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Column: looking for good news on the road to zero malaria deaths

January 23, 2014 - 20:40 -- Ingeborg van Schayk
Caminante, no hay camino. Se hace camino al andar. 
Traveller, there is no road. We make the road by walking.
Antonio Machado (1875-1939)
 
By George Jagoe
 
In 2011, RBM revised one of its key objectives for the Global Malaria Action Plan (GMAP):  it called for reducing “global malaria deaths to near zero by end 2015”. Shortly thereafter, Dr. Robert Newman, Director of WHO’s Global Malaria Programme commented:  “Reducing malaria deaths to near-zero is the right goal, a goal that we need to make every conceivable effort to achieve. But, let us be clear, it is also a wildly ambitious goal.” (1)

The recently released World Malaria Report 2013 shares the encouraging news that deaths from malaria in 2012 continued a positive downward trend: 627.000, a 2% reduction compared to 640.000 in 2011 and a 7% drop since 2010. (2) Yet with less than two years left to reach the goal of zero deaths, the target seen as 'wildly ambitious' in 2011 appears even more elusive today,  an impression corroborated by MalariaWorld readers, 100% of whom said 'no' when asked “will we reach zero deaths by 2015?” (3)

We have a choice as a malaria community. For the next two years, we may question the wisdom of setting a global Zero-Death target for 2015 and we can look for flaws in the aspiration. Or, during the countdown, we can amass evidence from victories along the road to Zero Deaths — examples showing us that indeed, in communities mobilized around this goal, no one needs to die from malaria. Today, we have an ample choice of tools and approaches to slash mortality immediately. Celebrating the work of those who have achieved small-scale wins is instructive and even inspirational — to keep us motivated and focused on the work at hand.

In the end, 'Zero Deaths' worldwide is the aggregation of hundreds of local victories. For now, as a newcomer to MalariaWorld, I’m shining a spotlight on two victory circle winners (one at a district level, the other at a provincial level), and highlighting a third community — an entire nation — that is making major progress on the road to zero. I look forward to tracking more stories like these in 2014-2015, and I would love to hear from those of us who have similar good news to share.

(1) From India, a community celebrates two years of zero-deaths from malaria (4)

In the community of Lanjigarh in the state of Odisha, zero deaths from malaria have been reported for the past two years. The commitment to reduce the burden of malaria has been a joint objective in a public-private partnership between the health department and the Vedanta Aluminium company with local operations in the community.

The medical officer for Lanjigarh attributes this achievement to extensive community awareness programmes, explaining how malaria is spread and how infection can be prevented. Vedanta began tight alignment with the national vector-borne disease control programme (NVBDCP) in India before 2009, with a jointly announced Roll Back Malaria programme (5), built around awareness, prevention measures, and diagnosis and treatment. The local work was supported by the company and the public health system. The tools used to accomplish this victory were not exceptional. Rather, this energetic collaboration between public and private partners recognized that behavior change and significant community buy-in would be critical to achieve and maintain the goal of zero deaths. In Odisha, a state that accounts for nearly 20% of all malaria deaths in India, the story of Lanjigarh serves as a beacon for sister communities in the state which aspire to stop malaria mortality.

(2) In Pakistan, Sindh Province accomplishes Zero Deaths

Sindh Province had over 58.000 cases of malaria in 2013, making this one of the four highest burden areas in Pakistan. Despite this case load, no deaths from malaria were reported during the same time period.

One of the contributing factors appears to be a significant increase in the number of centers providing diagnosis and free treatment. A mass distribution of nets was completed over the past two years. District level malaria superintendents have been routinely engaged with the diagnostic centers to track monthly progress, thus providing a direct link to the provincial control program.

The significant case burden in Sindh indicates that much effort is still required to prevent illness from malaria — and ultimately to eliminate the disease from the province.  Yet the remarkable 2013 achievement reminds us that a concerted push to increase access to early diagnosis-and-treatment can cut deaths to zero in a comparatively short period of time.

(3) Heading towards local zero deaths in Rwanda by 2017

On World Malaria Day 2013, Dr. Corine Karema, the head of Rwanda’s national malaria control program, delivered an inspiring message about the country’s progress towards zero deaths from malaria by 2017. This is not a hollow, euphoric target — rather, it is grounded in an impressive track record of diminishing malaria deaths by 75% between 2005 and 2011.

As with the other examples, the ingredients that are contributing to Rwanda’s success are widely known and available: prevention with nets, expansion of access to diagnosis-and-treatment, and selective vector control activities, all against the backdrop of long-term health-system strengthening. The catalyst that has transformed these standard ingredients into something remarkable is a sustained commitment by the government of Rwanda, coupled with a constant drumbeat of community engagement. Every Rwandan is invited to take part in the effort by helping reducing mosquito breeding sites, by using bednets regularly, and by seeking diagnosis and treatment from health centers or community health workers.

As Rwanda closes in on its last strongholds of malaria in six high burden districts, the next three years will be critical to meet its target of zero deaths nationwide. The same ingredients that have fed its successes since 2005 must be delivered reliably, with a high degree of community activation. The challenge is not simple — but the energy and commitment that powered its decade of improved malaria control will help Rwanda cover the last stretch of road leading to zero deaths by 2017.

The past two years have been marked by a renewed sense of energy in the funding and implementing communities to tackle the remaining challenges around malaria elimination and ultimately global eradication. Even the optimists are aware that the journey to achieve eradication will be counted in decades, not years. And yet, preventing death from malaria is a very different proposition, and sits astride two supporting pillars: (a) Stop the disease from entering a person’s body; (b) if we fail to stop the disease before infection, then respond immediately with a high quality, rapidly effective medicine.  Long before malaria is eliminated in countries or eradicated globally, the death count from the disease should have effectively vanished. And thus, tracking 'Zero Deaths from Malaria' is an early sign post on the highway that will take us to zero cases of malaria anywhere.

Contact 

Please contact me at jagoeg@mmv.org or comment on this site directly if you can bring additional stories of Zero Deaths to the forefront. While I humbly accept that by 2015, many communities will not be able to emulate the three encouraging stories I’ve cited, the victories that we document can light the road for those who are following shortly behind.  'Zero Deaths' can — will — be achieved everywhere.

The author is the Executive Vice President of Access & Product Management at Medicines for Malaria Venture.  The views expressed in this article are the author’s alone and not intended to reflect those of his organization.
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George Jagoe 
George heads up the Access & Product Management team at Medicines for Malaria Venture (MMV), a non-profit drug development partnership based in Geneva, Switzerland.  He and his team focus on those malaria drugs developed by MMV and its partners that are in the final stages of development and/or post-launch use. The goal: to ensure that these tools can gain acceptance and overcome access barriers in order to have maximum impact in saving patients' lives.

Prior to joining MMV, George has had a variety of roles in healthcare consulting, health systems management, and pharma-related endeavors. He was the first Country Director for the Clinton Foundation’s HIV/AIDS Initiative in Mozambique, where working with national and international stakeholders, CHAI helped introduce antiretroviral treatments into the national health system. After that experience, he led the sales and marketing division of Specialty Care products (Oncology, Neuroscience, and Infection) for AstraZeneca Spain. With family roots in Spain (Catalunya) and the USA (Washington, DC; Boston), George isn’t sure what to say when people ask him where he’s from, but he has a very warm spot in his heart for Barcelona. He holds a marketing and healthcare MBA from the Kellogg School of Management (USA) and an undergraduate degree from Harvard College (USA).