in the Greater Mekong Sub-region 05 07 August 2013
Towards Multi-sectoral Actions to Combat Malaria Drug Resistance in the Greater Mekong Sub-region Dr. Leonard Ortega Regional Adviser, Malaria WHO South East Asia Region
Improved malaria situation in the GMS, 2002-2010 Annual Parasite Index, GMS, 2002 Annual Parasite Index, GMS, 2010
Marked reduction of malaria deaths in the GMS, 2002-2010 Malaria mortality, 2002 Malaria mortality, 2010
Artemisinin resistance in the GMS is a global threat Source: Bustos MD et al. The Southeast Journal of Tropical Medicine and Public Health Volume 44 (Supplement 1), 2013.
The evolution of drug-resistant malaria (Plowe CV. Trans R Soc Trop Med Hyg 11 Dec 2008) Low Grade Pyrimethamine Resistance CHLOROQUINE SULFADOXINE-PYRIMETHAMINE Clinically Significant Pyrimethamine Resistance
Artemisinin resistance: some contributing factors Irrational use of anti-malarial medicines Use of oral artemisinin monotherapies Sub-standard / fake / counterfeit malaria medicines Poor access to health services Low coverage of malaria control interventions
Global Plan for Artemisinin Resistance Containment Action Pillars Contain or eliminate artemisinin resistance where it already exists Prevent artemisinin resistance where it has not yet appeared 1 2 3 4 Stop the spread of resistant parasites Increase monitoring & surveillance to evaluate the AR threat Improve access to diagnostics & rational treatment with ACTs Invest in artemisinin resistancerelated research 5 Motivate action and mobilize resources
Emergency Response to Artemisinin Resistance (ERAR) in the Greater Mekong Sub-region Regional Framework For Action Fifteen Actions in 4 Action Areas: 1)Full coverage of interventions in priority areas 2)Tighter coordination and management of field operations 3)Better information for artemisinin resistance containment 4)Regional oversight and support
ERAR Regional Framework for Action (1)
ERAR Regional Framework for Action (2)
Containment of Artemisinin Resistance in the GMS Tier 1 - Areas for which there is credible evidence of artemisinin resistance Tier II: Areas with significant inflow of people from tier I areas, including those immediately bordering tier I; Tier 3: Areas with no evidence of artemisinin resistance and limited contact with tier I areas
High-level political commitments (1) Increasing efforts within ASEAN to address drug resistant malaria July 2012 - ASEAN Health Ministers Meeting, and ASEAN+3 Health Ministers Meeting agreed that antimalarial resistance is a regional concern November 20 - Declaration of the 7 th East Asia Summit on Regional Responses to Malaria Control and Addressing Resistance to Antimalarial Medicines Endorsed by Heads of State/Government of ASEAN Member States, plus Australia, People s Republic of China, Republic of India, Japan, Republic of Korea, New Zealand, Russian Federation and the United States of America
High-level political commitments (2) Malaria 2012: Saving Lives in the Asia-Pacific October 2012, hosted by Government of Australia Adopted Consensus on malaria control and elimination in the Asia-Pacific, Creation of Asia-Pacific Leaders Malaria Alliance (APLMA) Two Taskforces 1) access to quality medicines and other technologies 2) regional financing for malaria and other communicable disease threats
Moving Forward: Translating political commitments into multi-sectoral actions Suggestions on key areas for multi-sectoral collaboration: Ensuring quality, availability and rational use of ACTs Addressing malaria prevention and control among migrant populations and ethnic communities Scaling up massively and rapidly the key interventions towards malaria elimination in the GMS
Malaria drug resistance: threatens lives and a major barrier for malaria elimination The road towards malaria elimination is long and difficult but together we can make it! Thank you!