While global progress against malaria has stalled, Asia is making unprecedented gains. In reviewing the 2019 Leaders’ Dashboard, delegates heard that the Greater Mekong Subregion has experienced a 75% reduction in cases and a 90% reduction in deaths since 2012. We noted a more than 50% reduction in Myanmar over two years and a 66% reduction in India over three years.
In many countries, we are truly reaching the endgame; zero deaths in Cambodia, zero human cases in Malaysia, only six indigenous cases in Bhutan and just a handful in Timor-Leste. As the disease becomes less visible, we must ensure eliminating countries stay the course. We must support those with a larger burden to rapidly accelerate, to deliver national, regional, and global benefits.
1. Vote of thanks to the Royal Thai Government as Hosts of Malaria Week, 2019
We thanked the Government of the Kingdom of Thailand for their hospitality as the hosts of this Malaria Week in 2019. We noted Thailand’s reduction of cases by 45% between 2017-2018.
2. Building leadership for health and human security
We reaffirmed our commitment to the goal of a malaria-free Asia Pacific by 2030 and welcomed the support from 23 Heads of Government.
- We acknowledged the 2018 Greater Mekong Subregion (GMS) joint Ministerial Call for Action;
- We welcomed the 2018 Melanesian Leaders’ commitment to the APLMA Roadmap.
- We noted the 2019 APLMA Leaders’ Dashboard and its new online interactive capacity.
We supported the call for a 5-year progress review for the 2030 goal, as foreshadowed in the Roadmap, to refocus Leaders’ attention on addressing the toughest remaining challenges.
- We tasked the APLMA Secretariat to form a working group, representative of the region, to steward this process, and report back to the next SOM.
We noted the increasing proportion of malaria in border areas requiring new strategies to reach isolated communities. Cross-border cooperation between government agencies; the military and civilians; and with civil society will be essential. We noted that collaboration is critical for elimination and welcomed:
- India’s continued commitment solve the challenge of cross-border malaria;
- Indonesia’s signing of MoUs with Timor Leste and PNG to improve coordination;
- Thailand and Cambodia’s collaboration, noting the joint MoU and cooperation with defence;
- PNG’s call for continued international support, and noted the Trilateral Partnership of Australia, People’s Republic of China and PNG – as an example of cooperation on malaria;
We noted that Cambodia, China, Lao PDR, Myanmar, Thailand and Vietnam announced a declaration on “Combatting Falsified and Substandard Medicine” in Phnom Penh in November 2018. This acknowledges that substandard / falsified medical products pose an unacceptable risk to public health.
We noted that resistance to artemisinin combination therapies is a major concern, particularly in the GMS. The detection of independent kelch13 genetic mutations in malaria parasites elsewhere in the region is concerning, and merits close monitoring and collaboration. Increased resistance to artemisinin-based therapies threatens to reverse significant gains already made towards elimination.
3. Paying for the endgame
We applauded the increases in domestic financing, with resources close to tripling in the last 10 years and agreed this trend must be maintained. We noted Thailand’s experience of using cost-benefit analysis to achieve significant increases in the annual budget for malaria elimination.
We agreed that countries must prepare now for a future of less external grant financing and continue to make the case for Asia-Pacific spearheading global eradication.
We noted that sustained increases in domestic financing requires a whole-of-government approach. Further, that we need new data to underpin future investments, the efficient use of those resources, and the engagement of new actors including the private sector and multi-lateral development banks.
We noted that APLMA has an important role in fostering multi-sectoral collaboration, keeping the spotlight on malaria and convening a broad range of partners.
4. Data for elimination
We noted that robust surveillance and real-time data is essential for malaria elimination.
- This includes case reporting across sectors, sharing data across borders and improved quality data for better planning and budgeting; identifying common protocols and approaches.
- We noted that making malaria a notifiable disease is critical in low transmission settings.
We discussed the need to build capacity for data accuracy down to subnational level, and to support the integration of malaria data into a single platform.
- We welcomed Thailand and Malaysia’s successful implementation of integrated drug efficacy data and integrated Foci investigation platforms.
- We acknowledged the need to capture innovations in data collection and reporting for improved data quality; from GIS mapping to web-based applications.
We noted APMEN’s statement on strengthening surveillance and welcomed the APMEN’s ongoing support to surveillance in endemic nations.
We requested the APMEN Surveillance and Response Working Group to redouble efforts to improve data-quality, and tasked APLMA to build support for investment in this agenda.
5. Ensuring a Whole of Government Response
We welcomed the formation of an elimination task force in PNG and APLMA’s offer of support.
We acknowledged the examples of China and Sri Lanka in ensuring whole-of-government coordination, including at provincial level. APLMA committed to further sharing these lessons.
- Myanmar called for collaboration with the private sector & CSOs, and for new tools for P. vivax;
- China noting their national malaria elimination committee, and its role in achieving elimination;
- Malaysia noting that all ministries must support elimination, from top leadership to the community;
- Indonesia’s experience in empowering multiple agencies for elimination, including the private sector, education and research institutions to Detect, Prevent and Respond;
- Cambodia’s Ministry of Interior ‘CCCC’ working to combat substandard products, with a high-level leadership, and steering committee, drawn from multiple ministries.
The APLMA Secretariat committed to redouble efforts to build political commitment and goodwill and will continue to work to make detailed case studies accessible.
We were pleased to note the progress made by APMEN, and in particular the development of the APMEN New Business Model. We reaffirmed our commitment to the Network with greater country ownership and increased South-South collaboration.
We strongly supported comments including from the United States President’s Malaria Initiative that technical expertise must be retained through the post-elimination phase.
We were pleased to note APMEN’s call to Senior Officials’ for sustained political commitment to the malaria elimination agenda, increased investments in subnational health systems strengthening, and prioritized focus on cross-border collaboration between countries in the region.
We reiterated that the region is entering a politically, financially, and technically challenging phase when the efforts must be increased and sustained while the disease burden shrinks. Previous efforts have foundered multiple times at this point. We remained determined to chart a successful path to regional and, ultimately, global elimination.