Malaria Eradication: Back to the Future

Malaria Eradication: Back to the Future


GOOD AFTERNOON EVERYBODY,
IT’S ONE O’CLOCK AND THIS IS OUR NEW TIME.
SO PLEASE, I HOPE YOU CAN GET USE TO IT. THIS IS AT THE REQUEST OF A LOT
OF COLLEAGUES ON THE WEST COAST WHO WERE NOT ABLE TO JOIN
US AT 9:00 IN THE MORNING. I’M TANJA POPOVIC, DIRECTOR OF
THE GRAND ROUNDS. I’M REALLY DELIGHTED TO SEE SO
MANY OF YOU STILL IN PERSON. I WOULD ALSO LIKE TO WELCOME
THOSE WHO ARE WATCHING US ON ICTV OR VIA INTERNET. YOU CAN SEE THAT THE GROUND
ROUNDS ARE PROMINENTLY DISPLAYED ON OUR DIRECTOR’S WEBPAGE. THIS ONE SHOT HAS BEEN CLIPPED
FROM THIS MORNING. SO WE’RE ALWAYS ON HIS WEBPAGE. WE WOULD LIKE TO WELCOME MANY,
MANY MORE PEOPLE WHO ARE WATCHING US LIVE THROUGH OUR
INTERNET. AS YOU DO KNOW, THIS IS A
CONTINUING EDUCATION ELIGIBLE EVENT AND SO IF YOU GO TO THE
WEBPAGE BELOW, YOU CAN REGISTER AND THEN, AGAIN, CHECK THE
MONTH, THE DATE AND FOLLOWING THE COMPLETION OF THE EVENT YOU
CAN SIGN UP AND SUBMIT FOR YOUR CREDIT. WE ACTUALLY HAVE BEEN TOLD BY
THE OFFICE WHO DOES TRAINING AND CONTINUING EDUCATION THAT THEY
ARE GETTING A LOT MORE REQUESTS FOR CONTINUING EDUCATION THAT IS
ASSOCIATED WITH OUR EVENTS AS WELL. THE OTHER THING THAT I DO WANT
TO POINT OUT IS THAT WE ARE COORDINATING THESE EVENTS WITH
OUR WEEKLY ISSUES OF SCIENCE CLIPS SO YOU WILL SEE THAT THIS
MONTH WE HAVE A NUMBER OF MALARIA FOCUSED MANUSCRIPTS
FEATURED IN OUR SCIENCE CLIPS. ONE OF THE THINGS THAT I DO WANT
TO POINT OUT IS THAT WE HAVE CONTINUED TO HAVE LARGE NUMBER
OF EXTERNAL VIEWERS AND IN SOME CASES, ACTUALLY, WE HAVE THE
NUMBERS GO THROUGH THE ROOF AS WAS THE — OUR CHLAMYDIA SESSION
THIS PAST JUNE. THIS STILL HOLDS THE BIGGEST
NUMBER OF VIEWERS, ALMOST 25,000 EXTERNAL VIEWERS THAT DAY. AS YOU MAY KNOW, WE ARE NOW ON
YOUTUBE AND THERE’S A LOT OF INTERESTING THINGS GOING ON
THESE DAYS ON YOUTUBE, BUT I DON’T WANT TO TALK ABOUT BEING
RADIOGRAPHED AND CHECKED WHEN I GO THROUGH THE ATLANTA AIRPORT. THAT WOULD PROBABLY GET A LOT
MORE VIEWERS THAN THIS, BUT STILL YOU WILL SEE THAT EACH ONE
OF OUR SESSIONS HAS GOTTEN MORE THAN 1,000 PEOPLE WATCHING US ON
YOUTUBE AS WELL. FINALLY, WHEN YOU COMBINE
EVERYTHING, VIDEOS, LIVE, DOWNLOADS, OVER 168,000 VIEWS,
ATTENDANCES OR HOVER YOU SS OR HOW FAR SS OR HOWEVER YOU WANT
TO CALL THEM. I FEEL GOOD ABOUT IT AND OUR
SPEAKERS APPRECIATE THIS LEVEL OF EXPOSURE. TODAY WE ARE GOING TO BE TALKING
ABOUT MALARIA ERADICATION. WE HAVE AN OUTSTANDING GROUP OF
EXPERTS AND SPEAKERS HERE. LARRY SLUTSKER WHO IS GOING TO
BE TALKING ABOUT CHALLENGES IN THE PAST, CHALLENGES TODAY AND
THOSE THAT ARE AWAITING US IN THE FUTURE IF WE WANT TO
ELIMINATE AND ULTIMATELY ERADICATE MALARIA. JOHN MacARTHUR WILL TALK ABOUT
WHAT IS IT THAT IS NECESSARY FOR THE FIRST STEPS TOWARDS
ELIMINATION. PATRICK KACHUR WHO WILL TALK
ABOUT SCIENTIFIC EVIDENCE THE CDC HAS PROVIDED TO SUPPORT AND
POSITION THE WORLD FOR ELIMINATION OF MALARIA, AND THEN
RICHARD STEKETEE. I DO WANT TO BRING TO YOUR
ATTENTION AND I KNOW JUDY SITTING HERE IN THE AUDIENCE IS
DELIGHTED THAT THERE WILL BE AN EXHIBITION COMING TO CDC AND
WILL BE WITH US FOR SEVERAL MONTHS FOCUSED ON MALARIA,
CALLED MALARIA: BLOOD, SWEAT AND TEARS. I WOULD LIKE TO SHARE WITH YOU A
FEW PHOTOGRAPHS THAT ARE GOING TO BE PART OF THAT EVENT THAT I
THINK ARE EXTREMELY TELLING OF THE MALARIA STORY. THINGS ARE NOT ENTIRELY GLOOMY. AS YOU WILL HEAR FROM OUR
SPEAKERS THERE IS SOME OPTIMISM AS WELL AND THERE ARE TOOLS THAT
PEOPLE ARE USING AGAINST THIS DISEASE. AND THIS IS ONE OF THE EXAMPLES. YOU WILL CERTAINLY HEAR ABOUT
THAT OVER AND OVER AND OVER. AND YOU WILL SEE FROM THIS
LITTLE CLIP HOW IMPORTANT AND PRECIOUS THOSE THINGS ARE IN THE
LIVES OF PEOPLE WHOSE HEALTH THEY PROTECT. THESE ARE THE FOUR MUSKETEERS
THAT ARE GOING TO TALK ABOUT THEIR OWN EXPERIENCES IN FIGHT
AGAINST MALARIA. AND WHO I THINK WILL LEAVE YOU
FEELING BETTER ABOUT WHAT IT IS THAT CDC AND THE GLOBAL
COMMUNITY CAN DO TO ELIMINATE AND ERADICATE THIS DISEASE. AND WITH THAT, I AM GOING TO ASK
THAT WE PUT A VERY BRIEF TAPE OF DR. FRIEDEN WHO HAS TAPED HIS
COMMENTS, AND THEN WE’LL MOVE ON TO OUR FEATURED SPEAKERS.>>MALARIA WILL KILL NEARLY A
MILLION PEOPLE THIS YEAR AND ALMOST ALL OF THESE DEATHS COULD
BE PREVENTED WITH CURRENTLY AVAILABLE, RELATIVELY
INEXPENSIVE TOOLS. TO MAKE PROGRESS IN MALARIA
PREVENTION AND CONTROL, WE NEED TO BETTER APPLY AND PROTECT THE
TOOLS WE HAVE TODAY. AND WE NEED TO DEVELOP NEW TOOLS
FOR TOMORROW. WE NEED TO OPTIMIZE INDOOR
PROTECTION WITH BED NETS, DRIVE DOWN MOSQUITO POPULATIONS WITH
INDOOR RESIDUAL SPRAYING AND SAVE LIVES THROUGH ACCURATE
DIAGNOSIS AND EFFECTIVE TREATMENT. WE ALSO NEED TO PROTECT AGAINST
AND DEVELOP NEW TOOLS TO COMBAT RESISTANT BY BOTH MOSQUITOES AND
MALARIA PARASITES. DEVELOPMENT OF NEW TOOLS COULD
ENABLE FURT ARE AND MORE SUSTAINED PROGRESS. BUT THE CURRENT CHALLENGE IS TO
SCALE UP AND PRESERVE THESE TOOLS AND TO PERSEVERE WITH GOOD
MANAGEMENT FOR AS LONG AS IS NEEDED TO SAVE LIVES EITHER
UNTIL MALARIA IS UNDER LONG-TERM CONTROL OR NEW TOOLS BECOME
AVAILABLE TO ENABLE ELIMINATION AND ULTIMATELY ERADICATION. I’M SURE THAT YOU’LL FIND
TODAY’S PUBLIC HEALTH GRAND ROUNDS ON MALARIA THOUGHT
PROVOKING, INTERESTING AND IMPORTANT. THANK YOU.>>MY INTRODUCTION. THANK YOU. I’VE GOT THE HONOR OF
INTRODUCING THE TOPIC TODAY. AND SORT OF SETTING THE SCENE. I’M GOING TO START OFF BY
BRIEFLY REVIEWING MALARIA BASICS. AND THEN WE’LL REVIEW THE FIRST
PUSH FOR MALARIA ERADICATION. I’LL THEN TOUCH ON HOW MALARIA
CONTROL WORSENED IN THE 1990s AND CONCLUDE WITH AN
INTRODUCTION TO PROMISING DEVELOPMENTS OVER THE PAST
DECADE THAT HAVE REAWAKENED INTEREST IN MALARIA ERADICATION. SO ALTHOUGH MALARIA HAS BEEN
RECOGNIZED FOR CENTURIES AS A DISTINCT DISEASE ENTITY THE
CAUSE WAS OFTEN ATTRIBUTED TO ENVIRONMENTAL SOURCES SUCH AS
EXPOSURES TO MIASMAS FOR BAD HAIR
AIRS. IT WAS ONLY A YEAR AGO WHERE
THIS TRIO ELUS KATED THE BIOLOGY INCLUDING THE PRESENCE OF
PARASITES IN THE BLOOD, TRANSMISSION BY MOSQUITOES AND
THE COMPLETE MOSQUITO-MAN-MOSQUITO LIFE
CYCLE. MALARIA IS CALLED BY A PARASITE
OF THE GENUS PLASMODIUM. HUMAN MALARIA IS CAUSED BY FOUR
MAJOR SPECIES. VALSIRARUM EXACTS THE BIGGEST
TOLL ALTHOUGH PEOPLE ARE AT RISK OF BOTH. FALCIPARUM MAY BE FATAL IN 10 TO
20% OF CASES IN NONIMMUNE PERSONS. EITHER FATAL SEVERE ANEMIA OR
BECAUSE OF SEIZURES AND COMA. FALCIPARUM IS ALSO THE SPECIES
IN WHICH THE ANTI-MALARIALS HAS APPEARED IN THE PAST 50 YEARS. WORLDWIDE, ABOUT 50 ANOPHELESAN
SPECIES HAS DISTINCT NICHES. BREEDING SITES CAN INCLUDE SALT
OR FRESH WATER AND MAY BE SMALL, TEMPORARY OR LARGER BODIES OF
WATER. THE MAJOR AFRICAN VECTORS BITE
INDOORS AND AT NIGHT BUT OTHER SPECIES MAY BITE OR REST
OUTDOORS. THESE CHARACTERISTICS AFFECT
VECTOR TRANSMISSION EFFICIENCY AS WELL AS SUSCEPTIBILITY TO
VARIOUS CONTROL MEASURES SUCH AS SPRAYING HOUSES OR USING
INSECTICIDE TREATED BED NETS. FALCIPARUM MALARIA IS ONE OF THE
LEADING GLOBAL CHILD KILLERS. IN 2008 IT CAUSED AN ESTIMATED
250 MILLION CLINICAL CASES WITH OVER 80% OCCURRING IN AFRICA,
MOSTLY IN CHILDREN UNDER FIVE. IN PREGNANCY PLA SENTAL
INFECTION INCREASES THE RISK OF LOW BIRTH WEIGHT AND SUBSEQUENT
INFANT MORTALITY OF THE DEATHS EACH YEAR MORE THAN 90% OCCUR IN
AFRICA AND THE BURDEN INCLUDES DISABILITY FOLLOWING SEVERE
DISEASE AND ECONOMIC LOSSES THAT ARE ESTIMATED AT OVER 1% OF GDP
ANNUALLY IN SUB-SAHARAN AFRICA. HERE WE SEE THE SPATIAL
DISTRIBUTION AND INTENSITY OF FALCIPARUM MALARIA. THE DARKER AREAS IN CENTRAL
AFRICA CORRESPOND TO THE MOST INTENSE TRANSMISSION WHERE THE
AVERAGE PREVALENCE OF INFECTION IS MORE THAN 40% IN CHILDREN
UNDER TEN. IN SOME OF THESE AREAS RESIDENTS
MAY RECEIVE MORE THAN ONE INFECTIOUS BITE EVERY DAY OF THE
YEAR. THERE WERE A NUMBER OF EVENTS
THAT INFLUENCED THE DECISION TO LAUNCH THE MA LARA ERADICATION
CAMPAIGN. THERE WERE EARLY SUCCESSES IN
MOSQUITO CONTROL INCLUDING IMPRESSIVE REDUCTIONS IN MALARIA
IN THE PANAMA CANAL. CHLOROQUINE AND DTT BECAME
AVAILABLE AT THE END OF WORLD WAR II AND ACCURATE DIAGNOSIS
WAS AVAILABLE WITH RELATIVELY SIMPLE AND CHEAP MICROSCOPY. WITH THESE TOOLS CONFIDENCE
SWELLED AND ENTHUSIASM FOR ERADICATION GREWP IN 1955 W.H.O. LAUNCHED THE GLOBAL ERADICATION
CAMPAIGN. THE KEY STRATEGY RELIED ON USING
THE MAGIC BULLET DDT TO REDUCE AND HOPEFULLY INTERRUPT
TRANSMISSION. THE UNDERLYING ASSUMPTIONS WERE
THAT PEOPLE STAY INDOORS AT NIGHT AND ANOPHELES WOULD FEED
ON RESTING PERSONS THEN REST ON THE WALLS WHERE THEY RECEIVE A
TOXIC DOSE OF DDT. OTHER MAJOR ACTIVITIES INCLUDED
ANTI-MALARIAL DRUG TREATMENT FOR PATIENTS OR OCCASIONALLY AS MASS
DRUG ADMINISTRATION TO RAPIDLY REDUCE INFECTIOUS BURDEN. SURVEILLANCE WAS CONDUCTED FOR
CLINICAL CASES AND THROUGH MASS BLOOD SURVEYS TO DETERMINE
ASYMPTOMATICCALLY INFECTED PERSONS. THOUGH WE KNOW THE ERADICATION
FAILED OVERALL. THERE WERE SOME SUCCESSES. 37 OF THE COUNTRIES THAT WERE
ENDEMIC IN 1950 WERE FREE FROM MALARIA BY 1978. IN MANY COUNTRIES MAJOR GAINS
WERE MADE IN DECREASING THE BURDENS OF DISEASE AND DEBT. IN THE U.S., MALARIA CONTROL WAS
ESTABLISHED IN THE EARLY 1940s THROUGH THE MALARIA CONTROL IN
WAR AREAS PROGRAM WHICH SUBSEQUENTLY BECAME CDC. IN 1951 MALARIA WAS CONSIDERED
AS ELIMINATED IN THE U.S. OVERALL, THOUGH, OF COURSE, THE
CAMPAIGN HAD SERIOUS PROBLEMS. THESE RANGE FROM TECHNICAL
SETBACKS SUCH AS DEVELOPMENT OF RESISTANCE IN MOSQUITOES TO DDT
AND PARASITES TO CHLOROQUINE. SO STRATEGIC ISSUES WITH A RIGID
INFLEXIBLE PROGRAM THAT RESULTED IN SLOW RESPONSES TO PROBLEMS
AND A LACK OF RESEARCH TO FIND SOLUTIONS. AFRICA WAS LEFT OW, MEANUT,
MEANING THERE WAS NEVER REAL HOPE OF
GLOBAL ERADICATION. THE MILITARY STYLE CAMPAIGN DID
NOT BUILD COMMUNITY BYEUY-IN, LEADING TO DECREASING
COOPERATION WITH THE PROGRAM INCLUDING ALLOWING ACCESS TO
HOMES FOR SPRAYING. IN 1969, THE WORLD HEALTH
ASSEMBLY ACKNOWLEDGED THE FAILURE OF THE CAMPAIGN AND
SUSPENDED IT INDEFINITELY. THE GOAL SHIFTED TO CONTROL TO
MINIMIZE THE HEALTH DAMAGE BY MALARIA. THE LESS AMBITIOUS, THE NEW
STRATEGY WAS MORE FLEXIBLE AS IT EMPHASIZED CONTROL ADAPTED TO
LOCAL CONDITIONS. THERE WAS A PROGRAMMATIC SHIFT
AWAY FROM DDT AND A RELIANCE ON TREATMENT AS THE MAJOR
INTERVENTION INTEGRATED INTO THE PRIMARY HEALTH CARE PACKAGE. IN THE LATE ’80s AND EARLY ’90s,
THE MALARIA SITUATION IN SUB-SAHARAN AFRICAN WORSENED. DECREASED FUNDING LED TO POOR
ACCESS TO TREATMENT. PARASITE RESISTANCE TO
CHLOROQUINE EMERGED IN SOUTHEAST ASIA IN THE LATE 1950s AND
SPREAD ACROSS SOUTH ASIA AND INTO AFRICA BY THE LATE 1970s. DESPITE WORSENING RESISTANCE
WITH TREATMENT FAILURE RATES EXCEEDING 50% IN EAST AFRICA IN
THE 1990s, CHLOROQUINE REMAINED THE MAINSTAY OF THERAPY
RESULTING IN HUNDREDS OF THOUSANDS OF EXCESS CHILD
DEATHS. DURING THIS PERIOD,
APPROXIMATELY 30% OF CHILDHOOD DEATHS IN SUB-SAHARAN AFRICA
WERE ATTRIBUTED TO MALARIA. AGAINST THE SOMEWHAT GRIM
BACKGROUND, NEW DEVELOPMENTS AT THE TURN OF THE MILLENNIUM GIVE
RISE TO OPTIMISM. NEW GLOBAL PARTNERSHIPS TO
CREATE WORK WERE ESTABLISHED AND FUNDING FOR PROGRAM SCALE UP
BECAME AVAILABLE. ENDEMIC COUNTRY LEADERS
PRIORITIZED AND COMMITTED TO CONTROL. BETTER TOOLS BECAME AVAILABLE
INCLUDING NEW DRUGS FOR TREATMENT AND INSECTICIDE
TREATED NETS FOR PREVENTION. I’D LIKE TO NOW TURN TO JOHN
MacARTHUR, WHO WILL TELL THE NEXT PART OF THE STORY.>>THANK YOU, LARRY. MY NAME IS JOHN MacARTHUR. I’M THE CHIEF OF THE PROGRAM
IMPLEMENTATION UNIT, CDC’S MALARIA BRANCH. TODAY I’LL PROVIDE AN OVERVIEW
TO KEY GLOBAL FRAMEWORKS USED IN MALARIA CONTROL. AND HOW THE PRESIDENT’S MALARIA
INITIATIVE HAS SUPPORTED THESE FRAMEWORKS UNDER TWO PRESIDENTS. FINALLY I WILL PRESENT SOME
RESULTS THAT MALARIA CONTROL PROGRAMS HAVE ACHIEVED IN
AFRICAN COUNTRIES. THE ROLLBACK MALARIA PARTNERSHIP
WAS LAUNCHED IN 1998 BY WHO, UNICEF AND THE WORLD BANK IN AB
EFFORT TO PROVIDE COORDINATED RESPONSE TO MALARIA. THE PARTNERSHIP IS A GLOBAL
FRAMEWORK THAT AIMS TO COORDINATE ACTIVITIES MOBILIZE
RESOURCES AND FORGE CONSENSUS AMONG PARTNERS THROUGH THE
ESTABLISHMENT OF WORKING GROUPS AND SUB REGIONAL NETWORKS. TO ASSIST IN BUILDING CONSENSUS,
DEVELOPED THE GLOBAL MALARIA ACTION PLAN IN 2008 TO REDUCE
MORBIDITY AND MORTALITY BY SCALING UP INTERVENTIONS FOR
IMPACT AND SUSTAINING THEM OVER TIME. THE U.N. MILLENNIUM DEVELOPMENT
GOALS AIM TO REDUCE POVERTY BY THE ESTABLISHMENT OF DEADLINE OF
2015. ADEQUATE CONTROL OF MALARIA IS
IMPERATIVE IF COUNTRIES ARE TO REACH THESE GOALS. RELATED TO THREE OF EIGHT. GIVE THAN THE GROUPSED A HIGHEST
RISK OF DYING ARE CHILDREN AND PREGNANT WOMEN. SIGNIFICANT REDUCTIONS IN
MALARIA WILL REDUCE CHILD MORTALITY AND IMPROVE MATERNAL
HEALTH. LASTLY, IT IS DIRECTLY RELATED
TO MALARIA CONTROL AND SERVES TO DRIVE THE PROGRAMS TOWARDS
ENSURING THAT EVERY CHILD SLEEPS UNDER A BED NET AND HAS ACCESS
TO APPROPRIATE ANTI-MALARIAL MEDICINE. WITH THE ONSET OF RBM AND THE
MPGs, INTERNATIONAL DISBURSEMENTS TO COUNTRIES HAVE
DECREASED FROM APPROXIMATELY $100 MILLION IN 2003 TO NEARLY
$1.5 BILLION IN 2009. THIS INCLUDES LARGE INCREASES BY
THE GLOBAL FUND, THE PRESIDENT’S MALARIA INITIATIVE AND THE WORLD
BANK. IN 2005, PRESIDENT BUSH
ANNOUNCED THE LAUNCHING OF THE PRESIDENT’S MALARIA INITIATIVE. IT WAS AN AMBITIOUS PLAN TO
SCALE UP MALARIA CONTROL AND PREVENTIONS IN HIGH BURDEN
COUNTRY. THE PRESIDENT PLEDGED $1.2
BILLION OVER FIVE YEARS AND CHALLENGED OTHER DONOR NATIONS
TO INCREASE THEIR FUNDING. IT IS LED BY USAID AND
CO-IMPLEMENTED WITH CDC. THE GOAL OF THE PLAN WAS BY THE
END OF 2011 TO REDUCE MORTALITY BY 50%. THIS WOULD BE ACCOMPLISHED BY
SCALING UP COVERAGE OF TEE TARGETS OF PEOPLE LIVING IN
ENDEMIC REGIONS OF AFRICAP THE FOUR KEY INTERVENTIONS ARE RAPID
DIAGNOSIS AND PROMPT TREATMENT WITH ARTEMSININ, PREVENTION
USING INSECTICIDE TREATED BED NETS, THE USE OF SPRAYING IN
PLACES WHERE APPROPRIATE AND PROTECTING PREGNANT WOMEN AND
THEIR UNBORN CHILDREN USING TREATMENT. THE PLAN BEGAN IN 2006 WITH $30
MILLION INVESTED IN THREE COUNTRIES. THE U.S. GOVERNMENT RAPIDLY
SCALED UP RESOURCES WHICH ALLOWED EXPANSION INTO AN
ADDITIONAL FOUR COUNTRIES IN 2007 AND REACHING THE TARGETED
15 COUNTRIES IN 2008 WITH THE FUNDING AVAILABLE DURING THE
CURRENT YEAR THE PLEDGED AMOUNT OF $1.2 BILLION WAS REACHED. DURING THE PRESIDENT’S CAMPAIGN
OF 2008, BARACK OBAMA SIGNALED HIS SUPPORT FOR ONGOING U.S. GOVERNMENT EFFORTS IN GLOBAL
HEALTH INCLUDING MALARIA. AFTER HIS ELECTION, THE
PRESIDENT LAUNCHED A BOLD NEW APPROACH. THE GLOBAL HEALTH INITIATIVE IS
A FRAMEWORK THAT THE US USES TO IMPROVE HELD OUTCOME. THIS PLAN IS A MAJOR COMPONENT
OF THE GLOBAL HEALTH INITIATIVE. THE 2008 ACT AUTHORIZED UP TO $5
BILLION FOR MALARIA PREPREVENTION AND CONTROL
THROUGH FISCAL YEAR 2013. CONGRESS INSTRUCTED CDC TO
ADVISE THE U.S. MALARIA COORDINATOR AND BE MONITORING
SURVEILLANCE AND OPERATIONS RESEARCH. CDC IS FULFILLING HA MANDATE
THROUGH COORDINATION WITH MALARIA INDICATOR AND PROGRAMS
THROUGH FIELD AND ATLANTA BASED STAFF. THIS MAP HIGHLIGHTS THE ORIGINAL
15 COUNTRIES THAT WERE SLATED FOR INVESTMENTS. IF YOU REMEMBER FROM LARRY’S
PRESENTATION, THESE REPRESENT COUNTRIES IN AFRICA WITH SOME OF
THE HIGHEST BURDEN OF DISEASE. WITH THE ADDITIONAL FUNDING MADE
AVAILABLE THROUGH THE ACT, THE PLAN HAS EXPANDED TO NIGHERIA
AND THE DEMOCRATIC REPUBLIC OF
CONGO. HERE ARE SOME SPECIFIC OUTCOMES. THEY CANNOT BE COMPLETELY
ATTRIBUTED TO SUPPORT AS A RESULT THEY ARE A RESULT OF
CUMULATIVE EFFORTS. SINCE ROUTINE SURVEILLANCE
SYSTEMS ARE OFTEN WEEK, THESE DATA ARE GATHERED THROUGH
SURVEYS DONE EVERY YEAR. THE LIGHT BLUE BARS REPRESENT
ITN COVERAGE PREPMI AND THE LIGHT BLUE BARS ARE DATA
COLLECTED AFTER PMI BEGAN INVESTING IN COUNTRIES. WE SEE A SIGNIFICANT INCREASE IN
THE PROPORTION OF HOUSEHOLDS WITH AT LEAST ONE BED NET. WHILE BED NET COVERAGE IS
IMPORTANT, IT IS EVEN MORE IMPORTANT THAT RISK GROUPS
UTILIZE THE INTERVENTION. THESE DATA SHOW THE PROPORTION
OF CHILDREN UNDER 5 THAT SLEPT UNDER A BED NET THE NIGHT BEFORE
A SURVEY. THE TARGET FOR THIS IS 85%. WHILE ALL COUNTRIES HAVE MADE
PROGRESS, NONE HAVE YET REACHED THE TARGET. IN ZANZIBAR, PMI SUPPORTS THE
PROGRAM’S EFFORTS TO SCALE UP INTERVENTIONS. IT IS THE PERCENTAGE COVERAGE OF
KEY INTERVENTIONS AND THE RIGHT-SIDED IS THE PROPORTION AF
PATIENTS AND FACILITIES WITH LABORATORY CONFIRMED MALARIA. AS THE COVERAGE OF BED NETS
AND/OR RESIDUAL PRAYING INCREASED THE MALARIA POSITIVITY
RATE DECREASED FROM OVER 40% TO 0.5%. THESE DATA SHOW THE REDUCTION IN
ALL CAUSE UNDER 5 CHILD MORTALITY IN PMI COUNTRIES. THESE DATA ECHO WHAT WE SAW IN
ZANS ZA BAR BUT ACROSS A LARGER SUB SET OF PMI COUNTRIES. WE ARE SEEING REDUCTIONS IN ALL
CAUSED CHILDHOOD MORTALITY. WHILE IMPRESSIVE STRIDES ARE
BEING REALIZED WITH THE MASSIVE SCALEUP OF MALARIA CONTROL
INTERVENTIONS RESISTANCE IS A LURKING THREAT. PMI TEAMS ARE BEGINNING TO
REPORT THE EMERGENCE OF RESISTANCE OF INSECTICIDES. ADDITIONALLY THERE ARE EARLY
SIGNS THAT RESISTANCE IS DEVELOPING TO THE ARTEMSININS, A
KEY DRUG CLASS. THIS IS OCCURRING IN THE
HISTORICAL BIRTHPLACE OF THE ANTI-DRUG RESISTANCE, THE THAI
CAMBODIAN BORDER. IT WOULD LIKELY SLOW OR REVERSE
THE REDUCTIONS SEEN IN MORTALITY. IN SUMMARY, IN ALL SEVEN PMI
CONDITIONS WITH HOUSEHOLD SURVEYS WE SEE SUBSTANTIAL
REDUCTIONS IN CAUSED MORTALITY IN CHILDREN FROM 19 TO 36%. WHILE OTHER FACTORS MAY
CONTRIBUTE TO THE DECLINE IN THE MORTALITY RATES THERE IS STRONG
EVIDENCE THAT ANTI-MA LAIRIAN EFFORTS ARE PLAYING A MAJOR
ROLE. THESE REDUCTIONS FOLLOWED A
MASSIVE SCALEUP OF PROVEN INTERVENTIONS. A THOROUGH ASSESSMENT IS UNDER
WAY FOR THE 15 PM COUNTRIES. I’LL NOW HAND OVER THE LECTERN
TO DR. PATRICK KACHUR WHO WILL SPEAK ON THE POSSIBILITY OF
ELIMINATION.>>THANK YOU, JOHN. GOOD AFTERNOON. I’LL REVIEW THE SCIENCE BASE FOR
CURRENT MALARIA INTERVENTIONS THIS AFTERNOON, TALK BRIEFLY
ABOUT THE GLOBAL MALARIA ERADICATION RESEARCH AGENDA AND
FINALLY DESCRIBE HOW CDC’S CURRENT OPERATIONS RESEARCH
PRIORITIES ADDRESS THE UNFINISHED WORK OF SCALING UP
INTERVENTIONS AS WELL AS THE PROMINENCE OF MALARIA
ELIMINATION. CDC SCIENCE CONTRIBUTED TO
DEFINING THE EFFECTIVENESS OF EACH ONE OF THE FOUR KEY
INTERVENTIONS THAT JOHN DESCRIBED. I’M GOING TO TAKE A MOMENT TO
DEMONSTRATE THIS IN MORE DETAIL WITH REFERENCE TO INSECTICIDE
TREATED NETS. HERE ARE DATA FROM THE IMPACT OF
ITNs ON CHILD DEATHS FROM A COCHRAN REVIEW THAT CONDUCTED A
MET TAANALYSIS OF ALL FOUR PUBLISHED TRIALS. CDC AND THE KENYA MEDICAL
RESEARCH INSTITUTE COMPLETED THE FINAL AND MOST COMPREHENSIVE
TRIAL AND THE ONLY ONE CONDUCTED IN AN AREA OF INTENSE YEAR-ROUND
TRANSMISSION. THE COLLECTIVE RESULTS
DEMONSTRATED A PROTECTIVE EFFICACY OF 17% ON CHILD
MORTALITY AND THAT THE INTERVENTION COULD SAVE 5 1/2
LIVES PER EVERY 1,000 CHILDREN PROTECTED OR A TOTAL OF A
QUARTER MILLION CHILDREN EACH YEAR. THE ON CONTRIBUTING EFFICACY
DATA, THOUGH, STUDIES CONDUCTED BY CDC HAS IMPORTANT POLICY
IMPLICATIONS IN OTHER WAYS. THEY SHOWED THAT PEOPLE WITHOUT
NETS EXPERIENCED THE SAME BENEFITS IN TERMS OF REDUCED
MALARIA INFECTION, ILLNESS, ANEMIA AND IMPROVED CHILD
SURVIVAL AS LONG AS THEY LIVED WITHIN 300 METERS OF THE
HOUSEHOLD THAT USED NETS. THEY SHOWED THAT CHILDREN
PROTECTED BY BED NETS FOR UP TO SIX YEARS EXPERIENCED A SURVIVAL
BENEFIT THAT LASTED BEYOND EARLY CHILDHOOD. THE INFANT AND CHILD MORTALITY
RATES WERE AS LOW AFTER THE FOLLOW-ON PERIOD AS THEY HAVE
BEEN DURING THE INITIAL TWO-YEAR STUDY. AND FINALLY, THEY SHOWED THE
DATA THAT HIGH COVERAGE WITH NETS INCLUDING COVERING
SCHOOL-AGED CHILDREN AND ADULTS COULD ENSURE PROTECTION EVEN FOR
THOSE WHO DID NOT HAVE NETS. TOGETHER, THESE FINDINGS LED TO
POLICIES THAT SUPPORTED WIDESPREAD SCALEUP OF
INSECTICIDE-TREATED NETS IN ALL TRANSMISSION SETTINGS AND FOR
PROMOTING UNIVERSAL COVERAGE. BEFORE I TALK ABOUT GLOBAL
RESEARCH PRIORITIES FOR ELIMINATION, I’D LIKE TO
ACKNOWLEDGE THE OBSERVATION THAT CONTINUED PROGRESS TOWARDS
SCALEUP AND ULTIMATELY ELIMINATION WILL REQUIRE
IMPROVED TOOLS FOR MALARIA CONTROL AND SURVEILLANCE. IT ALSO REQUIRES A SLIGHTLY
DIFFERENT EMPHASIS. WHILE SCALEUP AIMS TO MINIMIZE
MORBIDITY AND MORTALITY FROM THE DISEASE, ELIMINATION FOCUSES ON
REDUCING TRANSMISSION AS MEASURED BY THE BASIC
REPRODUCTION NUMBER. AS LONG AS EACH HUMAN INFECTION
RESULTS IN TRANSMISSION TO NO MORE THAN ONE ADDITIONAL PERSON,
LIL ELIMINATION IS POSSIBLE ALTHOUGH
THE PROSPECT MAY BE LONG RANGE. FOR THE PAST 18 MONTHS, MORE
THAN 200 SCIENTISTS FROM AROUND THE WORLD HAVE BEEN WORKING TO
DEFINE RESEARCH GAPS NEEDED TO MALARIA ELIMINATION. THEIR RECOMMENDATIONS UNDER THE
MALARIA ERADICATION RESEARCH AGENDA CONSIDER ALL ASPECTS OF
MALARIA INCLUDING BASIC SCIENCE AND PROGRAM. IN ADDITION TO NEW DRUGS,
VACCINES, DIAGNOSTICS AND INSECTICIDES, THE EFFORT WILL
REQUIRE HEALTH SYSTEMS THAT CAN ADAPT TO ACCOMMODATE THEM. IT WILL REQUIRE STRATEGIES TO
MANAGE THE TWIN THREATS OF ANTI-MALARIAL DRUG RESISTANT AND
INSECTICIDE RESISTANT. IN THIS EFFORT, COMBINATION
TREATMENTS HAVE BECOME THE MAINSTAY, BUT COMBINED DELIVERY
SYSTEMS AND ROTATIONAL OR MOSAIC DEPLOYMENT OF INSECTICIDES OR
MALARIA DRUGS HAVEN’T YET BEEN EXPLORED. AS LARRY NOTED, OUR BEST VECTOR
INTERVENTIONS HOUSE SPRAYING AND NETS ARE PRIMARILY EFFECTIVE
INDOORS. BUT IN MANY PLACES MALARIA
VECTORS FEED OUTSIDE AND INTERVENTIONS LIKE LARVA CIDING
AND TRAPS GIVE HOPE FOR COMBATING THAT. NEW APPROACHES USING TREATMENT
DRUGS IS ALSO IMPORTANT SUCH AS ACTIVE SCREENING AND DRUGS AND
VACCINES. FINALLY BETTER SURVEILLANCE
METHODS ARE NEEDED FOR MEASURING MALARIA TRANSMISSION BOTH FOR
DETECTING AND RESPONDING TO THE OUTBREAKS THAT WILL INEVITABLY
OCCUR ALONG THE WAY TOWARD ELIMINATION. I’LL SPEND THE REST OF MY TIME
TALKING ABOUT CDC’S CURRENT OPERATIONAL RESEARCH PRIORITIES
WHICH ENCOMPASS BOTH THE UNFINISHED WORK OF SCALEUP
OCCURRING TO INTERVENTIONS AND THE PROMISE OF ELIMINATION. THESE ADDRESS THREE BROAD
ISSUES. FIRST, TO OPTIMIZE THE DELIVERY
OF THE CURRENTLY RECOMMENDED INTERVENTIONS, SECOND, TO
ESTABLISH ROLES FOR NEW AND REVISITED INTERVENTIONS THROUGH
RESEARCH AND DEVELOPMENT AS WELL AS CLINICAL AND FIELD TRIALS. AND THIRD, TO INTEGRATE MALARIA
CONTROL WITH OTHER HEALTH AND DEVELOPMENT INITIATIVE. ONE PROMISING R&D EFFORT CENTERS
AROUND MALARIA DIAGNOSTICS. WHILE LIGHT MICROSCOPY CAN
IDENTIFY PARASITES MOST PEOPLE TREATED FOR MALARIA AROUND THE
WORLD DON’T BENEFIT FROM THEM. ONLY RECENTLY HAS THE WORLD
HEALTH ORGANIZATION CALLED FOR UNIVERSAL ACCESS TO MALARIA
DIAGNOSIS AND TREATMENT FOR EVERY CASE. DIAGNOSTIC CONFIRMATION COULD
HELP MINIMIZE THE OVERUSE OF MALARIA DRUGS, IMPROVE DETECTION
AND TREATMENT OF OTHER ILLNESSES AND FORM THE BASIS OF A RELIABLE
SYSTEM FOR MONITORING MALARIA AND ITS CONTROL. AS ENDEMIC COUNTRIES APPROACH
THE ELIMINATION THRESHOLD ACCURATE AND SENSITIVE TESTS
WILL BECOME MORE CRITICAL. WHILE THE CURRENT DIAGNOSTIC
FORMATS WILL IMPROVE MANAGEMENT OF ILLNESS, ELIMINATION MAY
FINALLY REST ON MOLECULAR THAT HAVE ONLY BEEN PRACTICAL IN
LABORATORIES FAR FROM THE REMOTE AREAS WHERE TRANSMISSION IS
LIKELY TO PERSIST THE LONGEST. RESEARCHERS AT CDA AND THE
UNIVERSITY OF GEORGIA ARE DEVELOPING A NOVEL SYSTEM FOR
MOLECULAR DIAGNOSIS THAT COULD OVERCOME THIS LIMITATION. THE TECHNIQUE, CALLED REALLAMP
FOR SHORT MAKES IT POSSIBLE TO DETECT PARASITES AT LOW NUMBERS
AND WITHOUT ACCESS TO REFERENCE LABORATORY STAFF AND EQUIPMENT. THEY’VE ALREADY VALIDATED THEIR
FIRST GENERATION PROTOTYPE ON SPECIMENS FROM TANZANIA. WE’RE WOULD INVOLVED IN SEVERAL
CLINICAL AND FIELD TRIALS. IN KENYA, THE FIRST PHASE THREE
TRIAL OF A MALARIA VACCINE IN AFRICAN CHILDREN. THE DEVELOPMENT OF THIS VACCINE
IS SUPPORTED BY THE MALARIA VACCINE INITIATIVE AT 11 SITES
IN NINE AFRICAN COUNTRIES. IN EARLIER STUDIES IT PREVENTED
39% OF SEVERE MALARIA OR UP TO SIX MONTHS. THE VACCINE CANDIDATE CURRENTLY
UNDER TRIAL COULD BE DEPLOYED AS SOON AS TWO OR THREE YEARS FROM
NOW. WHILE IT WILL BE IMPORTANT IN
REDUCING MORBIDITY AND MORT ATY, THIS VACCINE WON’T HAVE A DIRECT
EFFECT ON MALARIA TRANSMISSION. THERE ARE DOZENS OF OTHER
VACCINES AND HUNDRED OF CANDIDATE ANTIGENS IN VARIOUS
STAGE OF DEVELOPMENT AND SOME OF THOSE MIGHT ULTIMATELY HAVE AN
IMPACT ON TRANSMISSION. THE DEVELOPMENT OF A MALARIA
VACCINE HAS BEEN PARTICULARLY ELUSIVE PARTLY BECAUSE OF THE
COMPLEX WAY THE PARASITE AND HUMAN SYSTEMS HAVE CO-EVOLVED. SOME OF OUR OTHER FIELD
ACTIVITIES INCLUDE FIELD TRIALS OF INSECTICIDE-TREATED NETS IN
COMBINATION WITH OTHER VECTOR CONTROL INTERVENTIONS INCLUDING
INDOOR RESIDUAL HOUSE SPRAYING AND IN COMBINATION WITH DURABLE
INSECTICIDE-TREATED WALL LINERS. OUR THIRD OPERATION’S RESEARCH
FOCUS IS TO EXPLORE INTEGRATION OPPORTUNITIES. THIS IS IN KEEPING WITH THE
GLOBAL HEALTH INITIATIVE AGENDA, AN EXAMPLE OF OUR CURRENT WORK
INCLUDE COMMUNITY BASED DELIVERY OF MALARIA PREVENTION SUCH AS
NETS ALONGSIDE COMMUNITY BASED CHILD HEALTH CAMPAIGNS AND
CAMPAIGNS FOR ELIMINATING NEGLECTED TROPICAL DISEASES. IT INCLUDES MANAGEMENT OF
FEBRILE ILLNESS, EXPLORING INTEGRATED VECTOR CONTROL
PROGRAMS AS WELL AS INTEGRATED OPPORTUNITIES TO MONITOR AND
EVALUATE OUR PROGRAMS. THANK YOU POREFOR THE
OPPORTUNITY TO DISCUSS CDC’S PAST, PRESENT AND
FUTURE ROLE IN MALARIA CONTROL AND HOPEFULLY ELIMINATION. NEXT STEPS WILL REQUIRE
INTENSIVE PARTNERSHIPS AND SHOWN HERE ON THIS SLIDE ARE THE LOGOS
OF SOME OF THE GLOBAL AND DOOM STICK PARTNERS WITH WHICH WE
CURRENTLY WORK. I’D LIKE TO INTRODUCE OUR FINAL
SPEAKER, RICK STECKKETEE WHO REPRESENTS THE MALARIA CONTROL
AND EVALUATION PARTNERSHIP IN AFRICA.>>THANKS VERY MUCH, PATRICK. IT’S A PLEASURE TO BE HERE AND
SEE A LOT OF FAMILIAR FACES. I HAVE THE OPPORTUNITY TO TALK
TO YOU A LITTLE BIT ABOUT MALARIA ELIMINATION AND CDC’S
ROLE AND PROVIDE AN EXTERNAL PERSPECTIVE THAT, AS MANY OF YOU
REALIZE, I LEARNED MY MALARIA HERE IN THIS AGENCY. SO IT RUNS THE RISK OF BEING A
RECYCLED INTERNAL PERSPECTIVE. BUT LUCKILY, I STILL HAVE MY
BEARD AND WHILE IT’S A LITTLE GRAY IT DOES QUALIFY AS FACIAL
HAIR. LET ME POINT OUT FIRST, THAT
THERE’S A 500-PAGE BOOK THAT TELLS US WHAT TO DO AND HOW TO
DO IT. THIS DATES BACK FROM THE GLOBAL
MALARIA ERADICATION PROGRAM, WAS WRITTEN BY DR. POMPOMA WHO AT
THAT POINT LED THE W.H.O. EFFORT FOR MALARIA ERADICATION. WE HAVE THIS SESSION TWO WEEKS
AFTER THE “LANCET” PUBLISHED A SERIES OF FOUR ARTICLES ON
MALARIA ELIMINATION AND SEVERAL COMMENTARIES ABOUT THIS AS WELL. SO MAYBE MALARIA ELIMINATION IS
ACTUALLY BEING RECYCLED AS WE SPEAK. THE PROGRESS THAT JOHN AND
PATRICK JUST SPOKE TO YOU ABOUT LED PEOPLE TO SAY THAT NOW IS
THE TIME TO ACT. WE SHOULD NOT IGNORE THE
SHRINKING OF THE MALARIA MAP WHICH HAS BEEN SUCCESSFULLY
UNFOLDING OVER THE PAST CENTURY. SO TODAY I’LL TALK A LITTLE BIT
ABOUT THE OPPORTUNITY FOR ELIMINATION SUCCESS AND WHY
TODAY. I’LL GIVE YOU A BRIEF AFRICAN
COUNTRY EXAMPLE WHERE THEY’RE TRYING TO MOVE FORWARD AND
ELIMINATION IS POTENTIALLY IN THEIR SITES. A PARTNERSHIP PERSPECTIVE IN
TRANSITIONING FROM SCALE UP TO ELIMINATION AND SOME
OPPORTUNITIES WHERE CDC CAN MAKE A DIFFERENCE. FIRST, LET ME BEGIN WITH THIS
GRAPHIC. SOME OF THIS HAS BEEN SHOWN WITH
THE ROLL BACK MA RARE YA PARTNERSHIP AND SUGGEST THAT
THERE ARE STEPS ALONG THE PATH FROM WHAT I’LL CALL PRESCALEUP
TO ELIMINATION. WHEN THIS IS DESCRIBED IT IS
OFTEN SUGGESTED THAT EACH STEP ALONG THE WAY REQUIRES SOME
RECONFIGURING AND DOING WORK IN SLIGHTLY DIFFERENT WAYS. I OFFER THIS INSTEAD, AND THAT
IS THAT IF WE THINK THAT WE HAVE TO TAKE SIDE STEPS AND CHANGE
THE WAY WE DO THINGS, THEN WE MAYBE HAVEN’T THOUGHT OUT THE
PATH TO ELIMINATION. AND THE REAL OPPORTUNITY HERE
AND THE BEAUTY OF CONSIDERING ELIMINATION AND THE REASON WHY
WE CAN DO THIS TODAY IS THAT THE RECENT PROGRESS HAS ALLOWED US
THE OPPORTUNITY TO SEE THAT PATH AND PERHAPS FIGURE IT OUT AND
THEN TAKE IT. SO A LITTLE BIT BACKWARDS. WHY TODAY? WELL, FIRST OF ALL, WITH THE
GLOBAL MALARIA ERADICATION PROGRAM AND BETWEEN THAT AND THE
START OF THE ROLLBACK MALARIA PARTNERSHIP, IT WAS REALLY A
TIME OF SCIENCE. THIS HAS JUST BEEN DESCRIBED,
BUT TO SUMMARIZE THAT, THE SCIENTISTS BASICALLY IDENTIFIED
PREVENTION DIRECTED TO THE BIOLOGY OF THE VECTOR AND ABLE
TO BE DELIVERED PROACTIVELY INTO THE MOST VULNERABLE PEOPLE. AND UNTIL WE GOT TO THAT POINT,
WE DIDN’T REALLY HAVE PREVENTION INTERVENTION. THE SCIENTISTS ALSO IDENTIFIED
NEW TREATMENT WITH COMBINED DRUGS TO OPTIMIZE EFFICACY AND
DELAY RESISTANT, GAVE US HUGE HOPE AND DIAGNOSTICS THAT CAN BE
DEPLOYED CLOSE TO HOME AND IN FACILITIES AND CAN CLARIFY WHERE
MALARIA TRANSMISSION, ILLNESS AND DEATH IS OCCURRING. THAT SAID OF TR ARKSIAD TAKES US
A LONG WAY. WHILE SCIENTISTS ARE STILL
SEEKING NEW DIAGNOSIS AND TREATMENT AND NEW INTERVENTIONS
WE ALREADY HAVE THE FINAL INTERVENTION. AND I’LL CALL THAT OUT AS
SURVEILLANCE FOR INFECTION DETECTION AND TRANSMISSION
CONTAINMENT. AND I’LL COME BACK TO THIS. SO LET ME MOVE BRIEFLY TO AN
AFRICAN COUNTRY EXAMPLE FOR ZAMBIA, A PLACE I’VE HAD THE
PLEASURE OF WORKING OVER THE LAST FIVE YEARS WITH THE
NATIONAL MALARIA CONTROL PROGRAM. ZAMBIA’S LOCATED IN THE CENTER
OF SOUTHERN AFRICA. THERE’S PLENTY OF WATER THERE AS
SEEN BY THE PHOTO IN THE UPPER RIGHT. AND THAT TRANSMISSION MAP FOR
2006 IN THE LOWER RIGHT SHOWS DARK AREAS WHERE THERE’S MORE
INTENSE TRANSMISSION AND THE SOMEWHAT LIGHTER AREA WITH A
LITTLE BIT LESS. BUT LET ME SUGGEST THAT IN 2006
MALARIA WAS ENDEMIC ACROSS THE NATION. WELL, THIS IS SHOWING THE
MALARIA INTERVENTION SCALEUP OVER THE LAST DECADE. AND THE OWNERSHIP AND USE OF
INSECTICIDE-TREATED NETS BY VARIOUS GROUPS, PREVENTION AND
PREGNANCY ARE ALL SHOWN TO BE DRAMATICALLY INCREASING
PARTICULARLY FROM 2005 TO 2010. AND THAT RED LINE IS THE LINE
INDICATING THOSE HOUSEHOLDS WITH EITHER OWNERSHIP OF AN ITN OR
USE OF INDOOR RESIDUAL SPRAYING. AND THAT’S GETTING QUITE CLOSE
TO THEIR 80% TARGET. WHAT DOES THAT TRANSLATE TO? SO LET ME MOVE TO SOUTHERN
PROVINCE AND KULANGOOLA DISTRICT IN ZAMBIA. THEY REPORTED 981 CASES IN THEIR
SURVEILLANCE SYSTEM AT FACILITIES PER THOUSAND
POPULATION. ESSENTIALLY, EVERYONE WAS
GETTING MALARIA THAT YEAR. THEY SCALED UP INSECTICIDE HAD
BEEN TREATED NETS AND INDOOR RESIDUAL SPRAYING AND IN
SUBSEQUENT YEAR THEY DRAMATICALLY REDUCED THE NUMBER
OF CASES OF MALARIA. 2008 AND 2009 STABLE AT 20 CASES
PER THOUSAND POPULATION. THEY ALSO INCREASED RAPID
DIAGNOSTIC TESTS AND INTRODUCED THEM BACK IN 2005, 2006. SO ON THE ONE HAND, THIS SET OF
981 CASES OF MALARIA IN 2005 WAS REALLY REPORTED FEVER AND NOW
THEY’RE REPORTING MALARIA. ON THE OTHER HAND, 6,850 RAPID
DIAGNOSTIC TESTS USED IN 2008, ONLY 21 SHOWED UP WITH MALARIA. SO THEY’VE HAD HUGE PROGRESS,
AND THE DIAGNOSTIC TESTS HAVE ALLOWED THEM TO ACTUALLY KNOW
WHAT THEY HAVE. WELL, THAT WAS ONE DISTRICT. AND THESE ARE THE REMAINING NINE
DISTRICTS IN SOUTHERN PROVINCE WITH KUZANGOOLA. I SHOWED YOU THE BEST EXAMPLE. BUT THERE ARE MANY DISTRICTS IN
THE PROVINCE THAT HAVE ACHIEVED RAPID REDUCTION IN MALARIA AND
ARE LOOKING AT WHAT TO DO NEXT. LET ME MOVE BACK TO THE
PARTNERSHIP PERSPECTIVE. ELIMINATION IS ON SOME BUT NOT
ALL OF THEIR AGENDAS. THE BILL AND MELINDA GATES
FOUNDATION IN 2007 TOOK A QUITE BOLD STEP AND PUT MALARIA
ELIMINATION IN THE CENTER OF THEIR AGENDA. THE ROLLBACK MALARIA PARTNERSHIP
AND THE ROLLBACK MALARIA STRATEGIC PLAN ACTUALLY HAS
EMBRACED ELIMINATION IN THE MIDST OF THIS. WHAT ABOUT CDC? SHOULD CDC TAKE A POSITION ON
MALARIA ELIMINATION? MAYBE, MAYBE NOT. BUT LET ME SUGGEST THAT YOU
CONSIDER EMBRACING ELIMINATION. AND NOT BECAUSE YOU CAN
ELIMINATE MALARIA SOON AND EVERYWHERE, BUT BECAUSE CHARTING
THE PATH TO ELIMINATION IS ACTUALLY CHARTING THE IMPORTANT
WAY FORWARD AND CDC CAN BRING A HUGE NUMBER OF STRENGTHS TO
THAT. SO SOME COMMENTARY FROM — AGAIN
FROM THE OUTSIDE ON CDC ENGAGEMENT. FIRST, TO FOCUS ON AFRICA BUT
WORK ELSEWHERE BECAUSE THERE’S STILL PLENTY OF MALARIA
ELSEWHERE, AND YOU ALREADY DO THIS. THE SECOND IS WORK WITH MANY
PARTNERS. PATRICK JUST SHOWED YOU A SLIDE
WITH THE MANY PARTNERSHIPS. SO YOU ALREADY DO THIS. PARTICULARLY WITH THE U.S. PRESIDENT’S MALARIA INITIATIVE
AND W.H.O. AND OTHER. WHAT DO YOU DO WITH YOUR OWN
RESOURCES, YOUR PEOPLE AND YOUR MONEY? AND YOUR FOCUS? FIRST, I’LL SUGGEST THAT YOU
CONTINUE TO DO CONTROL AS YOU DO WITH THE PRESIDENT’S MALARIA
INITIATIVE. BUT IMPORTANTLY, I’M SUGGESTING
THAT YOU CONSIDER THE SCIENCE OF ELIMINATION ON CDC’S DIME. DO THIS MORE EXPLICITLY AND
BRING YOUR STRENGTHS. UNFORTUNATELY, IT WILL BE MORE
THAN A DIME. THE OTHER ISSUE IS ON CAPACITY
BUILDING. AND I THINK FOR A MOMENT ABOUT
THE WORK THAT CDC HAS DONE WITH STATE HEALTH DEPARTMENTS ACROSS
THIS NATION AND HAS REALLY TRAINED A CADRE OF PUBLIC HEALTH
OFFICIALS DOING WORK IN ALMOST EVERY STATE HEALTH DEPARTMENT. SO THERE’S A HUGE AMOUNT OF
STRENGTH TO BRING TO THIS. LET ME RETURN TO SURVEILLANCE IN
THE MIDST OF THE DISCUSSION OF THE SCIENCE OF ELIMINATION. SURVEILLANCE DESCRIBED IN
VARIOUS PAPERS WITHIN CDC IS THE ABOUT THE CONSISTENT COLLECTION,
ANALYSIS AND INTERPRETATION OF DATA USED FOR PLANNING,
IMPLEMENTING AND EVALUATING PUBLIC HEALTH PROGRAMS. THAT’S A FAIRLY BROAD
DEFINITION. IN POM POMA’S BOOK, HE DESCRIBED
SURVEILLANCE AS EPIDEMIOLOGIC AND REMEDIAL ACTION TO DETECT
CASE, REGISTER THEM, TREAT THEM, FOLLOW UP WITH AN INVESTIGATION
FOR THE SOURCE AND POSSIBLE ONGOING TRANSMISSION, DISCOVER
THAT TRANSMISSION, ESTABLISH ITS CAUSE, ELIMINATE RESIDUAL FOCI
AND END TRANSMISSION AND AVOID ITS RESUMPTION. AND TO SUBSTANTIATE THAT
ELIMINATION HAS BEEN ACHIEVED. THAT’S DIFFERENT. I’LL SUGGEST TO YOU THAT THAT’S
AN INTERVENTION IN AND OF ITSELF. AND SO CDC HAS THE OPPORTUNITY
TO TAKE THAT SURVEILLANCE AND INTERVENTION SPECIFICALLY TO
REDUCE TRANSMISSION. TO USE THE DIAGNOSTICS AND THE
ANTI-MALARIAL DRUGS AND PAIR THEM WITH INVESTIGATIONAL
PROCEDURES AND TO TEST THAT INTERVENTION AGAINST ITS
RESPONSIBILITY FOR CONTAINING TRANSMISSION. THE SECOND ISSUE WAS ABOUT
CAPACITY BUILDING. CAPACITY DEVELOPMENT FOR
INFORMATION MANAGEMENT IS PERHAPS A HUGE STRENGTH OF THIS
AGENCY. AND YOU CAN BUILD ON
SURVEILLANCE AND TRANSMISSION REDUCTION IN THE MIDST OF THAT. AN EXAMPLE IS TO LOOK AT THE
STOP POLIO MODEL THAT WAS USED. THIS IS A PARTNERSHIP WITH CDC
AND ROTARY INTERNATIONAL AND WITH THE WORLD HEALTH
ORGANIZATION WHERE PEOPLE WERE ABLE TO VOLUNTEER AND SPEND TIME
OVERSEAS WORKING ON SURVEILLANCE EFFORTS, SPECIFICALLY TO
IDENTIFY PARALYSIS AND IMMUNIZE AROUND IT AND CONTAIN
TRANSMISSION. SO A STOP MALARIA MODEL IS
SOMETHING THAT AT LEAST OUGHT TO BE THOUGHT ABOUT. THE SECONDARY IS AROUND THE
FIELD EPIDEMIOLOGY AND LABORATORY TRAINING PROGRAMS. YOU DO A NUMBER OF THESE IN
MALARIA ENDEMIC COUNTRIES AND I WOULD SUGGEST THAT FIRST YOU
TAKE A SPECIFIC LOOK AND MAKE SURE THEY’RE WORKING ON MALARIA
IF IT’S THERE THIS THAT COUNTRY AND, SECONDLY, WHAT MORE COULD
THEY BE DOING? IT GOES WITHOUT SAYING THAT
PARTNERING FOR THIS WORK WILL BE CRITICAL. THE OTHER THING THAT CDC BRINGS
IS A POTENTIALLY LONG VIEW, AN ELIMINATION AND ERADICATION WILL
REQUIRE NOTHING IF NOT A LONG VIEW. AND SO THIS CDC’S ABILITY TO
LOOK AT SUSTAINED PUBLIC HEALTH FOCUS AMIDST MANY COMPETING
PRIORITIES WILL ACTUALLY BE QUITE CRITICAL HERE. BELIEVE ME, THERE ARE PLENTY OF
COMPETING PRIORITIES. SO I’LL BEGIN TO CLOSE BY
SUGGESTING THAT YOU BRING DURABLE COMMITMENT, YOU PROVIDE
LEADERSHIP IN THE SCIENCE OF ELIMINATION, THAT WILL INCLUDE
THE DEVELOPMENT OF NEW TOOLS AND TESTING OF NEW
STRATEGYIESSTRATEGIES, BUT IN PARTICULAR, YOU SHOULD
CONSIDER BUILDING ON YOUR STRENGTHS IN WHAT YOU ALREADY
KNOW HOW TO DO. AND THAT YOU TRAIN THE NEXT
GENERATION. YOU ACTIVELY SEEK THE STRATEGIC
PARTNERSHIPS EN ROUTE TO THIS. BUT ELIMINATION AND ERADICATION
IS ACTUALLY NOT FOR THE FAINT OF HEART. THIS WON’T BE EASY, AND IT WON’T
DO WELL IF YOU HAVE ONE FOOT IN AND ONE FOOT OUT. THE ONE FOOT OUT LEAVING YOU
ABLE TO PERHAPS DENY RESPONSIBILITY WHEN THINGS DON’T
GO SO WELL. BUT STAYING OUT IS A DECISION,
TOO. AND THAT WON’T BE VERY HELPFUL
FOR AFRICAN CHILDREN AND THEIR FAMILIES. SO CONSIDER COMMITTING. THANKS VERY MUCH. [ APPLAUSE ]
>>THANK YOU VERY MUCH, RICK, AND I’D LIKE TO NOW OPEN UP THE
FLOOR FOR ANY QUESTIONS OR COMMENTS. I’M INSTRUCTED TO ASK YOU TO BE
BRIEF, THAT YOU GET ONE QUESTION PER CUSTOMER, AND THAT YOU
IDENTIFY YOURSELF AND IF YOU HAVE FACIAL HAIR, YOU GET TO GO
FIRST. ANN? [ LAUGHTER ]
>>THANK YOU. ANN SHOOK. THAT WAS TERRIFIC. ALL OF YOU. YOU KNOW, I LOVE THE LINE ABOUT
NOT FOR THE FAINT OF HEART. AND BEING IN THE MIDST OF THE
POLIO ERADICATION EFFORT AND CONSIDERED MEASLES ELIMINATION
OR ERADICATION RESOLUTIONS IN THE FUTURE, WE’RE FINDING THAT
YOU CAN LEARN A LOT ABOUT ELIMINATION CHALLENGES IN THE
PLACES WHERE IT’S THE MOST DIFFICULT. AND I WONDER, RICK, IN YOUR
ZAMBIA SLIDE YOU HAD A LOT OF PROVINCES GOING DOWN AND YOU HAD
ONE PROVINCE IN YELLOW THAT LOOKED PRETTY FLAT. IS THERE A STORY BEHIND WHAT WAS
HAPPENING THERE THAT WOULD BE SOMETHING TO LEARN FROM FOR THE
PROCESS?>>MOST DEFINITELY. FIRST OF ALL, WE’RE ACTUALLY
GOING THERE LOOKING TO SEE ONE ISSUE IS ABOUT THEIR USE OF
DIAGNOSTICS BECAUSE YOU CAN IMAGINE THAT SOME OF THE BENEFIT
THAT YOU SAW IN THE SLIDE WAS BECAUSE OF DIAGNOSTICS USE. SO THAT IF YOU DIDN’T SEE ANY
CHANGE ACROSS THAT TIME, IT’S PROBABLY INDICATIVE THAT
DIAGNOSTICS DIDN’T ACTUALLY REACH THAT PARTICULAR DISTRICT. SO THAT’S BEING INVESTIGATED. I’LL POINT OUT, THOUGH, THAT
YOU’RE ABSOLUTELY RIGHT. AND IN A COUPLE OF OTHER
PROVINCES IN THE COUNTRY, THEY ACTUALLY HAVE HAD SOME
CHALLENGES WITH RESOURCES. AND THEY’VE HAD SOME DELAYS IN
DELIVERING THEIR INSECTICIDE-TREATED NETS TO
MAINTAIN THEIR COVERAGE AND THEY’VE ACTUALLY SEEN
RESURGENCE. SO THIS IS NOT — LIKE I SAY,
THIS IS NOT FOR FAINT OF HEART AND EVERY TIME WE SEE A PROBLEM,
WE REALIZE HOW MUCH MORE AGGRESSIVE AND MORE PROACTIVE WE
NEED TO BE. AND THAT’S THE NAME OF THIS GAME
WILL BE BEING PROACTIVE ABOUT IT. THIS WON’T HAPPEN WITHOUT THAT
KIND OF WORK.>>DAN, PREPAREDNESS AND
EMERGENCY RESPONSE. STRUCK BY THE STATEMENT PATRICK
MADE ABOUT BENEFIT IN AREAS THAT WERE NOT HAVING THE INTERVENTION
DIRECTLY BUT WERE ADJACENT TO THEM. AND OBVIOUSLY, ONE OF THE
EXPLANATIONS IS YOU’RE ALSO DOING MORE DIAGNOSTICS AND
THEREFORE CATEGORIZING MORE ACCURATELY. YOU DON’T WANT THAT TO BE THE
ANSWER. HAVE STUDIES BEEN DONE OF
INFECTED VECTOR BURDEN TO ESTABLISH THAT THE BED NETS
THEMSELVES ARE REDUCING THAT BURDEN. AND THEN ARE BAITS AND
INSECTICIDES A SOLUTION FOR SOME OF THE EXTERNAL MOSQUITO ISSUES?>>THANKS, DAN. YES. A NUMBER OF THE STUDIES, BOTH OF
THE EXTENSIVE TRIALS LIKE THE ONE IN WESTERN KENYA DID INCLUDE
DOCUMENTING THE IMPACT ON THE VECTOR POPULATION AND, IN FACT,
BED NETS IN A RURAL AFRICAN CONTEXT WILL REDUCE THE TOTAL
POPULATION OF MOSQUITOES THAT ARE BITING. I EITHER, BY HAVING A DIRECT
EFFECT ON KILLING MOSQUITOES THAT HAPPEN TO LIGHT ON THEM, OR
SIMPLY BY CAUSING THEM TO FORAGE FURTHER FOR EACH MEAL AND YOU
JUST HAVE SOME MORTALITY AND DEFICIENT — EXTRA TIME THEY’RE
SPENDING IN THAT EXTRA EFFORT. WE DO THINK OUR FOLKS WHO ARE
REALLY KEENLY INTERESTED IN R&D IN THE TRANSMISSION REDUCTION
ASPECT, THE GATES FOUNDATION IN PARTICULAR ARE VERY KEENLY
INTERESTED IN EXPLORING WHETHER SPATIAL REPELLENTS AND BAITED
TRAPS WILL HAVE AN IMPACT ON OUTDOOR BITING MOSQUITOES THAT
TRANSMIT.>>KEVIN, THANK YOU VERY MUCH
INDEED FOR THE PRESENTATION. TO RICK. HOW FRAGILE IS ALL OF THIS? WHEN WE TALK ABOUT ELIMINATION,
THE DONORS OFTEN TALK ABOUT THAT WITH A VIEW THAT AT SOME STAGE
IN THE FUTURE THEY’RE GOING TO HAVE TO DO LESS OR PUT IN LESS. AND I GET THE IMPRESSION FROM
MALARIA THAT THAT’S NOT NECESSARILY THE CASE. AND ALLIED TO THAT ARE ANY OF
THE CHAMS S CHANGES IN AFRICA, COULD
THAT BE CHANGES IN CLIMATE, THE EXTENSIVE DROUGHT THAT’S
HAPPENING IN A LOT OF COUNTRIES?>>THERE’S NO — I THINK THE
IDEA THAT IN THE NEAR TERM THAT THIS WOULD ACTUALLY BE — YOU
COULD START TO SAVE THINGS BY DOING AGGRESSIVE CONTROL MOVING
TOWARDS ELIMINATION AND STOP DOING SOMETHING AS YOU GET
THERE, I THINK THAT’S ACTUALLY FOOLING YOURSELF. THIS WOULD — THIS WILL REQUIRE
AND MORE WORK. ON THE CLIMATE CHANGE ISSUE,
THERE’S NO QUESTION THAT THE UPS AND — WHEN YOU DON’T DO ANY
PREVENTION ACTUALLY AND YOU DON’T CONTAIN TRANSMISSION,
MALARIA GOES UP AND DOWN WITH THE CLIMATE. WITH GOOD PREVENTION IN PLACE,
WE SEE HUGE BENEFIT EVEN AGAINST CLIMATE CHANGES. HAVE WE GOTTEN BENEFIT FROM A
FEW DRY YEARS? SOME PEOPLE CLAIMED SOME BENEFIT
IN ETHIOPIA OFF OF WATCHING WHAT HAPPENS AFTER AN OUTBREAK WHERE
THEY NORMALLY IN ETHIOPIA COME AND GO. AND SO WITH THE CLIMATE CHANGE,
ETHIOPIA GETS A HUGE OUTBREAK, THEN IN SUBSEQUENT YEARS THEY
HAVE MUCH LESS MALARIA, THEN THEY CLAIM A LOT OF PROGRESS IN
THOSE YEARS. WE RUN THAT RISK BUT ACTUALLY
THAT DATA WOULD SAY AT THIS POINT THAT IT’S REALLY HUGELY
BUILT AROUND HIGH PREVENTION COVERAGE. BED NETS AND INDOOR RESIDUAL
SPRAYING REALLY WORK. IN SUB-SAHARAN AFRICA. WHILE THE WORST MALARIA IN THE
WORLD, IT IS THOSE TWO INTERVENTIONS ARE SO MUCH BETTER
ATTUNED TO THAT MOSQUITO VECTOR IN THAT ENVIRONMENT THAN THEY
ARE ELSEWHERE. SO IT’S ACTUALLY HUGELY FOCUSED
AND POSITIVE, BUT IT IS FRAGILE. AND PART OF THE REASON I’LL JUST
PUSH ON THIS FOR A SECOND. PART OF THE REASON FOR PUSHING
TOWARDS ELIMINATION IS THAT THE BUFFER BETWEEN JUST GOOD ENOUGH
CONTROL AND REALLY SUBSTANTIAL TRANSMISSION REDUCTION SO THAT
TRANSMISSION EDGES BACK AND YOU’VE GOT THE SYSTEM IN PLACE
TO TURN IT AROUND AND STOP IT, YOU WON’T GET THE MORBIDITY AND
MORTALITY AT THAT POINT WHERE YOU WILL IF YOU JUST GOT ALMOST
ENOUGH CONTROL BUT YOU LOSE IT. IN WHICH CASE IT WILL COME BACK
OVERNIGHT.>>DAN ROSS, CENTER FOR GLOBAL
HEALTH. MY QUESTION HAS TO DO WITH THE
PROBLEM OF FATALISM AND COMPLACENCY WHICH I ASSUME ARE
BOTH ISSUES IN THE AREAS THAT YOU’RE WORKING AT. THE SUCCESS, RICK, THAT YOU
POINTED TO, WHICH IS REALLY DRAMATIC OVER A SHORT PERIOD OF
TIME, IS THERE ANY EVIDENCE THAT THAT KIND OF SUCCESS IS SHOWING
OTHERS THE POSSIBILITIES AND CAN BE USED AS A VEHICLE FOR GAINING
TRACTION IN AREA WHERE PEOPLE MAY NOT THINK THAT THIS IS EVEN
POSSIBLE FOR THEM OR IN THE CARDS FOR ANY OF THEIR CHILDREN? IN TERMS OF IMPROVING THE RECORD
ON THE MALARIA?>>YOU KNOW, I THINK YOU’RE
ABSOLUTELY RIGHT. THIS IS — THIS IS
KALGTCATALYTIC WHEN YOU CAN GET IT TO HAPPEN. THE WORLD IS FULL OF PEOPLE WHO
ARE QUITE REASONABLE AND AWARE OF WHAT’S GOING ON AROUND THEM. WHEN THEY STOP SEEING THEIR KIDS
DYING DURING THE RAINY SEASON, THEY START TELLING THEIR FRIENDS
THAT THEY MADE A DIFFERENCE. WE’VE WATCHED — EVERYBODY’S
WORRIED ABOUT WE GIVE YOU AN INSECTICIDE-TREATED NET TO USE,
WILL YOU USE IT? THE ANSWER IS IT TAKES A LITTLE
WHILE, BUT WE’RE SEEING INCREDIBLY HIGH RATES OF USE
THAT WE DIDN’T SEE TWO YEARS AGO. I THINK THAT’S BECAUSE THE WORD
GETS OUT AND THE WORD COMMUNITY TO COMMUNITY IS JUST HUGE.>>IF I COULD JUST ADD, I THINK
THAT IT’S A DELICATE BALANCE BETWEEN IDENTIFYING SUCCESSES
AND USING THAT AS A CATALYST AND AVOIDING IRRATIONAL EXUBERANCE
WHERE ELIMINATION GOALS ARE DECLARED IN PLACES THAT REALLY
HAVEN’T MADE MUCH OF A SUCCESS IN SCALING UP AND REDUCING
TRANSMISSION WHICH HAS ALSO HAPPENED. THERE NEEDS TO BE SOBER
CONSIDERATION OF THE SITUATION AND CAREFUL USES OF THE WORDS
ELIMINATION AND ERADICATION. AS THE DISCUSSION GOES FORWARD.>>THANK YOU. MARK EBBER HART, PARASITIC
DISEASES. LOOKING FORWARD TO THIS CONCEPT
OF ERADICATION AND A LITTLE BIT ABOUT THE DETAILS. SO YOU TALKED ABOUT GETTING YOUR
TRANSMISSION LEVEL BELOW OR NOT WHERE YOU’RE LESS PARASITES
COMING INTO THE SYSTEM. YOU’VE GOT GOOD INTERVENTIONS,
POSSIBLY NEW INTERVENTIONS, THE COVERAGE RATES ARE GOING UP, THE
RATES S INCIDENT RATES ARE COMING DOWN,
BUT YOU STILL HAVE TO SOME INDICATORS TO MEASURE THAT
YOU’VE INTERRUPTED TRANSMISSION. SO SURVEYS IN YOUNG KIDS SHOWING
THAT YOU’RE NOT HAVING EXPOSURE AND YOU’RE LOOKING AT THE VECTOR
TO MAKE SURE IT’S BELOW A CERTAIN LEVEL AND YOU HAVE A
MODELING SYSTEM THAT CAN ACCOUNT FOR VARIOUS THINGS. IN THAT REGARD, WHERE ARE WE
WITH MALARIA LOOKING FORWARD TO ERADICATION IN TERMS OF WHAT ARE
THE INDICATORS GOING TO BE AND WHAT ARE THE LEVELS THAT YOU
THINK YOU’RE GOING TO HAVE TO BE MEASURING OR GETTING TO TO
ACTUALLY START WITHDRAWING YOUR INTERVENTIONS AND MARSHALING
YOUR RESOURCES INTO OTHER AREAS?>>THANKS. THAT’S A VERY GOOD QUESTION AND
A VERY PACKED TOPIC TO DISCUSS. BUT I THINK IMMEDIATELY THE
APPLICATION OF CONFIRMED DIAGNOSIS AND GETTING SYSTEMS TO
WORK THAT REPORT ILLNESS AND CONFIRMED ILLNESS DUE TO MALARIA
WILL BE IMPORTANT. THAT WILL TAKE US VERY FAR WITH
THE SCALE UPOF THE CURRENT SET OF INTERVENTIONS AND WITH AND
WITH THE FIRST GENERATION VACCINE THAT WE’RE LIKELY TO
HAVE AVAILABLE. BUT PART OF THE NEXT STEP WILL
HAVE TO BE BETTER METHODS FOR MEASURING MALARIA TRANSMISSION
AND WE CAN LOOK AT THING LIKE AGE DISTRIBUTION OF SEROLOGIC
OUTCOMES. THAT’S A BULKY MEASURE. WE CAN LOOK AT THINGS SUCH AS
EXVIVO STUDIES TO EXAMINE WHETHER OR NOT SOMEONE HAS
BEEN — HAS TRANSMISSION BLOCKING IMMUNITY. THAT’S INCREDIBLY CUMBERSOME AND
DIFFICULT TO AK TUALLIZE IN ANY WAY. SO THE TOOL THAT WE NEED ARE NOT
JUST PARASITE DIAGNOSIS OR VACCINES OR DRUGS, BUT THEY’RE
ALSO UNDERSTANDING TRANSMISSION BETTER AND HAVING A BETTER WAY
OF MEASURING I SO THAT WE CAN MARK PROGRESS.>>I THINK WE HAVE TIME FOR ONE
MORE QUESTION. I DON’T KNOW IF THERE ARE ANY
FROM THE VIRTUAL WORLD. IF NOT, ONE LAST QUESTION? SURE. GO AHEAD.>>I WAS JUST WONDERING, YOU
MENTIONED ABOUT THE VACCINE AND THE FACT THAT IT REDUCES
SEVERITY AND MORTALITY. BUT MY QUESTION IS THE
CONSEQUENCES BY BRSING SUCH A VACCINE ON THE CURRENT EFFORTS
THAT ARE GOING ON IN PREVENTING MALARIA. MALARIA IMMUNOLOGY IN NATURE
IS VERY COMPLEX. AND IT COMES AT THE EXPENSE OF
QUITE A FEW LIVES LOST IN THE PROCESS. SO THERE IS A LOT OF CONCERN
THAT MALARIA VACCINES MIGHT ALSO — MIGHT ALSO ELICIT A LOT
OF THE IMMUNE PROCESSES THAT ARE ASSOCIATED WITH SEVERE ILLNESS
FROM THE DISEASE. I THINK THAT HAS TO BE WATCHED
VERY CAREFULLY AND THAT’S BEEN A STUMBLE
STUMBLING BLOCK FOR A NUMBER OF MALARIA VACCINES IN EARLY STAGE
OF DEVELOPMENT. WE HAVEN’T GOT THIS FAR AS WE
ARE WITH THE CURRENT VACCINE, THE RTSS VACCINE BEFORE. SO RIGHT NOW I THINK ONE OF THE
MAJOR OUTCOMES FOR THESE LARGE FIELD TRIALS IN 11 SITES IN
AFRICA IS NOT ONLY TO LOOK AT THE IMMUNOGENICTY BUT THE OTHER
VACCINES THAT ARE DELIVERED TO CHILDREN ALONGSIDE IT.>>THANK YOU ALL VERY MUCH FOR
ATTENDING IN PERSON OR VIRTUALLY. PLEASE CONTINUE SENDING YOUR
FEEDBACK. WE ARE RECEIVING A LOT OF
FEEDBACK. AND REWE REALLY NEED TO CONTINUE
IMPROVING OUR EVENTS. WE’LL SEE YOU IN SEVERAL WEEK,
SAME TIME, SAME PLACE. ONE MORE ROUND OF APPLAUSE FOR

5 Replies to “Malaria Eradication: Back to the Future”

  1. Thank you for sharing and reinforcing that there is profit from effort. The Lord bless your continued effort!

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