Letter to partners

Dr Pedro Alonso, Director, WHO Global Malaria Programme

19 June 2019

Dr Pedro Alonso
M. Henley/ WHO

Dear friends and partners,

Greetings from the beautiful city of Wuxi in the People’s Republic of China, host of this year’s global forum of malaria-eliminating countries. Held annually, the forum offers a platform for malaria programme managers from the 21 “E-2020” countries to share experiences and lessons learned in their quest to get to zero malaria. All are united by a common goal: eliminating indigenous transmission of the disease from within their borders by the year 2020.

This June edition of my bi-annual “Letter to partners” spotlights our new E-2020 progress report, launched at the China forum, and other areas of our work in the Global Malaria Programme since January.

As always, we welcome your feedback on our work; please send your comments to:

You can also reach me directly on Twitter at: @PAlonsoMalaria

Topics covered in this letter

– Tracking progress in E-2020 countries
– Malaria-free certifications: Algeria and Argentina
– Update on the “High burden high impact” initiative
– Introduction of the RTS,S malaria vaccine
– Progress in the Greater Mekong
– Explaining our policy-setting process
– Improving access to our policy guidance
– Other updates

Tracking progress in E-2020 countries

A critical 2020 milestone of our global malaria strategy is the elimination of malaria in at least 10 countries that reported transmission of the disease in 2015. As of this writing, 11 E-2020 countries are on track to reach this target by the end of next year. WHO’s latest E-2020 progress report – available in 4 languages (English, French, Spanish and Chinese) – provides a snapshot of indigenous cases across the 21 malaria-eliminating countries. See, also, our interactive map and country profiles, published today.

Last year, we documented malaria elimination efforts in Costa Rica, host of the 2nd annual E-2020 forum. This year, we focus on China, host of the 2019 forum. You can learn about the country’s remarkable success in tackling malaria – from an estimated 30 million cases annually in the 1940s to zero indigenous cases in 2017 – in our photo essay, feature story and video.

Malaria-free certifications: Algeria and Argentina

In May, the WHO Director General certified Algeria and Argentina as malaria-free on the sidelines of the 72nd World Health Assembly, the annual meeting of WHO’s decision-making body. Representatives from the 2 countries accepted the certificates at a high-level event held in collaboration with the RBM Partnership to End Malaria.

The certification is granted when a country proves, beyond a reasonable doubt, that it has interrupted indigenous transmission of malaria for at least 3 consecutive years. A national surveillance system capable of rapidly detecting and responding to any malaria cases must be operational, together with an effective programme to prevent re-establishment of the disease. Globally, a total of 37 countries and 1 territory have achieved this milestone.

Speaking at the event, Dr Tedros noted that the elimination successes in Algeria and Argentina were underpinned by universal health care. “With free malaria diagnosis and treatment in both countries, everyone received the services needed to prevent, diagnose and cure the disease,” he said.

Algeria is the second country in the WHO African Region to be officially recognized as malaria-free, after Mauritius attained this status in 1973. Argentina is the second country in the WHO Region of the Americas to be certified in 45 years, after Paraguay in 2018.

Update on the “High burden high impact” initiative

As we celebrate the achievements of E-2020 countries, let us not forget that – on a global scale – progress against the disease has stalled; our latest World malaria report showed that no significant gains were made in reducing malaria cases in the period 2015 to 2017. Eleven countries, including 10 in Africa, account for just over 70% of all malaria cases worldwide.

Last November, WHO and the RBM Partnership catalyzed a new approach to help countries with a high burden of the disease get their malaria control efforts back on track. Launched in Mozambique, the initiative – called “High burden high impact” (HBHI) – is gathering momentum and has earned broad support from leaders of high burden countries and global malaria partners.

To date, 6 HBHI countries – Burkina Faso, Cameroon, Ghana, India, Nigeria and Uganda – have held meetings with partners and are developing action plans. Mozambique will hold an HBHI meeting in the next few weeks. Lessons learned from the first wave of countries will help shape the new approach in the coming months.

Introduction of the RTS,S malaria vaccine

On 23 April, just ahead of World Malaria Day, Malawi introduced the RTS,S malaria vaccine in selected areas of the country through a landmark pilot programme. Ghana rolled out the vaccine on 30 April, and Kenya has set a launch date of 15 July.

This country-led, WHO-coordinated programme has been made possible through an unprecedented public-private partnership. We salute the 3 donor agencies that are financing the programme – Gavi, the Vaccine Alliance, the Global Fund to Fight AIDS, Tuberculosis and Malaria, and Unitaid – as well as all of our valued partners.

GSK, the vaccine manufacturer, deserves special mention: after a 3-decade investment in the development of RTS,S, with co-funding from the Bill & Melinda Gates Foundation, the company has committed to provide up to 10 million vaccine doses for the programme free of charge. PATH has also been also been an important and long-standing partner.

The malaria vaccine pilot aims to reach about 360 000 children per year across the 3 countries. Ministries of health will deliver RTS,S in areas of moderate-to-high malaria transmission, where it can have the greatest impact. Evidence and experience from the programme will inform future WHO policy decisions around the possible wider-scale deployment of the vaccine.

Progress in the Greater Mekong

I am very pleased to report that countries of the Greater Mekong Subregion continue to show substantial progress in the fight against malaria. From January to March in 2019, the number of malaria cases reported region-wide fell by 29% compared to the same 3-month period in 2018.

Notably, there has been a considerable decline in P. falciparum malaria cases – our primary target in view of the ongoing challenge of antimalarial drug resistance. In the first quarter of 2019, for example, the number of P. falciparum cases in Cambodia fell by 72% and by 32% in Thailand compared to the same period last year.

WHO continues to closely monitor the efficacy of antimalarial drugs through therapeutic efficacy studies (TES). These studies show that the majority of first-line antimalarial treatments remain effective in the subregion. TES results help to guide national treatment policies and catch early warning signs of treatment failure.

Explaining our policy-setting process

In May 2018, the Global Malaria Programme launched an extensive review of WHO’s processes for developing and disseminating policy guidance on malaria. We solicited feedback from a broad range of stakeholders, seeking to better understand your needs and the perceived bottlenecks.

Through this 6-month exercise, a number of areas for improvement were identified, such as a perceived lack of transparency, inconsistencies in review standards, and lengthy timelines. With support and input from the Malaria Policy Advisory Committee – the Global Malaria Programme’s highest-level advisory body – several recommendations were developed in response to the issues raised. We are moving quickly to implement these recommendations.

As a first step, we have created a new section on our website dedicated to explaining our policy-making process. Our policy development process is structured around 3 high-level steps, as seen on the website and in this diagram:

  • better anticipate unmet public health needs;
  • develop policy through an open and transparent process, with shortened timelines;
  • optimize uptake of the guidance through simplified taxonomy and digital dissemination tools.

Complementing efforts to identify unmet public needs, the Global Malaria Programme has opened an online consultation window to collect nominations for new or updated recommendations from the malaria community. You can contribute to this work by submitting your nominations through our pilot portal, which will be open through 31 July 2019.

This new section of our website is a work in progress, and feedback from our stakeholders – especially end users of our guidance – is actively sought. Please send any comments to:

Improving access to our policy guidance

According to feedback received from our country-based and global malaria partners, many of you have found it difficult to locate WHO’s malaria guidance on our website and to understand how the various policy documents fit together. We are taking steps to address this.

In April, we published a new Compendium of WHO malaria guidance that compiles, for the first time, all WHO policy documents on malaria in a single resource. On pages 4-5 you will find a table that clearly shows how the documents fit together in one malaria “toolkit”.

You will also find in the compendium a full list of all formal WHO policy recommendations on malaria. Importantly, only recommendations that have been approved by the Guidelines Review Committee are included. The Committee was established in 2007 to ensure that WHO guidelines are of a high methodological quality, and that they are developed through a transparent and evidence-based decision-making process.

All of the information in the compendium will soon be available in a user-friendly format on our website; we will share the link to our new pilot microsite next week. We also plan to release a policy guidance mobile app later this year.

Other updates

Before I sign off, 3 final updates:

  • At the latest meeting of the Malaria Policy Advisory Committee, held in Geneva on 10-12 April, Committee members heard updates on the work of the WHO Strategic Advisory Group on malaria eradication, drug efficacy and response, and a range of other topics. Key discussions and outcomes are summarized in our meeting report.
  • Our Guidelines for malaria vector control, launched in February, consolidate more than 20 sets of WHO recommendations and good practice statements in one user-friendly format. The web-based guidelines will be updated as and when new evidence is assessed by WHO. To support the roll out of the guidelines, we developed an information package, including key points, a Q&A and a slide deck.
  • WHO is forging a critical path to ensure access to – and the safe use of – tafenoquine, a new single-dose treatment for P. vivax malaria relapse. Our guidance around the use of tafenoquine will be developed in parallel with a review of G6PD point-of-care quantitative tests, as explained in this information note.

Best wishes,

Pedro Alonso
Director, Global Malaria Programme
World Health Organization