The Schistosomiasis Control Initiative Summary for 2012/13 and strategic direction for 2014/20 Professor Alan Fenwick OBE

What is involved to upscale to country level we need to: –Mobilise political will –Define disease distribution – collect mapping and base line data –Develop a national plan with strategies at each district level –Define drug needs and order drugs –Develop local advocacy tools –Conduct training for teachers –Deliver the drugs –Monitoring and evaluation

Treating school children is easy

And adults at high risk are offered treatment

Phase One SCI started with funding from Bill and Melinda Gates Foundation Ministries of Health and Education in 6 countries with SCI support delivered over 43 million cumulative Schistosomiasis treatments and over 100 million albendazole (purchased) m 12 m 26 m 43 m /32003/4 2004/5 2005/62006/7 SCI Treatment Years Number of Treatments (millions) 2002/3 2003/4 2004/5 2005/6 2006/7

Phase Two - Ministries of Health and Education with SCI support and USAID funding Treatments delivered shown below 6 m 3 m >40 m Rwanda/ Burundi YemenBurkina Faso NigerUganda SCI supported countries Number of Treatments (millions) 4 drugs 4 drugs (RTI) Pzq and alb

Phase Three – expansion - Ministries of Health and Education with SCI support and DFID funding +++ Treatments delivered in 2012/13 1m/6m 10 m 2 m 8 m 1 m Rwanda/ Burundi Yemen TanzaniaMalawiCote D’Ivoire SCI supported countries Number of Treatments (millions) Pzq/alb 75 million treatments to 8 countries planned for 2011 – 2016 funded by DFID Could be doubled with a new award Uganda Niger 1 m 3 m Mozambique 8 m

Phase Four Consolidate in existing countries Consolidate in existing countries –DFID – reach national coverage in all 8 countries –DFID – move towards elimination in Zanzibar, Uganda and Niger –DFID expand into Ethiopia and DRC –Move towards elimination in Rwanda and Burundi (SCORE and ENDFUND and Private) –Expansion of coverage in Yemen –Use donations to move into new countries (Mauritania, Madagascar, Zimbabwe, Senegal)

Phase Four A More holistic approach A More holistic approach –Maintain and increase income (more proposals, maintaining status with givewell and GWWC) –Strengthen staff (management, new disciplines, more local staff Ethiopia, DRC) –Water and sanitation – what shall we do ? –Behaviour change – is this feasible –Snail control – when and where

Phase Four Operational research Operational research –Monitor drug efficacy –Improving coverage –Gaining and maintaining control –Possibility of elimination –Water and sanitation –Snail control –Cysticercosis

Director Managing Director Finance Manager ICOSA Project Manager ICOSA M and E Programme Manager (Rwanda, Burundi, Senegal) Director of Monitoring and Evaluation Senior Biostatistician Health Economist Mathematical Modeller Finance Officer Office Manager Programme Manager (Yemen and Ethiopia) Africa Capacity Building Liaison Africa country coordinators Long and Short Term Technical Assistants Liverpool CNTD Sub-Contract 3 Programme Managers DFID (8 Countries) RESEARCH UNIT IMPLEMENTATION UNIT FINANCE AND ADMINISTRATION UNIT Programme Manager UGA (Niger, Mozambique) PR and fund raising SCI ORGANOGRAM

Niger Mali Burkina Faso Uganda Tanzania Zambia SCI coverage Burundi and Rwanda With support from the Gates Foundation USAID/NTD, Geneva Global and DFID, UK And Yemen With World Bank funds Malawi and Mozambique Cote D’Ivoire and Liberia Proposed expansion into DRC, Ethiopia Senegal. Mauritania and Zimbabwe Senegal Zim DRC Ethiopia Mauritania

With the new WHA resolution calling for global schistosomiasis elimination: what is the WHO strategy, the feasibility and what are the major challenges? How does this affect SCI ?

Proportion of PC for schistosomiasis, soil-transmitted helminthiases, lymphatic filariasis, onchocerciasis and trachoma, 2011 Population requiring preventive chemotherapy Proportion, % Schistosomiasis Soil-transmitted helminthiases Lymphatic filariasis Onchocerciasis ~ 243 million~ 873 million~ million~ 127 million Trachoma ~ 281 million Schistosomiasis Soil-transmitted helminthiases Lymphatic filariasis Onchocerciasis Trachom a # of counties reported ND # of people treated28,140,136302,523,800557,434,30598,089,495ND Coverage (%) ND

National Programmes GSK Eisai J&J ALB DEC MBD Joint Virtual Review Panel Merck KGaA PZQ SHIPMENT Joint Request + Joint Report + Annual work plan ORDER IVMAZI MDP ITI Applications Shipments WHO Joint drug request, review & reporting mechanism But with pzq there are other sources DFID and USAID Regional review groups

Merck KGaA's expanded commitment of praziquantel supply for unlimited period

Likely future praziquantel availability (millions of tablets) USAID Annual commitment 100+ DFIDConfirmed47 DFID Not yet confirmed23 Other NGO’s 10 Merck Incremental Total Treatments80 million100 million120 million170 million

The US Government Launched in 2006 by USAID The Neglected Tropical Diseases Cooperative Agreement - Initially $100 million, and in 2010 a new commitment of $450 million $250 m to “ENVISION”

The British Government £50 million over 5 years for NTD control announced in 2008 A new £200 million 4 year commitment in January 2012

Other donors to/through SCI The World Bank The World Bank The END FUND (Geneva Global and Legatum) The END FUND (Geneva Global and Legatum) Childrens Investment Fund Foundation (CIFF) Childrens Investment Fund Foundation (CIFF) Vitol Vitol The Bill and Melinda Gates Foundation The Bill and Melinda Gates Foundation SCORE (UGA/ BMGF) SCORE (UGA/ BMGF) Global Network for NTD control (END7) Global Network for NTD control (END7) Private Donors Private Donors

How much can we reach out to the countries with maximum requirements - the 10 highly endemic AFR countries, statusPopulation received treatment, 2010 Estimated Infected population, Countries Carter C, CIFF, DFID and USAID 2,297,28236,728,013Nigeria USAID, CNTD and SCI1,298,26323,189,294United Republic of Tanzania Starting 2013/14 -19,157,807Democratic Republic of the Congo Ongoing USAID/ CNTD1,739,83717,644,805Ghana Expanding 2012/13 488,35916,326,177Mozambique SCI in 2013/14 -11,087,896Madagascar Ongoing CIFF -9,396,937Kenya Expanding SCI657,9678,628,298Côte d'Ivoire Expanding SCI/ CNTD938,9996,725,050Malawi Starting ,026,639Ethiopia 7,420,707154,910,91510 Countries 33,642,598243,598,854GLOBAL 22.1% 63.6%Proportion of global

Control of Morbidity Elimination as a public health problem Interruption of transmission PCT 100% geographical and 75% national coverage with PCT Adjusted PCT and complementary interventions recommended Intensified PCT in complementary interventions essential Prevalence of heavy intensity infection <5% Prevalence of heavy intensity infection <1% Reduction of incidence of infection to zero Up to 5-10 years from joining the group Up to 3-6 years from joining the group Up to 5 years from joining the group

WHO Strategic Plan Milestones Global Strategic Plan for SCH is adopted Global coordination mechanism is in place for  Adequate supply of praziquantel  Resources for country level implementation  Harmonisation of partners activities National policies for NTD control including SCH are in place in 50% of the countries requiring PCT A school-deworming manual including M&E available A resolution on SCH elimination is adopted

WHO Strategic Plan Milestones National Plans of Action for NTD control developed by 75% of the countries requiring PCT for SCH Procedures and Guidelines for verification of interruption of transmission are established Interruption of transmission is verified in countries which request it Geographical mapping of at least 75% of countries requiring PCT is completed and PCT database updated Guidelines for snail control revised and disseminated Training for NTD programmes managers conducted SOP to monitor drug efficacy of PZQ s developed

ChallengeStrategyQuestions Lack of political commitment/ WHO USAID and DFID RTI/SCI/CNTD Integration vs Coordination Advocacy for political commitment and country ownership of programmes – increased country financial contribution -High level advocacy by WHO and donor countries to ensure NTD programmes are prioritised by governments -Encourage an inter sectoral approach to NTD control -Advocacy for increased country and donor support for SCH in particular -Improve relations between similar groups be better dialogue control Role of SCH/STH NDGO group in advocacy at different levels The importance of advocacy

The UK Coalition against Neglected Tropical Diseases (NTDs) is a collaborative partnership between UK organisations actively engaged in the implementation, capacity building and research of neglected tropical disease control at scale

London Centre for NTD Research Launched on January 30 th 2013 Launched on January 30 th 2013 (Sir Roy Anderson) (Sir Roy Anderson) Partners include PCDSCI London School of Hygiene and Tropical Medicine Natural History Museum

Where we are now Where we can get with existing tools and strategies 2020 Goals Diseases Targeted For Elimination Diseases Targeted For Control Schistosomiasis River blindness Soil- Transmitted Helminthes Visceral Leishmaniasis Chagas Guinea worm Leprosy Lymphatic filariasis Blinding trachoma Sleeping sickness Where we can get with new tools and strategies