Despite recent achievements in fighting malaria, the international community must not become complacent or distracted, says Dr. Steven Phillips, medical director of global issues and projects for ExxonMobil. Phillips, who also serves on the board of Malaria No More, spoke with allAfrica.com ahead of World Malaria Day, reflecting on progress in the fight against the disease.
When we spoke last year you were very positive about the battle against malaria, citing increased funding, the availability of good tools to fight the disease and greater political will. Are you still as positive now as you were then?
I think there’s even more cause for being positive but there’s also some cautionary flags. The positive is that the investment is working. Global investment in malaria control is paying off, and the funding which has cascaded dramatically over the last 10 years has resulted in saving lives and improvement in prevention and treatment.
We, as in the global malaria partners – governments, public sector, private sector, NGOs etcetera – have a plan in place and it is increasingly receiving good country-level attention, especially in Africa, and more political will and more local resources are going toward implementing the plan.
The funding commitments have gone up considerably, somewhere from U.S. $50 million a year for malaria a decade ago from the entire international community to now something like U.S. $2 billion committed from all international institutions in 2011.
You can imagine with the economic headwinds, with the global downturn and also with a lot of competing priorities that donor governments have, the real question is will this level of finance be sustained? And if it’s not sustained what’s going to happen to the progress?
Is that the note of caution that you mention?
The note of caution to me mainly is finance in terms of levels, but also the competing priorities that are very legitimate and very real and very pressing. With disease control, whether it’s malaria or smallpox or polio or cholera, the more effective the battle and the closer you get to the endgame the more the world tends to shift its priorities to more pressing issues.
So, for example, now some of the issues are hunger and nutrition and the empowerment and human rights of women and girls. One of the things about malaria that is under appreciated and under publicized is how much the fight against malaria can contribute to the health and welfare and productivity of women and girls.
The malaria community is getting much better at profiling itself and making the world, including policy makers, taxpayers and the general public, recognize that malaria … is not just a single human scourge but it does in fact have repercussions for all of human development.
The Abuja declaration on malaria signed by African leaders set 2010 as the target year for having cut malaria deaths in half. Last year you said trends were disappointing in terms of reaching that target. Where do we stand now and what more needs to be done?
Malaria deaths have been reduced from an estimated one million to approximately 850,000 per year between 2003 and 2009, and malaria cases have fallen from at least 350 million cases per year to 250 million a year in the same time interval. Among African children under five, malaria-associated deaths have dropped from an estimated 3,000 per day to approximately 2,000 per day.
My sense is that this is evidence of progress. One of the issues with malaria statistics is they tend to be dated. There is a one- to two-year lag time between where you are and getting reliable statistics. I think there’s every hope and expectation that these trends are continuing.
As you were saying, as you fight malaria you’re fighting not just one disease, you’re fighting a number of things. Can you elaborate?
In general I think what’s really under-appreciated is how prevalent malaria is. Let’s say we have 250 million cases a year of malaria and sub-Saharan Africa has a population of about 750 million of whom about two-thirds live in a malaria zone. That is about 500 million people. So what we’re saying is that about half the people every year get a case of malaria throughout sub-Saharan Africa.
Pregnant women and young children are disproportionately affected. It’s been shown, for example, in studies that about one-quarter to one-fifth of all deaths of children under five in a typical village are caused by malaria. And consequently, if you effectively fight malaria you will decrease what is called all-causes child mortality by that number by about 20-25 percent. That’s a huge… saving of lives.
On malaria and pregnancy – it’s not broadly appreciated how both the life of the mother and the fetus and infant-to-be are affected by malaria. The malaria parasite crosses the placenta and goes from the bloodstream of the mother to the fetus and then the infant. It causes growth retardation, it causes failure to thrive, which is a medical term for young infants not growing, not maturing and not developing physically or mentally. This is prevented very easily by a couple of doses of preventive medicine during pregnancy.
So one of the aspects of malaria that is especially important at the village level is to make sure that women, even women who don’t attend formal antenatal care, get a couple of preventive doses of anti-malarial drugs. Not only does that secure their own health throughout pregnancy and delivery, but also results much more likely in a robust and healthy infant.
If malaria infection decreases in a village with normally high malaria prevalence, what does that mean for the community?
Since malaria is both physically debilitating and takes children from school, takes mothers from tilling the soil and takes fathers from local employment … what it means is that more human resources can be devoted to activities of daily life and economic productivity.
What that means in turn is more food, more education, probably better social integration and development of the entire community. And this is not [just] theory. This now in certain parts of Africa, especially with strong community-based malaria programs, has become a reality.
Tell us about Nets for Life and where that project currently stands.
We feel Nets for Life is one of the most unique and creative private/state-based partnerships. It comprises six operational partners. They are six organizations that have banded together to form a single secretariat and then a single operational program.
The six organizations are: the Coca-Cola Foundation of Africa; Standard Chartered Bank; ExxonMobil; and the faith-based organization Episcopal Relief and Development, which works through a number of African dioceses in 17 countries. The non-corporate, non-faith based partners are two private foundations: Starr Foundation and the White Flowers Foundation.
Together we have banded together not only to finance the delivery and distribution of bednets at the end of the road, at the village and community level in Africa, but also to instill a bednet culture at the end of the road.
We use the power of the faith-based community, which has local trust and credibility, and the communication access and skill. So in many, many villages … the Nets for Life consortium is developing and delivering malaria messaging about the importance of prevention and treatment of malaria, using community volunteers and faith-based volunteers at the end of the road where there are typically no health facilities. And [the consortium is] also delivering bednets.
The consortium over the last three years has delivered three million bednets throughout 17 African countries. So it’s really a case example to me of partnership at its best. It builds on the core competencies of each partner and leverages it to maximum benefits.
ExxonMobil’s contribution to this is the monitoring and evaluation program. What we’ve done with Nets for Life is work very closely with what is a faith-based culture and together we have adopted monitoring and evaluation measurement at all levels, all the way from the village levels to the country headquarters level to the regional Africa level.
We now know exactly how many malaria messages are being delivered, how many bednets are being delivered, how many diagnostic kits are being delivered and whether they’re being used or not…
Can you tell us about any new projects that are underway in the fight against malaria?
It’s not just exciting for ExxonMobil but exciting for the world of malaria. It’s an impending drug trial for a new anti-malarial drug, pyramax. The clinical trial of this drug is scheduled to start in August of this year in Papua New Guinea (PNG). ExxonMobil is the operator of a very sizeable new LNG (liquefied natural gas) project in Papua New Guinea, which is a U.S. $14 billion civil engineering project. It’s scheduled to bring new gas resources on stream by 2014. That’s the commercial background.
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But the malaria background of PNG is [that] it’s a hotbed of what is called dual-infection malaria. PNG is one of those places that has two different species of malaria: falciparum and vivax. Typically those species do not coexist in the same human ecological environment - it’s either one or the other. Falciparum predominates in Africa and vivax predominates in Latin America and in many parts of Asia. This coexistence does exist in parts of Asia, too, but it’s a minority.
The Papua New Guinea environment is ideal for testing this drug, which is potentially effective against both of these species at the same time. Pyramax is a fixed-dose combination manufactured by a Korean pharmaceutical company called Shin Poong. This drug was just submitted for regulatory approval in Europe. To get final approval you have to run a Phase Three clinical trial, which ExxonMobil is helping to finance and conduct in Papua New Guinea. It’s going to be run by a Geneva-based, Swiss non-profit called Medicines for Malaria Venture and the protocol is going to be managed by a very esteemed clinical authority in PNG called the Institute for Medical Research.
But the bottom line is if this drug is proven effective against both forms of malaria it’s going to make huge headway in those parts of the world that have this dual infection. We hope to see pyramax become the standard of treatment in the world for dual infection malaria and we should know more in about a year.
Where do things stand now in terms of a vaccine against malaria?
ExxonMobil is a sponsor of the malaria vaccine initiative. Currently there is a vaccine that has entered Phase Three clinical trials and it’s being tested in Africa. The trial will run about three years.
The earliest that the result is anticipated is 2013 or 2014. This is the first ever Phase Three clinical trial. Everyone is keeping their fingers crossed that it will have the level of effectiveness and safety that will allow it to be put into the pipeline as the next great tool against malaria.
