The risk of malaria worldwide: prospects for control and elimination Bob Snow KEMRI-University of Oxford collaboration, Nairobi, Kenya

Evangelism and global malaria eradication

Context Risks and types of disease different in different parts of the world Suites of control strategies need to be tied to the basic scientific understanding of risk The future of malaria control worldwide must be driven by a map – the last one developed almost 50 years ago

Global limits of P. falciparum malaria – 87 countries in 2007 Guerra et al. (2008) PLoS Medicine

Iterated spatial Pf limits based on – Med Intelligence mapping and biology of parasite with remotely sensed satellite data on Temperature and Aridity Guerra et al. (2008) PLoS Medicine

Interpolated global stable endemic surface of P. falciparum parasite prevalence to 2007 Hay et al. (2009) PLoS Medicine

0.9 Billion people at unstable risk < 1 case per 10,000 people each year 1.4 Billion people at stable risk 67% of world population exposed to any risk of P. falciparum live in Central and South Asia and Pacific 73% of P. falciparum risk world live in areas of unstable or low endemic risk Only 14% of Pf world live in areas of high transmission – 98% in Africa In 2007…..

Americas 91 million people at risk of Pf 50 Million in Unstable areas 41 Million in areas where PfPR < 5%

South, Central and Eastern Asia 1.6 Billion people at Pf risk 911 million at risk of unstable transmission (57%) 603 million at risks of stable transmission with PfPR <5% (38%) 80 million people at risk of transmission > 5% (5%)

Africa 679 million people at risk of Pf – ¾ Africans 171 million (25%) in stable PfPR 5-39% 377 million (56%) in Stable PfPR 40%+ 428 Million clinical events in all ages 0.98 Million deaths directly due to PF among children aged 0-4 years

Malaria-specific mortality in African children aged 0-4 years per 1000 children p.a. from 31 community-based surveillance studies between What are we shooting for in Africa?

What can be done to reduce the public health burden of P. falciparum? Just two simple interventions that cost a few dollars per person each year Effective and prompt treatment with drugs that work Protection from infectious bites through the use of a net treated with insecticide or IRS

Speed of international public health policy change

Percentage of Kenyan Health facilities without Paed doses of AL on day of survey? 3/5 health facilities don’t have drugs to treat malaria effectively in young children……….

Of children living in stable endemic areas of Africa c % under an ITN c % under an ITN Intervention Coverage - ITNs 90 million children do not sleep under an ITN in 2007 Most within only 7 countries 25% of all unprotected children are Nigerian Noor et al., Lancet 2009, 373: 58-67

2004 Social Marketing & Commercial Sector approaches – 33 Million USD 2005 Above + heavily subsidized – 54 Million USD 2006 Above + FREE – 17 Million USD Noor et al., PLoS Med (2007) The Kenyan Example

Financing Stable populations at risk per capita national and international funding unmet financial need in countries < 1$ per person Only three countries > 4$ per person Djibouti ST&P Equatorial Guinea Snow et al., PLoS Medicine 2008, 5: e142

We must get the plan for Africa right We can make a huge public health difference in our life-times without elimination – a legacy we’d all be proud of We can predict this impact and we can measure it The way forward? There are some areas of the world where regional or small scale elimination is feasible but these areas must ensure political and financial sustained commitment themselves

World Vision launches bold initiative for worldwide elimination of mosquitoes 15 Oct Source: ASSIST News Service Richard Stern pointed out that now it's time for the rest of the world to benefit from the U.S experience and that by God's mercy and in partnership with other humanitarian organisations and individuals, World Vision is determined to end malaria in the entire world. Tanzania still expecting to eradicate malaria by Oct 2008 By Christopher Magola, Dar es Salaam Rwanda - Anti-mosquito spraying 19 Oct 2008 By Frank Kagabo – The New Times Rwanda Late last year, the country embarked on a spirited anti-mosquito spray in homes with a view of eradicating malaria, from the country How is this interpreted internationally and regionally? Malaria to be eradicated in Nigeria by Aug 2008 by AbdulAzeez Sani Lagos Times Minister of State for Health, Arc. Gabriel Aduku, has disclosed that the federal government has set 2015 for the total eradication of malaria in the country