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Fifth Session of the Intergovernmental Negotiating Committee
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U.S. Agency for International Development Since the start of USAID's Infectious Disease Initiative in 1997 the Agency has stepped up significantly its efforts in the battle against malaria, especially in developing new technologies and approaches for the prevention and control of malaria; building malaria control networks among U.S. government agencies, multi-lateral donors, NGOs and other bilateral donors; "rolling-out" Roll Back Malaria (RBM); and establishing new malaria programs in more than 20 countries. The long-range control of malaria depends on such integrated approaches and collaboration, as it is clear that no one method will work everywhere, and collaborative approaches to developing locally-appropriate interventions are required. USAID supports activities related to the development and/or implementation of alternatives to DDT use in Indoor Residual Spraying, as well as efforts for overall improvement of malaria prevention and control. DDT alternatives: USAID activities which reduce reliance on DDT include the following three areas: THE ROLLING-OUT OF Roll Back Malaria. Over the past year USAID has worked closely with the WHO Geneva secretariat for RBM http://www.rbm.who.int/, the regional offices in Africa, the Western Pacific, PAHO and host of partners to lay out RBM's agenda and formulate its strategic approach. USAID has been especially active in promoting strong operational linkages between RBM and ongoing maternal and child health programs, such as Integrated Management of Childhood Illness (IMCI) and SafeMotherhood. [Fiscal Year 2000 contribution $3.4 million]. THE LAUNCHING OF NetMark. NetMark http://www.netmarkafrica.org/ is an innovative Africa regional public-private venture with the home products giant SC Johnson promoting commercial distribution of insecticide treated bednets (ITNs). In many areas of Africa ITNs may provide an effective alternative to indoor residual spraying. Insecticide-treated net studies have shown reductions in child mortality of 17-63% in various African countries. Expectations are that more than 30 million African children will be protected from malaria over the five-year life of the program. The public-private partnership should offer unique advantages in providing sustained and expanded delivery of insecticide treated netting services. During 2001 product launches are expected in Senegal, Ghana, Nigeria, Uganda and Zambia. [FY 2000 contribution $1.75 million]. IMPROVING EFFECTIVENESS OF NATIONAL VECTOR CONTROL PROGRAMS. Historically, vector control programs have been a mainstay of national malaria control programs, but increasing resistance to insecticides, high costs and wasteful practices have limited their effectiveness. USAID's Environmental Health Project (EHP) http://www.usaid.gov/environment/ is working with national malaria control programs in Eritrea and Mozambique to strategically target operations according to local ecological factors. These countries have identified priorities for integrated approaches to malaria control, and USAID is working in partnership with these countries to build capacity to collect, analyze and use broad-based surveillance data for more effective control activities. EHP is also collaborating with WHO/Roll Back Malaria to develop an assessment tool for vector control programs to be used with the RBM national assessment process. USAID is also collaborating with WHO/AFRO in addressing the lack of entomology and vector control program management skills in the field. [FY 2000 contribution $800,000]. USAID's overall malaria efforts: In addition to these programs, USAID has a long-standing commitment to improving malaria control through a variety of interventions which would ideally be combined into locally-appropriate integrated control programs. Funding for malaria work through USAID has increased dramatically in recent years, as shown in the following graph.
Strategically, USAID's efforts are focused in five key areas:
MANAGING MALARIA ILLNESS IN THE COMMUNITY. It is estimated that in Africa up to 80% of people, when seeking medical care, first visit a private drug outlet or practitioner. As noted in a recent field study by USAID's Quality Assurance Project in western Kenya, the technical quality of private medical and pharmaceutical services is often questionable. Shops or kiosks were found to be the main source of drugs for rural people, yet the survey revealed that 87% of the shopkeepers had never received training on drug use though 60% routinely gave instructions on dosages to their customers. The main reasons for low technical quality of private services is that they are beyond most governments' capacity to inform, update, monitor, and regulate. USAID is currently working with the Kenyan Ministry of Health and the Kenyan NGO AMREF to test new strategies to improve quality of private services without increasing the burden of government. It is expected this effort will provide valuable lessons on how best to reach the private sector, improving the quality of an important provider of community health services. SLOWING THE EMERGENCE AND SPREAD OF DRUG RESISTANT MALARIA. The emergence and spread of multidrug resistant malaria (MDR) across the Mekong region of Southeast Asia over the past decade and the corresponding increase in deaths and cases of severe malaria have posed an especially difficult challenge to planners and policy makers. As a first step in establishing a regional capacity to address the threat posed by MDR malaria in the Mekong region USAID, in partnership with WHO/Roll Back Malaria has established a regional sentinel surveillance network among the six Mekong countries -- Burma, Cambodia, China (Yunnan Province), Laos, Thailand and Viet Nam -- for the routine monitoring and coordinated response to the emergence and spread of multidrug resistant malaria. In addition, USAID has established programs in western Cambodia and along the Thai-Burma border to deliver more effective preventive and curative services among populations most at risk from MDR malaria. PROTECTING PREGNANT WOMEN FROM MALARIA. Each year 22 million African women who become pregnant in malaria endemic areas are at high risk of experiencing severe sequelae and additional risk of delivering a low-birth weight baby - the most common contributing factor to perinatal death. Yet, these deaths are easily preventable. Recent field trials supported by USAID and conducted by CDC have shown that women can be fully protected from the risks of malaria infection by taking a two dose treatment of the antimalarial drug sulfadoxine-pyrimethamine, SP, at the beginning of their second and third tri-mester of pregnancy. Yet only a few African countries have adopted policies for the provision of SP through antenatal clinics. USAID is working to build a "malaria and pregnancy network" to advocate for wider use of intermittent anti-malarial therapy and is planning on co-hosting with WHO an Africa regional meeting on expanded MIP activities in 2001. DEVELOPING SIMPLE AND EFFECTIVE HEALTH TECHNOLOGIES. USAID's efforts to improve the health status of children and other vulnerable populations throughout the developing world are too often constrained by existing technologies, which may be too expensive, fragile, or rendered ineffective by adaptive disease pathogens. The long-term success of health programs requires the development of simple, effective and affordable interventions. Among recent USAID accomplishments is the development of low-cost, reliable malaria diagnostics suitable for use at peripheral health facilities. Already, they are proving an important new tool for the management of drug resistance, especially in the Mekong region of Southeast Asia. ADVANCES IN MALARIA VACCINE DEVELOPMENT. An entirely new process for production of a protein malaria vaccine has been developed and human trials are scheduled. A multi-component DNA vaccine is also ready for human trials. USAID is playing a leading role in both of these efforts, which are being conducted at DOD facilities. Following demonstration of safety, field trials of these vaccines are planned in Kenya and Ghana in 2001. For more information please contact:
Dennis Carroll
Matthew Lynch [end of document]
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