Medicines for Malaria Elimination: The Role of Governments Yongyuth Yuthavong Deputy Prime Minister, Royal Thai Government MMV Stakeholders Meeting 2015. “In Pursuit of Medicines for Malaria Elimination: Strong Partnerships, High Impact.” Le Meridien Angkor Hotel, Siem Reap, Cambodia 24‐26 February 2015.
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Medicines for Malaria Elimination: The Role of Governments
Yongyuth YuthavongDeputy Prime Minister,Royal Thai Government
MMV Stakeholders Meeting 2015. “In Pursuit of Medicines for Malaria Elimination: Strong Partnerships, High Impact.”
Le Meridien Angkor Hotel, Siem Reap, Cambodia 24‐26 February 2015.
King Rama IV observed a total eclipse on 18 August 1868 at Wa Ko, Prachuab, after which he became fatally ill with malaria
Rama IV“ Father of Thai
Science”
Thai National Science Day: 18 August
Possible Scenarios in Combat against Malaria
• A world completely free of malaria
• Continuously shrinking pockets of malaria• Stable, small pockets of malaria
• Still very much the same
Malaria reflects socioeconomic status of countries
World Malaria Report 2014
DHFR is a moving targetDrugs must be guided arrows
Our target as proposed to MMV, 1999
•MMV‐funded project : Bangkok/Melbourne/London
•Excellent enzyme and cell‐based potency. •No cytotoxicity, mutagenicity.
MMV/BIOTEC DHFR team
P218 selected
Binding of P218 to malarial and human DHFR
P. Chitnumsub
J. Vanichtanankul
Major problems of malaria in Southeast Asia
• Artemisinin‐resistant malaria is on the rise.• Government control efforts affected by
– Other infectious diseases– Non‐communicable diseases.
• For Thailand, malaria patients from neighbouring countries pose serious burdens on control efforts.
Confirmed Malaria Cases and Deaths by Fiscal Year 2010‐2014
2010 2011 2012 2013 2014Refugee 8,016 8,396 5,983 6,899 2,286M2 14,198 11,483 6,502 6,278 3,408M1 8,948 7,123 9,184 8,500 4,986Thai 24,847 15,396 19,158 23,585 23,941Deaths 80 43 37 47 39
24,847
15,396 19,158
23,585 23,941
8,948
7,123
9,184 8,500 4,986
14,198
11,483 6,502
6,278
3,408
8,016
8,396 5,983 6,899
2,286
0
10
20
30
40
50
60
70
80
90
‐
10,000
20,000
30,000
40,000
50,000
60,000Thai M1 M2 Refugee DeathsCases
Department of Disease Control, MOPH, Thailand
Malaria cases by Nationality 2013 (Source : Malaria Online)
Department of Disease Control, MOPH, Thailand
Malaria Intervention Financing 2000‐2013
Department of Disease Control, MOPH, Thailand
Expenditure by Intervention 2013
Department of Disease Control, MOPH, Thailand
Goals 10 years Goal:
Thailand is free from malaria by the year 2024 5 years Goal:
The majority of people will not at risk of malaria infection in the year 2018
Objectives To increase the number of districts without malaria
transmission up to at least 95% in the year 2018 To reduce the annual parasite incidence to be 0.20 per
1,000 populations in the year 2018 To reduce malaria case fatality rate to less than 0.01% in
the year 2018
National Malaria Strategies 2014 – 2018
Malaria Elimination Target
Country Target year for malaria elimination
1. Bangladesh 2020
2. Bhutan 2016
3. DPRK 2020
4. Indianot yet fixed; pre‐elimination phase in the
whole country by 2017)
5. Indonesia 2030
6. Myanmar 2030
7. Nepal 2026
8. Sri Lanka 2015
9. Timor Leste elimination goal not yet decided
10. Cambodia 2025
11. Thailand 2024Department of Disease Control, MOPH, Thailand
IndicatorsTargets
2014 2015 2016 2017 2018
1. Percentage of districts without malaria transmission (baseline data in 2013 = 83.3% or 775 districts)
85.80 88.30 90.80 93.30 95.00
2. Malaria case rate per 1,000 populations (baseline data in 2013 = 0.51/1,000)
0.46 0.39 0.33 0.26 0.20
3. Malaria death rate populations (baseline data in 2013 = 0.25%) 0.20 0.15 0.10 0.05 0.01
National Malaria Strategy 2014‐2018
Department of Disease Control, MOPH, Thailand
Malaria Elimination Plan for Thailand
• Start : 2015 as planning and preparation– Policy deployment at Ministry of Public Health levels – The Cabinet approval of Malaria Elimination Plan– Resources mobilization – Training – Community engagement and empowerment
• Wide scale implementation : 2016• Internal Certification to achieved target areas : 2021
Department of Disease Control, MOPH, Thailand
Recent Trends and Current Situation for Greater Mekong Subregion
• Over the last 10 years the GMS countries with the highest malaria burden, namely Cambodia, Lao PDR and Myanmar, have scaled‐up key interventions towards universal coverage to control malaria. The reduction in disease burden has been remarkable; similar to what was seen in China, Thailand and Viet Nam in the years 1985‐2005•Estimates of malaria morbidity and mortality show a 35% and a 30% reduction between 2000 and 2012, respectively• Myanmar accounted for 77% and 79% of estimated cases and deaths, respectively (2012)• In all countries (except Lao PDR due to recent epidemic) the number of reported malaria cases has been on the decline
Number of estimated cases of malaria in the GMS, 2000‐2012
1,0001,5002,0002,5003,000
Thou
sand
s
Population at Risk & Estimates of Malaria Cases & Incidences in Countries of the GMS, 2012
Country Population at risk (mil.)
Estimated cases of malaria
(upper‐lower limits)
Estimated incidence per
1000 pop. at risk
% Plasmodium falciparum
Cambodia 7.9 160000(130000‐200000)
20.3(16.5‐25.4)
51
Yunnan, China 9.2 3000(2000‐4000)
0.32(0.22‐0.43)
28
Lao PDR 3.9 110000(89000‐140000)
28.0(22.7‐35.7)
87
Myanmar 31.7 1400000(1200000‐1800000)
44.2(37.9‐56.8)
64
Thailand 33.4 140000(77000‐310000)
4.2(2.3‐9.3)
35
Viet Nam 34.0 27000(24000‐30000)
0.8(0.7‐0.9)
61
TOTAL 120.1 1840000(1522000‐2484000)
15.3(12.7‐20.7)
58
9th East Asia Summit (EAS), November 2014 in Nay Pyi Taw, Myanmar, regional leaders welcomed the proposal championed by the Australian and Vietnamese Prime Ministers, as co‐chairs of APLMA, to commit to an Asia Pacific free of Malaria by 2030. Summit Chair’s Statement:
19. We reiterated our commitment to the Declaration of the 7th East Asia Summit on Regional Responses to Malaria Control and Addressing Resistance to Anti‐malaria Medicines. We welcomed the Asia Pacific Leaders Malaria Alliance (APLMA) Task Force Progress Report 2014 and agreed to the goal of an Asia Pacific free of Malaria by 2030. We tasked the APLMA co‐chairs to submit to the 10th EAS in Malaysia a plan for achieving this goal and to implement the recommendations of the APLMA Task Forces.
Commitment from Regional Leaders
GMP‐Elimination strategy in the GMS‐16Dec14 vpostreview.pptx 21
GMS Malaria Elimination Strategy: Goals, Objectives and Milestones
3
YearElimination goals and objectives in
approved national plansGoals, objectives and priorities identified at
Phnom Penh workshopProposed milestones based on all goals
and objectives
2015‐16Priority of Cambodia‐Thai border area (5 provinces in each country) and Myanmar‐Thai border area
2016 Thailand: Eliminate malaria in 60% of districts
Cambodia: All areas in elimination phase
2019 Thailand: All areas in elimination phase
2020
Cambodia: Eliminate Pf China: Eliminate malaria Lao PDR: Eliminate malaria in 6 provinces in the north Thailand: Eliminate malaria in 80% of districtsViet Nam: Eliminate malaria in 40 of 63 provinces
Myanmar: enter elimination phase
2024 Thailand: Eliminate malaria
2025 Cambodia: Eliminate malaria Lao PDR: All areas in elimination phaseViet Nam: All areas in elimination phase
2030Lao PDR: Eliminate PfMyanmar: Eliminate Pf Viet Nam: Eliminate malaria
2035 Lao PDR: Eliminate malaria Myanmar: Eliminate malaria
GMP‐Elimination strategy in the GMS‐16Dec14 vpostreview.pptx 23
Feasibility of elimination2
Interventions
Effectiveness in field research and
programmes
Conclusions
Different interventions are identified to participate to elimination Chemotherapeutic interventions: case management, chemoprophylaxis, prolonged treatment & triple combinations therapies or targeted mass treatments
Vector control: LLINs, LLIHNs, IRS, Alternative interventions for personal protection, spatial repellents, Endectocides or Larval source management
Vaccines: effective pre‐erythrocytic vaccine
Controlled trials in forested areas in Cambodia and Vietnam showed very promising results
Hainan, Malaysia and Sri Lanka have succeeded in eliminating Malaria
Malaria elimination with current tools could become feasible in the future The global threat of drug resistance, the momentum of scientific advances, the
commitment of Governments and keen interest of partners encourages elimination However, to succeed, it will require donor support and a high engagement of MOHs
and partners
Financing Prospects• It is critical for any GMS country aiming for elimination to ensure that adequate financial resources provided by partners and countries concerned are available during all phases of GMS strategy implementation
0
50
100
150
200
250
2008 2009 2010 2011 2012 2013 2014 2015 2016
Malaria funding in the GMS by source, USD million
GF allocations / disbursements
BMGF
Government funding
WHO (exc China)
UNICEF (exc China)
Bilaterals (exc China)
PMI (exc China)
Others
Australia‐UK/ ADB Trust Fund
Forecast
Back to Thailand:Life after Global Fund
• Global Fund will cease operation in Thailand in 2016‐7.
• Thailand still has considerable problems with AIDS, TB and malaria.
• It hopes to continue collaboration with Global Fund in border areas with neighbouringcountries.
• A Foundation for Disease Control is planned, with donation from the private sector and people.
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