World Malaria Day

April 25, 2013

By the time you finish reading this article, malaria will have killed five children. Malaria kills an estimated 660,000 people every year of which some 85% are children under five years of age. That is roughly one death every minute of every day. Neatly 3.3 billion people, half of the world’s population, are at risk of acquiring malaria. In 2010, there were over 219 million cases of malaria. Eighty percent of all cases occurred in just 17 countries with forty percent occuring in only three countries- the Democratic Republic of the Congo, India, and Nigeria.

Although malaria is most common in Africa, it is endemic in many Asia-Pacific countries including Papua New Guinea. Eighteen percent of all deaths at PNG hospitals are malaria-related. With 90% of the country at risk, approximately 800 Papua New Guineans die from malaria each year.

Malaria is a preventable and curable disease. However, many countries do not have the funding or access to the prevention services, early diagnosis, or treatments that could save thousands of lives. On World Malaria Day, April 25, we reflect on the severity and cruelty of this disease but also recognize the progress we have made towards defeating one of the world’s greatest killer diseases.

Malaria is caused by parasites that are transmitted to people through the bite of an infected mosquito (specifically the Anopheles genus). Effective prevention involves the use of insecticide-treated bed nets (ITNs) which act as a barrier between an uninfected person and a malarial mosquito. ITNs have been shown to reduce all-cause mortality in children under 5 by about 20 percent and malarial illnesses among children under 5 and pregnant women by up to 50 percent. An additional preventive measure is the use of indoor residual spraying, which repels and kills mosquitoes. The Global Fund to Fight AIDS, Tuberculosis, and Malaria has provided malaria-endemic countries with some 310 million insecticide-treated bed nets and provided indoor residual spraying units to 44 million buildings.

Malaria is curable and there have been recent advances in treatment. Artemisinin-based combination therapies (ACTs), the most effective antimalarial drugs, have been increasingly available worldwide. The number of ACT treatment courses acquired by public health authorities increased from 11.2 million in 2005 to 76 million in 2006, and 181 million in 2010. The Global Fund has played a critical role in the introduction and expansion of coverage of ACTs in many countries where resistance to older malaria drugs has increased. In addition to financing treatment for 260 million cases (cumulatively) of malaria by mid-2012, the Global Fund has been piloting a pioneering financing mechanism to improve access to ACTs by making them more affordable.

With the Global Fund’s new US$15 billion replenishment target for 2014-16, announced in Brussels earlier this month, we have every hope that malaria will soon be a problem of our past. We have come a far way in treatment and prevention of malaria, but with a child dying every minute, we clearly still have a long way to go.

Shawn Clackett

Mrs Thatcher’s Progressive and Pragmatic Drug Policies

Guest post by Dr Alex Wodak, Former head, Drug and Alcohol Services at the St Vincent’s Hospital

Former British Prime Minister, Mrs Margaret Thatcher

The former British Prime Minister, Mrs Margaret Thatcher, who died this week, was universally regarded as a no-nonsense ‘conviction politician’.

Few know of her important role in the early adoption and vigorous implementation of a needle syringe programmes to control the spread of HIV in the United Kingdom. At that stage, in 1986, the Netherlands was the only country in the world to have started a similar policy. The discovery of the condition, now referred to as HIV/AIDS, was first announced to the world on 5 June 1981. It was clear very early on that this condition was a serious health, social and economic threat to the world but little was known about the nature and extent of this threat.

 Mrs Thatcher accepted the recommendations to establish a national needle exchange programme to slow the spread of HIV among and from people who inject drugs. The recommendation was made by a UK committee established to develop an effective response to HIV. The UK needle exchange programme undoubtedly prevented many HIV infections and much needless suffering as well as saving many lives and many pounds. Mrs Thatcher’s decision influenced many other countries to adopt needle syringe programs. Australia’s first needle syringe programme was established on 12 November 1986 as an act of civil disobedience and prompted the then NSW Government to establish a state wide system. All other states and territories followed within two years.

 Many assume that pragmatic drug policies are generally a product of left wing political parties and governments. This is not so. The experience of Mrs Thatcher in establishing a needle exchange programme in the UK in 1986 and President Nixon establishing a national methadone treatment programme in the USA in 1969 are examples of conservative politicians adopting pragmatic drug policies. Both were excellent decisions though still often criticised.

 On 2 April 1985, the then Prime Minister of Australia, Bob Hawke, convened a ‘Special Premier’s Conference’ (the ‘Drug Summit’) at which it was agreed by all 8 governments represented (the Commonwealth, six states, the Northern Territory) that ‘harm minimisation’ would henceforth be Australia’s official national drug policy. At the time, five of the governments were Labor while three – Queensland, Tasmania and the Northern Territory – were centre-right (National, Liberal and Country Liberal respectively). For many years, Australia’s response to HIV and drug policy has enjoyed support from all major parties. All nine Australian governments have continued to support harm minimisation since 1985 whatever the political hue of the party or parties forming government.

Global Fund Selects its Next Board Chair and Vice-Chair

Dr Nafsiah Mboi of Indonesia to be the new Board Chair of the Global Fund

GENEVA – The Board of the Global Fund to Fight AIDS, Tuberculosis and Malaria has selected Nafsiah Mboi of Indonesia to be its next Board Chair and Mireille Guigaz of France as its next Board Vice-Chair. Both will begin a two-year term starting in late June, 2013.

Dr Nafsiah Mboi is the Minister of Health for the Republic of Indonesia. She has more than 40 years of experience in national and global public health, including a full career as a civil servant in the Ministry of Health. She served six years as Secretary of Indonesia’s National AIDS Commission, where she oversaw planning, coordination and implementation of the national response to HIV and AIDS, and expanded the involvement of both government and civil society organizations including work with faith-based communities and private sector initiatives.

Originally trained as a pediatrician, Dr Nafsiah subsequently earned an MPH degree. She served as a member of Indonesia’s Parliament from 1992 to 1997. Internationally, she has served as Chair of the United Nations Committee on the Rights of the Child and also as Director of the Department of Gender and Women’s Health at the World Health Organization in Geneva.

“Nafsiah Mboi is an inspiring and highly effective leader,” said Simon Bland, Chair of the Global Fund Board. “She is committed to building upon the reforms of the past two years, and she and Mireille Guigaz will make an outstanding team that can lead the Global Fund to a new level of achievement.”

Mr Bland and Dr Mphu Ramatlapeng will serve as Board Chair and Vice-Chair through the next Board meeting on 18-19 June 2013. At the conclusion of that meeting, responsibility will be transferred to incoming Chair and Vice-Chair. It will be the first time since the Global Fund was established in 2002 that its Board will be led by two women.

Madame Guigaz most recently served as France’s Ambassador for the fight against HIV and AIDS and communicable diseases, representing France on the Board of the Global Fund, a position she also held in the early days of the Global Fund. She has served on the Board’s Strategy, Investment and Impact Committee and its Audit and Ethics Committee, as well as on the Boards of UNITAID and Roll Back Malaria.

In a career devoted to issues of global health, development and human rights, Mme Guigaz has served in numerous positions, including as France’s Permanent Representative to the Food and Agriculture Organization. She earned a PhD in medical law and health care economics at the University of Lyon. She also earned a Master of law and political sciences from the Institute of Political Studies of Lyon and a Master’s degree in mediation from the Kurt Bösch Institute.

A planned handover period during May and June will allow for a smooth transition of leadership, at a time when the Global Fund is preparing to raise funds at a once-every-three-years pledging conference in late 2013, intended to accelerate the fight against HIV and AIDS, tuberculosis and malaria.

Partnership is a founding principle of the Global Fund, and one the Board’s practices to embrace partnership between donor and implementer countries has been to alternate between a Board Chair from a donor nation, and from an implementer country.  The same applies to the role of Board Vice-Chair.

Dr Nafsiah and Mme Guigaz will serve in a personal capacity.  In their new roles, they will represent the interests of the entire Global Fund, instead of representing their home country.

Dr Nafsiah and Mme Guigaz were selected by unanimous electronic vote by the Board on 18 March 2013.

Dr Mark Dybul visits Australia

If the world of infectious diseases had superstars,
Mark Dybul would probably be one of them.

- Australian Financial Review

Between 13 – 16 March 2013, the newly-appointed Executive Director of the Global Fund to Fight AIDS, Tuberculosis, and Malaria, Dr Mark Dybul, visited Australia for the first time. Prior to assuming his new position as Executive Director of the Global Fund in February 2013, Dr Dybul served as the head of PEPFAR (President’s Emergency Plan for AIDS) between 2006 and 2009. In 2004, he moved to PEPFAR as Deputy Chief Medical Officer. Soon he was promoted to Assistant, then Deputy, and then Acting U.S. Global AIDS Coordinator. In 2006, Mark Dybul was appointed to head the organisation as U.S. Global AIDS Coordinator, equivalent level to an Assistant Secretary of State in the U.S. State Department. He served there until 2009. Under his tenure PEPFAR budgets quadrupled.

During his visit, Dr Dybul was accompanied by Dr Christoph Benn, Director of External Relations at the Global Fund; Mr Don Baxter, Australian Board Member on the Global Fund; Mr Bill Bowtell, Executive Director of Pacific Friends; Mr Chris Puplick, Senior Advisor to the Health Minister of New South Wales; and Mr Shawn Clackett, Administrative and Communications Officer of Pacific Friends of the Global Fund.

On Wednesday 13 March, the Global fund team visited Melbourne for a roundtable discussion with representatives of Australian non-government organisations (NGO) and leaders of HIV research institutions. The meeting was co-hosted by Professor Brendan Crabb, Executive Director of the Burnet Institute; and Ms Maree Nutt, National Manager of RESULTS Australia. Dr Dybul and Dr Benn briefed the meeting on recent structural changes to the Global Fund, including the revision of new grant and financial management arrangements; and strategy for the 2013 Replenishment year of the Global Fund. Sir Gustav Nossal, a distinguished Australian research biologist, famous for his contributions to the fields of antibody formation and immunological tolerance; Professor Sharon Lewin, Co-Chair of the 2014 Melbourne International AIDS Conference; and Mr Bill Whittaker AM, Advisory Council Member of Pacific Friends of the Global Fund were among those who attended the Melbourne meeting.

Burnet’s Professor Brendan Crabb with Global Fund’s Dr Mark Dybul

Between 13 – 15 March, Dr Dybul and Dr Benn visited Canberra. During the visit, Dr Dybul was received by the Governor-General, Her Excellency Ms Quentin Bryce AC, who is also the Patron of Pacific Friends of the Global Fund. Dr Dybul and Dr Benn also met Senator the Hon Bob Carr, the Minister for Foreign Affairs; the Hon Tanya Plibersek, the Minister for Health; and the Hon Julie Bishop, the Deputy Leader of the Opposition and Shadow Foreign Minister. Dr Dybul and Dr Benn also met Mr Peter Baxter, Director General of AusAID, and senior AusAID officers.

Dr Mark Dybul Meeting the Governor-General, Her Excellency Ms Quentin Bryce AC

On the final leg of his journey, Dr Dybul visited Sydney between 15 – 16 March 2013. On Friday, 15 March, he met with some forty representatives of Sydney based non-government organisations (NGO) involved in HIV. Ms Wendy McCarthy AO chaired this meeting.

On March 16, Dr Dybul visited the Access to Life Exhibition at the Powerhouse Museum, Sydney.  This powerful photographic exhibition has already moved millions of people around the world through its touching images of AIDS-affected communities. Dr Dybul was accompanied by Ms Anni Turnbull, the Curator of the Exhibition; Mr Mark Goggin, General Manager of the Powerhouse Museum; Mr Ross Hutton, Public Health Manager at the Oil Search Health Foundation; Dr Kevin Miles, HIV Technical Specialist at the Oil Search Health Foundation; and Mr Tim Siegenbeek van Heukelom, Program Analyst and Information Coordinator at the Oil Search Health Foundation.

In an interview with the Australian Financial Review given during his visit, Dr Dybul said that “…we have this small window to beat two plagues… and we can actually do it if we pull together; that’s something we can do. The world is pretty constrained financially, but it’s still a pretty wealthy world.”

Mark Dybul made the strong point that with a little more funding, we can turn these pandemics into low-level endemics, but we need to step up our game to become a true global family. We hope that Dr Mark Dybul will have a good and lasting effect on the Global Fund, on these three diseases, and on the world. As the Australian Financial Review commented, “if the world of infectious diseases had superstars, Mark Dybul would probably be one of them.”

Global Fund News Flash

Issue 16 – 21 March 2013

New Funding Model Hits the Ground Running

The Democratic Republic of Congo is one of the countries taking the lead in implementing the Global Fund’s new funding model that was launched last month. Among the 50 or so countries that will access new funding in a transition phase this year, the DRC  is one of a handful invited to participate fully, going through all steps of the application process from submission of a concept note to creation of a new grant. At a gathering in Kinshasa, senior officials from DRC and the Global Fund discussed the context and dynamics of the new funding model, where US$130 in additional funding has been identified for HIV programs and US$ 85 million for malaria. Those investments will support programs that provide a significant amount of antiretroviral drugs to HIV patients and provide millions of replacement mosquito nets to people trying to prevent the spread of malaria. The DRC’s Minister of Health, Dr Felix Kabange, cited the flexibility and the inclusive dialogue in the new funding model, and said he had already seen signs of it in preparatory work in recent months. “I have seen things change significantly, both in our way of discussing things and in the way of dealing with problems and defining priorities,” Kabange said. The DRC and the Global Fund had established a true partnership, he said. “We are engaged in a constructive dialogue, which cannot fail to lead to advances.”

Mark Edington, Head of Grant Management at the Global Fund, who was also in Kinshasa for the event, said that partnership is most effective in countries which are already investing significant amounts of their own resources in fighting disease. He highlighted Kabange’s strong personal commitment to increased domestic funding of health programs, but said that the DRC’s government needed to make more health financing available for HIV, TB and malaria to match the grants. “We need to see the leadership of the Democratic Republic of Congo recognize the importance of investing in health and we need to see them put money into fighting the three diseases,” he said. “There is so much to do in the DRC and, while the Minister of Health is extremely committed to putting sufficient amounts in the budget, to date, the National Assembly has not upheld his budget lines.” Only 12 percent of people who need antiretroviral therapy are getting the medication in DRC and only 6 percent of pregnant women receive antiretroviral therapy that prevents the transmission of HIV to their child, he added. Kabange and Edington both promised to work to succeed in getting the DRC to invest more in health services given its high disease burden.