Friday, 25th April 2014 remains a special day in Speak Up Africa's institutional memory: the day that Zero Malaria Starts with Me was brought into the world. Government officials, led by the then Minister of Health and RBM Partnership to End Malaria Board Member Pr. Awa Coll-Seck, alongside donors, NGOs, and many others, gathered for the launch ceremony, without the knowledge of what would become of this campaign in just a few short years.
Let's rewind to two months prior. Speak Up Africa's Senior Communication Manager, Maelle Ba (who was at the time an intern) alongside Angelo Zogo, Speak Up Africa's longest serving graphic designer, met up with Philippe Guinot, PATH's Senegal Country Director at the time, and Senegal's National Malaria Control Program (NMCP) at the King Fahd Hotel in Dakar to brainstorm ideas for a new campaign.
What was beginning to become clear at this historical juncture - the end of a decade and a half of massive reductions in malaria deaths and the beginning of a period of stagnating decline - was that further progress against malaria was not guaranteed, self-evident or beyond contestation.
Let's remember that malaria is one of the oldest, deadliest, and most persistent diseases that humanity has ever had to confront. Deep evolutionary time has produced a wily and wicked weapon's system - the mosquito + plasmodium parasite - which is capable of rapid adaptation to avoid humanity's intentional (i.e malaria control interventions) and unintentional (i.e immune responses) attempts to interfere with its propagation.
To continue to move the malaria elimination agenda forward, something needed to shift. Business as usual was no longer an option if we were to take seriously - which we certainly do - the ultimate goal of malaria elimination and eventual eradication. From this basic realization emerged the central idea of the campaign: every sector, and every individual has an important and unique role to play; only through a collective, multi-sectoral and society-wide approach will "zero malaria" be reached. This would constitute building the enabling social, economic, and political environment fundamental to mounting a full-throated counterattack to the mosquito-parasite weapons system. Furthermore, the concept had to be simple yet compelling as well as action oriented. Putting these pieces together, the name Zero Malaria Starts with Me was conceived, accompanied by the 3 campaign pillars of political engagement, private sector engagement and community engagement.
Back to the launch. The Minister of Health provides the official cachet for the campaign to begin in earnest. With support from PATH, a major international public health NGO, Speak Up Africa and the National Malaria Control Program, led at that time by Dr. Mady Ba, embark on the pilot phase of the campaign over the next 3 years.
Here are some of the notable activations, activities, and results from 2014-2018:
- 134 Declarations of Commitment signed by national and international opinion leaders, including 53 mayors in Senegal and Admiral Tim Ziemer, former PMI Coordinator.
- 585 Declarations of Commitment signed during the 7th Multilateral Initiative on Malaria Conference in Dakar (April 15-20, 2018).
- A mobile photo exhibition, highlighting the importance of each citizen's commitment, was installed in nearly 20 locations in Senegal including 1 private sector company.
- 14 private sector companies pledged to support the NMCP and the campaign's activities to eliminate malaria in Senegal.
- As part of the broadcasting of original TV series "Bonaba's Champion", a social media campaign highlighted the 10 episodes on the Zero Malaria Starts with Me Facebook page reaching a total of 112 601 views, 2515 Likes and 893 shares. On Marodi TV's YouTube page, the TV show counted 465,000 views in one year.
- 8 community champions were trained in Pikine, a suburb of Dakar. In less than 6 months, the champions impacted close to 8310 people through their community outreach and 3840 home visits. This program has more recently been rolled-out in other areas of the country by PATH.
- Production of a song and music video by young Senegalese artists to raise awareness and promote the campaign.(see video)
Sink or Swim: The Road to Nouakchott (2018)
Following what was widely considered to have been a highly innovative, impactful, and inspiring campaign in Senegal, Speak Up Africa brought the campaign to the RBM Partnership to End Malaria and together presented it to the African Union (AU) Commission in January 2018. The AU Commission, conscious of the need for renewed energy behind the malaria elimination agenda, were fully supportive and facilitated the process by which the campaign could be brought before African heads of state to seek high-level political endorsement.
The following 6 months were dedicated to conducting national, regional and partner consultations around the campaign, refining the campaign framework and developing a set of tools to support campaign implementation, resulting in the production of the Zero Malaria Starts with Me toolkit, which provides a step-by-step guide and framework for rolling-out the campaign at the national level.
In mid-2018 - from June 25 to July 2 - AU heads of state gathered in Nouakchott, Mauritania, for the 31st African Union Summit, presided over by then Chair of the African Union, Paul Kagame. On July 2, all heads of state endorsed the Zero Malaria Starts with Me campaign, championed in particular by the President of Senegal, Macky Sall, thereby providing the political impetus to take the campaign across Africa. [8] [9] [10]
Championing the Fight from Grassroots to Global
One strategy of the Zero Malaria Starts with Me campaign has been to identify champions able to articulate the importance of prioritizing and investing in malaria control and elimination. One such individual was El-Hadji Diop, a community champion from the Senegalese village of Thieneba. Having lost his daughter to malaria at the turn of the century, El-Hadji subsequently dedicated his life to passionately raising awareness among Senegalese communities about malaria prevention and treatment.
Beyond providing platforms at the national level for El-Hadji to advocate for increased governmental support, the Zero Malaria Starts with Me campaign ecosystem also provided him an opportunity to give a speech at the Global Fund Replenishment Conference in Lyon in 2019, taking the stage just before the French President, in order to share his story and communicate the perspective of local communities, all too often absent from such fora, as well as to deliver a powerful call-to-action to the global donor community.
El-Hadji tragically passed away the day after World Malaria Day in 2022, though his powerful legacy remains alive and well through his community association, AISM-Thienaba, now run by his son, Alpha.
Will they, won't they? The Ultimate Catalytic Test
It is one thing to seek such high-level buy-in as the endorsement of all heads of state of the African Union - which is no mean feat - but this does not guarantee roll-out and operationalization. The ultimate test began in the second half of 2018, following the African launch in Nouakchott: would member states themselves see the interest and relevance of the campaign and were they ready to invest their time and resources in adopting, adapting, and rolling-out the campaign at the national level? With support from the RBM Partnership to End Malaria's secretariat and the AU Commission, member states gradually began launching and implementing the campaign in late 2018 and throughout 2019. To date, 29 member states have launched, the latest being Togo in October 2023.
A Case Study: Benin's Zero Malaria Starts with Me Story
In November 2020, the government of Benin took the step to launch the Zero Malaria Starts with Me campaign, as well as the Zero Malaria Business Leadership Initiative (more on that later!). Following the launch, Speak Up Africa supported the national malaria control program to develop a national advocacy plan, structured around the 3 pillars of the campaign. This plan gives teeth to the campaign by outlining advocacy objectives and strategies aligned to the national strategic plan and ensuring that all stakeholders are working towards the same vision, thereby counteracting the tendency within the field of advocacy for efforts to be dispersed, unaligned and inefficient. It was designed to be ambitious yet realistic and based on a sound analysis of the country's social, economic, and political context.
From early 2021, a series of actions were undertaken to renew the momentum behind the drive towards malaria elimination within the public sector, the private sector and at the community level, including:
- A prominent parliamentarian, Hon. Ake Natondé, officially embarks on his journey as Zero Malaria Champion, alongside private sector leaders Dr. Annabelle Ekeu and Mr. Esperat Tossa.
- A high-level and multi-sectoral advocacy event on World Malaria Day 2022, which included a photo-exhibition under the patronage of the Vice-President of Benin, Mrs. Chabi Talata.
- Audiences with the parliamentary budget oversight committee and briefing sessions with parliamentarians in 2022 and 2023 ahead of the budget debates and votes.
- Capacity building with civil society organizations and provision of grants to implement annual advocacy plans to drive national and sub-national advocacy efforts.
- Media engagement through the "Lines of Impact" initiative in which Media Fellows are supported to generate high-quality and accurate media productions on malaria as well as help to engage other journalists, networks and media houses.
As a result of these, and many other, advocacy moments and initiatives over the last 3 years, Benin's government increased their national budget for malaria control by at first 140% in 2023 (compared to the average over the prior 4 years) followed by a further 20% increase in 2024 (from $1.7 million to almost $5 million). This clearly demonstrates the government's recognition of the importance of getting Benin back on track towards malaria elimination.
The case of Benin is a pristine example of the power of the Zero Malaria Starts with Me campaign, bringing together a wide variety of individuals, organizations, and sectors around a common purpose and vision.
Innovation, Experimentation, and Integration: the Branching Effect of a Successful Campaign
Once the snowball had been set in motion, it became larger and larger, with more and more countries deciding to launch their own version of the campaign, altering its focus (and even sometimes its name) to reflect the priorities and perspective of the country. The strikingly high level of member state interest in taking ownership over this grassroots campaign was indicative of its Pan-African appeal.
In addition, what we believe is the sign of a living and breathing campaign is one that is in constant flux, undergoing a continuous process of innovation and evolution (we have to learn something from the mosquitoes and parasites we are trying to defeat!).
Some manifestations of this branching effect are as follows, though for brevity's sake I won't go into detail about each:
- A rebranding exercise was undertaken in 2019 to create a more polished and professional Zero Malaria 'brand', as an in-kind contribution to the RBM Partnership to End Malaria by Denstu, a global marketing company, facilitated by Malaria No More UK.
- In 2019, a "Zero Malaria Starts with Francophone Mayors" declaration was signed by members of the International Association of Francophone Mayors (AIMF).
- In 2020, artists, singers and activists came together in Sierra Leone to engage a mass audience of youth to insist on greater action against malaria as well as raise awareness among the general public about malaria prevention best practices. A music video featuring 12 Sierra Leonean artists was produced and widely shared, as well as a call-to-action video.
- The March to Kigali campaign launched in April 2021 developed an integrated advocacy approach combining the No to NTDs and Zero Malaria Starts with Me campaigns in the run up to the Commonwealth Heads of Government Meeting (CHOGM) in Kigali, Rwanda. More than 300 CSOs, businesses, media organizations, and individuals signed the March to Kigali declaration, with a total campaign reach of over 300,000 including 2000 people reached through 69 media outlets. More than $4 billion in funding commitments were announced at the conference by governments, private sector and international organizations.(see more)
- In July 2020, the Zero Malaria Business Leadership Initiative was launched, led by Ecobank Group in partnership with Speak Up Africa and the RBM Partnership to End Malaria, supporting the second pillar of the Zero Malaria Starts with Me campaign (private sector engagement) in Benin, Burkina Faso, Ghana, Senegal and Uganda. Between January 2021 and March 2024, $6 million was mobilized in in-kind and financial contributions from 60 companies.(see more)
- In September 2022, the Local Elected Officials Against Malaria (ELCP) association emerged during the "Zero Malaria Starts with the Diaspora" event organized in the run-up to the Global Fund Replenishment Conference. ELCP is a non-profit, non-partisan association which supports French elected representatives and other stakeholders wishing to invest in the fight against malaria, through awareness-raising, prevention, promoting research and the development of new tools to combat the disease, supporting people affected by malaria and/or their families, and mobilizing funding for malaria control and elimination.
- In October 2023, ELCP visited Benin as part of the international congress of the International Association of Francophone Mayors. During this visit, ELCP met with the National Association of the Communes of Benin (ANCB), following which the ANCB decided to launch the Alliance of the Mayors of Benin Against Malaria, which brings together representatives from each region and aims for a strong, lasting mobilization against this disease. Other associations of local councilors in French-speaking countries have since expressed interest in launching similar initiatives.(see more)
- In April 2022, the Zero Malaria Campaign Coalition (ZMCC) was launched in Kenya to lead the Zero Malaria Starts with Me campaign. Its goal is to foster partnerships within the public and private sectors to amplify the work of the malaria community, increase awareness of the negative impact of malaria within society and drive momentum towards malaria elimination. In February 2024, the ZMCC announced the launch of an innovative initiative dubbed "The Power of Everyone".
- In April 2023, the Zero Malaria Football Club was launched. Zero Malaria F.C is a 'squad' of globally renowned footballers joining forces to end malaria. Led by Co-Captains Luis Figo and CAF and FIFA legend Khalilou Fadiga, the team seeks to increase awareness of the disease, communicate the need for urgent action especially among young people, and increase pressure on policymakers to act. To date, Kader Keita, former Ivorian footballer player and Jay-Jay Okacha, former Nigerian player have joined Zero Malaria F.C as well as international artist Didi B.
- In July 2023, as part of a high-level celebration in Dakar, Senegal, to mark the 5th anniversary of the continental launch of the Zero Malaria Starts with Me campaign, youth leaders from across Africa gathered to draft an official statement on behalf of African youth regarding the urgent need to take further action to get back on track towards malaria elimination. (see statement)
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This is just a snapshot of the wide array of the incredible initiatives taken across a wide range of sectors and geographies over the last few years and demonstrates the depths of creativity and action that is generated when true mass mobilization occurs.
Optimistic, pessimistic or nihilistic : Reflecting on the Fight Against Malaria
Before concluding, it would be remiss if we did not step back to take stock of where we are in the fight against malaria at the present moment.
First of all, it is important to recognize how far we have come in a relatively short time. Since 2000, malaria deaths have halved while the population has grown exponentially, with new tools such as long lasting insecticide-treated nets (LLINs), intermittent preventive treatment for pregnant women (IPTp), and seasonal chemo-prevention (SCP) for infants and young children, making serious contributions to controlling, and, in some places, eliminating malaria.
However, progress has stalled over the last several years, and has in many cases begun to reverse. Since 2015, malaria incidence has declined by 7.6% and mortality by 11.3%, well short of African Union's interim goals of 40% reductions by 2020 and 70% by 2025. Indeed, there were more cases globally in 2022 than prior to the Covid-19 pandemic, and there are massive gaps in the financing required to get back on track towards malaria elimination.
Current projections show that African states will find it increasingly difficult to sustain existing levels of essential malaria interventions over the next 3 years, especially in 2026, with at least a $1.5 billion budget shortfall. An additional $5.2 billion is required annually to make progress towards elimination.(see more) And current levels of coverage are far from ideal: according to the 2023 World Malaria Report, in 2022 almost half of pregnant women (42%) did not receive the recommended 3 doses of intermittent preventive treatment (IPT), and around one-third of febrile children were not taken to a health provider for care.
As well as these stark facts related to the current situation regarding malaria financing, many other factors threaten to further slow progress, and even reverse it, such as: insecticide, drug and diagnostic resistance, climate change, and the spread of the invasive Anopheles Stephansi mosquito.
Although it is crucial to recognize progress made, and the power of collective campaigning, a sober analysis of our current situation and the scale of the challenges ahead is of critical importance. A dose of pessimism is healthy, it allows us to remain realistic and hard-headed about the difficult road ahead; a dose of optimism is crucial to remaining sane, motivated and action-oriented; and, most importantly, we must fight at all costs to ensure that our leaders, our movements, and our local and global communities, do not descend into a counter-productive nihilism about the future of the fight against malaria and the vision of a malaria-free world.
At the end of the day, a sound appreciation of the scale of the challenges with which we are confronted demonstrates the fundamental need to continue to build, create and collaborate, in the knowledge that our strength as a species is based on our ability to work together at a mass scale to solve seemingly intractable problems.
Now, more than ever, we must continue to push the malaria elimination agenda through the Zero Malaria Starts with Me campaign.
Here's to another 10-years and to malaria elimination!
#ZeroMalariaStartsWithMe
