After 18 months of intense discussions and reflections on how best to redirect the fight against malaria, outcomes of the exercise ‘Rethinking malaria in the context of COVID-19’ were presented on September 1st. The process was organized by Harvard University and co-chaired by Dyann Wirth (Harvard University, USA) and Rose Leke (University of Yaoundé I, Cameroon), engaging over 200 individuals that concluded that malaria endemic countries should become the center of gravity for decision making, technical expertise, funding and political commitment in the fight against malaria.
‘Rethinking malaria’ is the continuation of previous reflective exercises. In this occasion, it addressed the changing scenario resulting from the COVID-19 pandemic, which not only has put health systems on the ropes, but has also showed the limitations and inequities of health services around the globe. The main objective was to critically look at how things have been done to date and how we can do better, an effort particularly important to overcome the irrefutable fact that hardly any improvement against malaria has been achieved since 2015, as highlighted by Matshidiso Moeti, regional director for Africa of the World Health Organization.
Conclusions were shared with the malaria community through a live webinar that was notable for the fact that more than halve of the experts leading discussions and presentations came from malaria endemic countries in Africa and for the high representation of women, a bias celebrated by participants through comments in the webinar ‘chat’.
‘Rethinking malaria’ was organized around three working groups that met regularly and gathered input from key interviews, literature reviews, commissioned background papers and an advisory committee per group. The process engaged academic research institutions, National Malaria Control Programs, multilateral organizations, the private sector and Non-governmental organizations, among others. Overall 200 individuals were part of the exercise that expects to publish 6 papers in the weeks to come.
Working Group 1 was devoted to Malaria Governance. Among their key recommendations, they included changing the perception of malaria so as to depict it as the true societal problem of development that it is in most endemic countries, largely beyond a mere medical issue. The group called for relying on Universal Health Coverage in the fight against malaria, to enhance availability and visibility of data to drive political decision making, and to take into account the cost of malaria illness and disability when calculating malaria financing. They also suggested appointing a malaria advisor to the Heads of State, to ensure multi-sectoriality and political commitment.
The second working group dealt with ‘Integrated service delivery for malaria’, including the role of R&D and the private sector. Its aim was to identify how we can effectively deliver malaria services universally and in an integrated manner, identify opportunities to maximize impact and highlight areas where innovation can catalyze enhanced and more equitable coverage. Among key messages, the group included the need to integrate malaria services within strengthened health services, to embed local capacity development within research & development, and support implementation science.
Finally, the working group on Training and Capacity building called to invest in the health workforce at all levels, including paying community health workers; making data available to inform best decisions, and ensure health staff capable to design multidisciplinary approaches to malaria.
One of the highlights of the event was the participation of the president of the Republic of Uganda, Yoweri Museveni, who publicly committed to “launch a full war against the mosquito and the plasmodium so we are free of malaria”, and to do so from a country located at the very heart of Africa. To achieve success, he added, we will need to engage affected communities, ensure evidence base practices and provide sufficient funding and support to research institutions in malaria endemic countries.
The webinar was the scenario for other announcements and discussions. The director of AFRO announced that they will launch an independent assessment of the WHO High Burden High Impact Initiative, while one entire section was devoted to sharing lessons from successful elimination of malaria in China and Sri Lanka. George Gao and Kamini Mendis joined a conversation on this regard with Pedro Alonso, director of the Global Malaria Programme at WHO, for whom the most critical point is to achieve a ‘problem solving’ approach against malaria, responding to specific needs and tailoring strategies to the local context in an effort led by local experts.
To finish the webinar, high level discussants reflected on what it will take to make recommendations actionable. “I am optimistic more than ever”, said Halima Mwensi, summarizing the general feeling that impregnated the entire webinar. “What it will take? –she continued–: domestic and external resources, human resources for universal health coverage, and community, community, community! We must do something so that these conclusions don’t remain aspirational and rhetorical”. The director of AFRO shared the optimistic looking towards the future, thanks to the ‘exciting’ results of scaling up RTS,S vaccine and the impact of combining it with chemoprophylaxis, the ongoing development of a RNA vaccine against malaria, and the consensus around the importance of empowering people working in the frontline.
Leonardo Simão (Fundação Joaquim Chissano, Mozambique), stressed that the health sector should not have the sole responsibility for malaria elimination but should be supported by Ministries of agriculture, environment, finance, education, etc., and by other sectors, to ensure that all dimensions of the problem are addressed, while Evelyn Ansah (University of Health and Allied Sciences, Ghana), stressed that “integrated service delivery of malaria with other health services is a win-win situation”.
After the webinar, Núria Casamitjana, director of Training and Education at ISGlobal and co-chair of the Working Group on Training and Capacity building, stated: “I am very pleased to have participated in this enriching process, witnessing the strong commitment and leadership of talented, brave and enthusiastic African stakeholders, especially women. If they lead the malaria fight in the future, things are going to be different”. Regina Rabinovich, director of the Malaria Elimination Initiative at ISGlobal and member of the advisory committee for Working Group 2, highlighted for its part the consensus around the role of science. “It is critical that malaria programs count with reliable data to make best decisions and rely on implementation research that can help overcome challenges and increase effectiveness of the interventions we already have”, she said.
Steps forward in the reflection exercise include an upcoming event to further discuss the key conclusions, which will be held on September 28-29th, and the publication of a series of papers produced by the working groups.
The webinar, which was co-sponsored by ISGlobal, the MESA Alliance and the Manhiça Health Research Centre (CISM), among other institutions, can be seen here in English and with simultaneous translation into Spanish, French and Portuguese.