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An Unexpected Threat: Malaria and drug resistant malaria in Asia and the Pacific

The Asia and Pacific region is mobilizing to meet MDG 6 malaria targets -- but a new wave of drug resistant parasites is threatening progress. Health systems are responding, but there is a need for urgent action beyond health.

Susann Roth

on 16 March 2016

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Transcript of An Unexpected Threat: Malaria and drug resistant malaria in Asia and the Pacific

Changing disease profile
Increasing regional public health threats
Increasing inequalities in access to quality health services
Weak health systems
Limited health financing
An Unexpected Threat: Malaria and drug resistant malaria
in Asia and the Pacific

Why ADB?
ADB's niche
Provide cross border and cross-sectoral solutions
Convene stakeholders
Support public goods for health through regional cooperation and integration
Drive innovations and scale up pilots
Mobilize funding
Strengthen networks and partnerships


Strengthened regional cooperation in health
Greater regional health security
Sustained malaria elimination
Task Force
Regional Financing
APLMA Secretariat
ADB provides the secretariat for the APLMA.

The APLMA Secretariat will:
Convene and support the APLMA meetings;
Develop the APLMA work program;
Provide logistical support;
Oversee 2 policy streams of work (task forces).
Task Force
Improving Access to Quality Medicines

Accelerate progress toward the 2015 MDG 6 target of 75 per cent sustained reduction in Malaria cases and deaths.
Sustain progress on control and eventually elimination of malaria in the region.
Reduce and control the spread of drug resistant malaria in the Greater Mekong Sub-region.
The APLMA will unite countries in the fight against malaria, promote regional political leadership and collaboration.
The APLMA is envisaged to be only the starting point for a high level regional alliance on public health threats.
APLMA aims to mobilize regional financing for regional public health threats.

Responding to Asia Pacific needs
75% of emerging human infections come from animal sources.
Drug-resistance Malaria is a serious public health concern.
Still around 30 Mio Malaria cases in Asia/Pacific each year.
Approx. 64 per cent of Asia/Pacific's population at risk of Malaria infection.
Dengue has increased fourfold in GMS in 2012.
Mosquitoes habitat improving with climate change, even biting frequency is increasing.
Up to 20% increase in revenue from high end diagnostic medical equipment in Asia and the Pacific.
Globally largest inequalities in health service delivery in Asia and the Pacific.
Health MDGs most lagging behind.
Globally, highest out of pocket expenditures are in Asia/Pacific.
The region could face a potential shortfall in healthcare financing of approx. USD 200 billion in 2020.
This require additional fiscal spending or higher out-of-pocket funding by individuals.
Support regional public goods on health
Asia Pacific Leaders Malaria Alliance

Response to the call by Leaders at the East Asia Summit in 2012 for joint action on malaria and drug resistant malaria.
Regional initiative of Heads of Government with Australia and Viet Nam serving as the co-Chairs.
ADB is the secretariat for APLMA.
The APLMA supports malaria leadership across the region, but particularly for those countries facing high-burdens from the disease: Cambodia, PRC, Lao PDR, Myanmar, Thailand, Viet Nam and the Pacific Region (PNG and SOL).
Other EAS members are encouraged to join as political solidarity is needed on this regional issue.
80 per cent of the global supply of artemisinin is produced in the region, mainly in China and Vietnam.
Often available medicine is of low quality since money comes directly from the patient.
In many countries the instituions regulating the manufacture and sale of medicine are weak.
The task force will formulate policy recommendation to address:
Weak regulatory capacity;
Substandard medicines;
Fragmented markets;
Ineffective delivery channels;
Low affordability;
Misuse of medicines.

The Asia-Pacific region has the highest rates of anti-malarial drug resistance in the world.
Spreading of artemisinin drug resistance would be a global disaster.
With increased mobility, parasites travel in people across borders.
With climate change, vectors have better breading habitats.
Vector borne diseases became a regional/global public health threat.
Review estimates of funding needs and gaps in the region
Identify funding sources and mechanisms
Ensure cost effective interventions
Identify policy recommendations to mobilize and sustain domestic and regional financing
Countries finance most of the burden
Most external funding is from the Global Fund
In the Pacific from Australia
Financing Partnership Facility
Financing Partnership for Health
Health and Climate Change
Non-Communicable Diseases
Health Financing
Malaria and other public health threats
Build on ADB's comparative advantage:
to integrate;
innovate; and
to be inclusive (include border areas, disadvantaged groups etc).
Examples for Possible Trust Fund Themes
Gates Foundation and others
FUNDING for Malaria and public health threats
CATALYZE innovations
GOVERNANCE at regional level
INVESTMENTS at national and regional level
Advocacy and Governance
Capacity Development
Project Development Facility
Additional Financing for CDC 2
Co-financing of infra inv
Cross border inv
Trade and RCI inv
Pooled donor contributions incl private sector and foundations
Provide financing for innovations and project development
Build strategic long term multi-partner cooperation
Transaction costs low
Mobilize financing
Develop an investment pipeline with impact on malaria control and elimination.
Strengthen Partnerships
Expand membership and scope
Drive innovations in e- and mhealth
Patricia Moser
Lead Health Specialist

Susann Roth
Senor Social Development Specialist

Regional Sustainable Development Department
Joana Marie A. Narvasa
APLMA inaugural meeting will be held in the margins of the East Asia Summit on 10 Oct in Brunei.
Why Malaria?
Health projects were evaluated successful by IED.

Public sector management
Involve all stakeholders (public, private sector, CSO)
Address pockets of poverty
Work in isolated areas (e.g. borders) and communities

Malaria control and elimination needs regional approaches.

ADB can build on its experience in regional cooperation and integration.
Migrant health
Universal health coverage
Access to quality medicine in border areas
Climate change linked health issues
Help find solutions which improve efficiency and efficacy
Provide innovative approaches for health issues
outside the health sector
Scale up innovative pilots
Innovation Triangle
Transforming knowledge, innovation and evidence into action
Impact on health inequities and reduce poverty
Improve access to quality health care for the poor
Support development of social health insurances for the poor
Strengthen regulations and oversight of the private sector
Support public-private partnerships to improve affordability and quality of health services
Improve access to affordable health service!
Countries in the region:
endorsed the global target of achieving universal coverage of key malaria interventions by 2015.
aim to reduce malaria cases and death by 75% by 2025.
contain drug-resistance malaria.

Yet, malaria remains a major threat to development in the region.

The emergence of drug-resistant malaria is a regional/global public health threat.

Poor populations are most at risk.

Large numbers of people with malaria can impact on economic growth, investment and income from tourism.

Malaria control can have positive economic benefits: one study suggests that a 10 per cent reduction in malaria can lead to 0.3 per cent higher economic growth.
Malaria control has a direct impact on 4 of the 8 MDGs:
MDG 4: ‘reduce child mortality’
MDG 5: ‘reduce maternal deaths’
MDG 6: ‘combat HIV/AIDS, malaria and other diseases’
MDG 8: ‘develop a global partnership for development’

and an indirect impact on 2 MDGs:
MDG 1: ‘eradicate extreme poverty and hunger’
MDG 2: ‘achieve universal primary education’.
The World Malaria Report 2008, WHO
Rapidly evolving multi-drug resistant parasites;
The locally abundant ‘vivax’ malaria strain which is hard to detect and difficult to treat;
Mosquito species adapt to standard control tools;
High reliance on often unregulated private health care;
Counterfeit or poor quality antimalarial drugs; and at-risk populations that are hard to reach.
National malaria programs often vertical programs not well integrated in health systems (challenging for M&E).
More is needed than bed nets!
Solution outside the health sector are required!
Private sector
Connectivity - transport (risk mitigation)
Regional approaches, cross border
Around 32 million people in the region get infected each year in the region.
Mostly the poor!
Full transcript