 and 7.1 million estimated clinical cases every year, P. vivax is the most common type of malaria outside of sub-Saharan Africa. It presents a major challenge to achieving global malaria targets because of the difficulties in eliminating hypnozoites, a form of the parasite that remains in a person’s liver even after successful blood-stage treatment, leading to malaria relapses and contributing significantly to transmission.

Tackling P. vivax, by treating both the blood- and liver-stages of infection – known as radical cure – is essential to achieve the WHO 2030 targets of reducing global malaria case incidence by at least 90% and eliminating malaria transmission in 35 countries; as well as target 3.3 of the Sustainable Development Goals: end the epidemics of AIDS, TB, and malaria by 2030.

PAVE will continue to work closely with the WHO, National Malaria Control Programmes, and country-based partners to support the introduction and use of effective diagnostics and treatments for P. vivax malaria, including shorter-course primaquine and single-dose tafenoquine liver-stage treatments and better point-of-care glucose-6-phosphate dehydrogenase (G6PD) diagnostics needed to identify patients that are at risk of having adverse reactions to the class of drugs currently used for liver-stage treatments. Patients with the genetic disorder known as G6PD deficiency need to be screened because they are at risk of developing haemolytic anaemia when taking these drugs.

GSK and MMV have developed a paediatric version of tafenoquine, which is currently under review by regulators. PAVE aims to add to this and complete the full set of relapse prevention treatments suitable for children by supporting, with funding provided by Unitaid, the development of a quality-assured, child-friendly formulation of primaquine.

“Malaria elimination is one of the main objectives of the Ministry of Health of Peru. For this reason, MINSA appreciates the support of the PAVE initiative to find new tools for an optimized radical cure for the treatment of P. vivax malaria. This will contribute to the National Malaria Elimination Program’s “Plan Malaria Cero” (Plan Zero Malaria). Said Veronica Soto Calle, Executive Director of the Directorate for the Prevention and Control of Metaxenic Diseases and Zoonoses, Ministry of Health of Peru (MINSA). “In this sense, we salute the launch of PAVE, an expansion of the VivAccess initiative, and its commitment to supporting endemic countries in their efforts to eliminate malaria.”

“With COVID-19-related interruptions threatening progress against malaria, investing in game-changing innovations remains one of our best chances to advance the frontier towards the elimination of malaria in all countries. By accelerating the adoption of a shorter radical cure and better diagnostics, we can reduce the burden of P. vivax malaria and draw the line against this disease,” said Philippe Duneton, Executive Director of Unitaid.

“We are thrilled to further expand this important work,” said Elodie Jambert, Director, Access and Product Management at MMV. “Families and communities affected by relapsing malaria have been suffering for too long. The new paediatric treatment options, and the real-world evidence that we will generate as part of PAVE, will represent a big step forward in eliminating this disease.”

“PATH is excited to continue our close engagement with MMV started under the VivAccess grant in working to generate evidence that will support scale-up of life-saving drugs and diagnostics for P. vivax malaria” said, PATH’s Ethiopia Country Director, Tirsit Grishaw. “By combining efforts with the National Malaria Elimination Program as well as the National Malaria Elimination Strategy, PAVE will help shift the paradigm for P. vivax case management.”

About the Partnership for Vivax Elimination (PAVE)

PAVE combines a new investment of USD 25 million from Unitaid with existing work led by MMV and PATH to increase access to radical cure for P. vivax malaria; most notably the five-year VivAccess initiative funded by the Bill and Melinda Gates Foundation and launched by PATH and MMV in 2019, and involving the Clinton Health Access Initiative, Global Health Strategies, and Population Services International as implementing partners. PAVE also encompasses operational research funded by the UK Foreign, Commonwealth and Development Office (FCDO) currently ongoing in Lao PDR and Vietnam; as well as feasibility studies on the use of tafenoquine and point-of-care G6PD testing planned in Thailand and Brazil and funded with MMV core funds. These studies known as TRuST and ARCTIC are planned to be conducted in 2021.

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/AIDS, malaria, and tuberculosis, as well as HIV co-infections and co-morbidities such as 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. Unitaid is hosted by the World Health Organization.

About MMV

Medicines for Malaria Venture (MMV) is a leading product development partnership in the field of antimalarial drug research and development. Its mission is to reduce the burden of malaria in disease-endemic countries by discovering, developing and facilitating delivery of new, effective and affordable antimalarial drugs. Since its foundation in 1999, MMV and partners have built the largest portfolio of antimalarial R&D and access projects ever assembled, have brought forward 11 new medicines and have assumed the access stewardship of a further two. An estimated 2.7 million lives have been saved by these medicines. MMV’s success is based on its extensive partnership network of around 150 currently active partners, including from the pharmaceutical industry, academia and endemic countries. MMV’s vision is a world in which innovative medicines will cure and protect the vulnerable and under-served populations at risk of malaria and help to ultimately eradicate this terrible disease.

About PATH

PATH is a global non-profit dedicated to health equity. With more than 40 years of experience forging multisector partnerships, and expertise in science, economics, technology, advocacy, and dozens of other specialties, PATH develops and scales up innovative solutions to the world’s most pressing health challenges.

Media contacts
Hervé Verhoosel, Unitaid, Geneva | verhooselh@unitaid.who.int | tel. +44 77 29 618 634

Maggie Zander, Unitaid, Geneva | zanderm@unitaid.who.int | tel. +41 79 593 17 74

Akolade Omishope, MMV, Geneva | omishopea@mmv.org | tel. +41 79 896 20 61

Katy Athersuch, MMV, Geneva | athersuchk-consultant@mmv.org | tel. +33 61 999 56 21

Lindsay Bosslet, PATH, Seattle | lbosslet@path.org or media@path.org

Journée mondiale de lutte contre le paludisme : Unitaid s’engage à garantir un accès accru et équitable à des solutions de santé pour tous

Genève – À l’approche de la Journée mondiale de lutte contre le paludisme, célébrée chaque année le 25 avril, Unitaid réaffirme son engagement à intensifier ses efforts pour prévenir, contrôler et, à terme, éliminer la maladie.

L’émergence de la pandémie de COVID-19 il y a plus d’un an a profondément éprouvé les systèmes de santé et forcé de nombreux pays à réorienter les ressources normalement consacrées au paludisme. Cette situation menace d’annuler les gains durement acquis, en particulier dans les pays les plus touchés par le paludisme, où les progrès ont ralenti ces dernières années.

L’Organisation mondiale de la santé (OMS) avertit les pays que les perturbations des programmes de prévention et de traitement du paludisme pourraient entraîner un doublement des décès dus à la maladie en Afrique subsaharienne en 2020 par rapport à 2018.

Un nouveau rapport du Fonds mondial de lutte contre le sida, la tuberculose et le paludisme souligne la nécessité urgente d’intensifier les mesures d’adaptation adoptées pour contrer l’impact de COVID-19 afin de garantir la poursuite de la prestation de services de santé vitaux pour le paludisme.

“Bien qu’il soit possible de le prévenir et de le guérir, le paludisme tue encore plus de 400 000 personnes chaque année, dont la plupart sont des enfants. Les efforts mobilisés pour vaincre la COVID-19 ne doivent pas se faire au détriment des progrès réalisés contre cette maladie” a déclaré le Dr Philippe Duneton, Directeur exécutif d’Unitaid. “Aujourd’hui plus que jamais, nous devons redoubler d’efforts pour réduire la charge du paludisme dans le monde et sauver des vies en donnant accès à des traitements et des diagnostics essentiels aux personnes qui en ont le plus besoin”.

Tant que le paludisme existera, il continuera à peser sur les plus vulnérables et à perpétuer la pauvreté et les inégalités. Les efforts déployés pour contrôler et éliminer cette maladie contribuent directement à améliorer la santé et la prospérité économique des communautés, en augmentant leur capacité à relever des défis sanitaires nouveaux et inattendus.

Les pays qui ont investi dans la lutte contre le paludisme et son élimination bénéficient aujourd’hui de systèmes de santé renforcés, d’une meilleure gestion des cas et de mécanismes de surveillance accrue, ce qui a renforcé leur capacité à répondre à des épidémies comme celle de COVID-19 ainsi qu’à d’autres maladies infectieuses.

Alors que la pandémie se poursuit, les efforts de prévention du paludisme sont devenus encore plus essentiels pour réduire la transmission et la pression sur des systèmes de santé surchargés. Dans ce contexte, Unitaid s’est rapidement adapté, a renforcé ses investissements dans la prévention du paludisme et s’est concentré sur la continuité des services.

Le nouveau rapport du Fonds mondial de lutte contre le sida, la tuberculose et le paludisme souligne que les visites de premiers soins prénataux ont chuté de 43 % en 2020 par rapport à 2019 en raison de la pandémie de COVID-19. Le projet TIPTOP financé par Unitaid a facilité la délivrance d’un traitement antipaludéen essentiel pour les femmes enceintes en utilisant une approche communautaire innovante.

D’autres projets visant à développer de nouveaux outils pour la prévention du paludisme ont également fait de grands progrès. Le projet AEGIS lance des études cliniques au Kenya, au Mali et au Sri Lanka afin d’évaluer l’efficacité et la rentabilité de nouveaux répulsifs pour mieux prévenir le paludisme.

Dans le cadre du projet BOHEMIA, des essais sont prévus au Mozambique et en Tanzanie afin de vérifier si un traitement qui tue les moustiques après avoir piqué des humains ou du bétail peut contribuer à réduire la charge du paludisme.

D’autres initiatives à venir viseront à lutter contre le paludisme à Plasmodium vivax (P.vivax) qui est advantage present dans les pays proches de l’élimination dans toute la région Asie-Pacifique et en Amérique latine.

En 2018, les investissements consentis à l’échelle mondiale pour mettre fin au paludisme ont permis de sauver 600 000 vies et d’éviter près de 100 millions de cas par rapport aux niveaux de 2000. Selon un évaluation conduite par les chercheurs du Wellcome Trust concernant les coûts épidémiologiques et économiques de l’inaction dans la région Asie-Pacifique, l’élimination du paludisme d’ici 2030 pourrait sauver plus de 400 000 vies, prévenir 123 millions de cas et entraîner un retour sur investissement de 6:1.

Le moment est venu d’intensifier les efforts pour soutenir le développement d’innovations cruciales dans le domaine du paludisme et de veiller à ce qu’elles soient mises à la disposition de tous, partout, afin d’éliminer la maladie.

En savoir plus sur nos activités pour lutter contre le paludisme :

Contacts pour les medias:

Maggie Zander, tel. +41 79 593 17 74, zanderm@unitaid.who.int

Hervé Verhoosel, tel. +44 77 29 618 634, verhooselh@unitaid.who.int

Lutter contre les récidives de paludisme avec de nouveaux tests et traitements

Le financement d’Unitaid permet le lancement du premier centre de recherche sur les médicaments à action prolongée du monde à l’université de Liverpool

Genève – Les efforts visant à révolutionner les traitements contre les maladies infectieuses débilitantes ont été amplifiés aujourd’hui  avec le lancement d’un nouveau centre de recherche à l’université de Liverpool.

Créé dans le cadre d’un consortium international de recherche de 40 millions de dollars US, principalement financé par Unitaid, le Centre d’excellence pour les thérapies à action prolongée (CELT) de l’université de Liverpool sera le premier du genre au monde.

En transformant des médicaments existants en formulations à libération lente, efficaces pendant plusieurs mois, les technologies « à action prolongée » ont déjà été mises en œuvre avec succès dans les domaines de la contraception et de la schizophrénie.

Elles ont désormais le potentiel d’améliorer les résultats en matière de traitement et de prévention de maladies mortelles telles que le VIH, le paludisme, l’hépatite C et la tuberculose, qui touchent particulièrement les pays à faible et moyen revenu.

Les médicaments actuels contre ces maladies ont souvent donné de mauvais résultats dans des environnements à faibles ressources, car les personnes atteintes de maladies doivent se battre avec des régimes qui peuvent impliquer la prise de dizaines de comprimés chaque jour et dépendent d’un accès régulier aux établissements de soins.

La mission du CELT est d’approfondir les connaissances sur les médicaments à longue durée d’action et de diffuser les résultats des recherches clés, dans le but de révolutionner la manière dont ces maladies dévastatrices sont traitées, en particulier dans les pays où l’accès aux soins de santé est difficile.

Les travaux seront menés dans deux laboratoires de pointe de l’université de Liverpool, où la mise au point de formulations à longue durée d’action pour la prévention du paludisme et de la tuberculose, ainsi que la mise au point d’un traitement par injection unique pour l’hépatite C, sont déjà en cours dans le cadre du projet LONGEVITY financé par Unitaid. Dans le cas de la prévention du paludisme, par exemple, l’objectif est de couvrir un individu pendant toute la saison du paludisme avec une seule injection.

Parallèlement, en facilitant la collaboration entre les scientifiques œuvrant dans les domaines de la pharmacologie et de la chimie des matériaux, ainsi qu’avec les partenaires mondiaux, le CELT veillera à ce que les médicaments à action prolongée soient conçus de manière sure et en tenant compte des besoins spécifiques des communautés touchées.

D’autres projets visent à aider les chercheurs à mieux comprendre les facteurs clés de succès des approches à longue durée d’action par voie orale, injectable et implantable.

Philippe Duneton, Directeur exécutif d’Unitaid, a déclaré : « Il y a des décennies, les médicaments à action prolongée ont révolutionné des domaines tels que la schizophrénie et la contraception. Aujourd’hui, nous souhaitons permettre l’utilisation d’innovations similaires pour soutenir les efforts mondiaux visant à combattre, voire à éliminer les principales maladies qui touchent les pays à revenu faible et intermédiaire, dont le VIH. Le pipeline des nouveaux produits à action prolongée est prometteur. En tant que financeur d’initiatives pilotes, nous sommes enthousiastes de soutenir l’Université de Liverpool et d’autres partenaires qui ouvrent la voie à cet égard. »

Le co-directeur du CELT, le professeur Andrew Owen, a déclaré : « Fournir des médicaments à action prolongée promet de transformer la prise en charge des patients, avec un impact potentiel énorme pour le traitement et la prévention des maladies infectieuses. Ces produits ont l’avantage de résoudre certains problèmes liés au fait que des patients ne prennent parfois pas leurs médicaments. Ils peuvent également contribuer à réduire l’émergence de la résistance aux antimicrobiens. Le CELT s’appuie sur le potentiel de la collaboration à l’échelle locale, nationale et internationale pour accélérer le développement des médicaments du futur. »

Contact pour les médias: Maggie Zander | +41 79 593 17 74 | zanderm@unitaid.who.int

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