Putting the pieces together for malaria eradication

By Catherine Cheney*

Habiba Suleiman, a district malaria surveillance officer, visits the home of Sofia Samuel and her family to re-test and treat them for malaria in Tanzania. What would it take to eradicate malaria? Photo by: Morgana Wingard / USAID / CC BY-NC
Habiba Suleiman, a district malaria surveillance officer, visits the home of Sofia Samuel and her family to re-test and treat them for malaria in Tanzania. What would it take to eradicate malaria? Photo by: Morgana Wingard / USAID / CC BY-NC

In Mwanza, Tanzania, as in many local governments, health sector workers and environmental monitoring professionals rarely spoke to each other. They gathered data points, and their surveys accumulated in piles in different offices. But when mWater, an organization that develops technology for water and health, collected those surveys together in an open access database, the technology became common ground now that data was gathered, analyzed, and acted upon from one place.

The husband and wife team who founded mWater entered graduate school the year development economist Jeff Sachs published “The End of Poverty.” They were drawn to his argument that malaria was one of global health’s low hanging fruit.

“Sadly, 12 years later, malaria has not been solved,” co-founder Annie Feighery told Devex following her appearance at SwitchPoint in Saxapahaw, North Carolina, last week.

Vertical interventions that target specific problems and channel resources toward them can work, as the world has seen with the near eradication of polio. But solutions for malaria must be horizontal by nature, Feighery said. “And horizontal solutions require intersectoral collaboration,” she said.

That is why mWater, which is known for its flagship app “Surveyor” that monitors data sets like water points, sanitation facilities, and health clinics, is applying for funding from the Bill & Melinda Gates Foundation to tackle malaria. The team is responding to a Gates Foundationchallenge, to “design new analytics approaches for malaria elimination.”

Elimination to eradication

Global health experts disagree about whether eliminating malaria is possible. For the Gates Foundation, a malaria free world is the only acceptable end goal.

In a recent analysis of what it will take to eradicate malaria, Bill Gates and Ray Chambers, the United Nations secretary-general’s special envoy for financing the health Millennium Development Goals and for malaria, pointed out that when organizations and governments set their sights on eradication, the goal helps them to pursue the kinds of malaria control interventions that are most effective.

“There’s not much difference in many countries between effective malaria control and malaria elimination,” Bruno Moonen, deputy director of the malaria program at the Gates Foundation, told Devex. “If you’re doing really effective malaria control, then it should set you up to move toward malaria elimination.”

A malaria-free world is possible, as long as there are sustained funding commitments, robust regional collaborations, and the global endorsement that is needed to move from national elimination to global eradication, said Sir Richard Feachem, director of the Global Health Group at the University of California San Francisco.

“Eradicating malaria will require nothing short of unwavering support at all levels,” he said. “The targets we set must be as big and bold as our aspirations.”

UCSF’s Global Health Group has a Malaria Elimination Initiative built around the belief that malaria eradication is possible within a generation. In a study released just ahead of World Malaria Day, Feachem and his co-authors examined the progress of 35 countries working to move from low malaria rates to countrywide elimination. Cases of malaria, once a leading cause of death and illness in most countries worldwide, have declined 91 percent since 2000, they write. Twenty countries are on track to eliminate the disease by 2020, and the entire world may get to eradication by 2040, according to the study.

A lack of urgency

To some degree, malaria eradication can be a victim of its own success. As the list of countries that have eliminated the disease continues to grow, there is a greater risk of complacency — and sometimes the disease comes back.

A majority of the malaria resurgences since 1930 are attributable to funding cuts, according toa study by the Clinton Health Access Initiative. When a country achieves eliminating country status, external aid can come to a halt. Eliminating countries are expected to face a 31 percent decline in national funding from The Global Fund to Fight AIDS, Tuberculosis, and Malaria, the largest financer of malaria eradication efforts, according to the UCSF study. In malaria-eliminating countries, nearly 80 percent of elimination funding comes from the national governments, but these dollars risk being diverted to other diseases perceived as more urgent priorities.

Globally, as other global health emergencies like Zika and Ebola have taken priority, malaria advocates hope this World Malaria Day will present an opportunity to reinvigorate the eradication movement and to raise awareness of new challenges — the growing threat of drug resistance, for example. Advocates also hope new sources of funding, from the private sector and emerging economies, will help keep funding flowing despite tight public budgets.

Innovation in interoperability

The Gates Foundation is seeking ideas from innovators in hopes that tools developed for other sectors can be applied to rapid data exchange for malaria elimination. mWater is applying for “innovation in interoperability,” which the Gates Foundation defines as “solutions that will reduce the time for data harmonization by automation or skill set simplification.”

“The most important part of this for us is skill set simplification,” Feighery told Devex.

mWater’s cloud-based platform allows government departments to view this information on demand, which would be a vast improvement over the current process that has local governments receiving records on a monthly basis, Feighery said. “In a time of serious outbreak, this can lead to quickly treating the locations where mosquitoes are breeding in the neighborhoods where the most cases are being reported.”

The platform would also “unite sectors” of government responsible for responding to an outbreak, “by automating the correlation of environmental health workers’ reports, neighborhood representatives’ reports, and health professionals’ reports,” she said, and these would be available to all the branches on a mobile app.

Beyond the development of state-of-the-art malaria surveillance, innovation is needed in vector control, rapid diagnostic testing, and improved treatment and prevention methods, Moonen told Devex.

That is why TechChange, which leverages technology for social change, partnered with the nonprofit organization Malaria Consortium to create an interactive course to improve malaria management in Uganda and Nigeria. Private sector health workers learn more about rapid diagnostic tests, which allow them to diagnose malaria quickly and cheaply with a drop of blood and a few drops of solution. These tests can help stem presumptive treatment, which sees pharmacists overprescribing antimalarial medication, worsening the drug resistance problem.

“It is absolutely essential to work toward a global consensus in regard to what tools, resources, and strategies are required to achieve eradication,” Moonen said. “But we need to recognize that we can’t wait until all of these things are in hand.”

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