Malaria Eradication: Ethics, Autonomy, Priorities David Brandling-Bennett Deputy Director, Malaria Infectious Diseases, Global Health Program May 3, © 2010 Bill & Melinda Gates Foundation |

An Audacious Goal Set in October 2007  Every life is of equal value; accepting malaria undervalues lives where it persists  The cost of malaria control will continue indefinitely  There will be an ongoing need to adjust control measures as the parasites and vectors adapt  The time is right for charting a long- term course to eradication, knowing that it will take several decades, sustained commitment, and an array of new tools to reach such an ambitious goal 2 © 2010 Bill & Melinda Gates Foundation |

Understanding Eradication  RBM Global Malaria Action Plan, 2008  Global Health Group Malaria Elimination Initiative Exploring the technical, financial, and operational feasibility of elimination Four papers in Lancet in October 2010  Malaria Eradication Research Agenda – malERA 2-year consultation about new tools needed for eradication Twelve papers in PLoS Medicine in January 2011 © 2010 Bill & Melinda Gates Foundation | 3 Scale up for Impact Sustain Control Eliminate Prevent Reintroduction Research

November 24, 2015 © 2010 Bill & Melinda Gates Foundation | 4 Reduce the burden Shrink the margins Develop transfor- mational tools Global Malaria Eradication Getting to Eradication Overlapping activities required to achieve eradication

Progress and Impact 1  Financing for malaria has risen over 10-fold in the past decade  Malaria deaths have gone from 1 million in 2000 to 781,000 in 2009, now saving nearly 500 children’s lives daily  11 countries and one area in the Africa Region achieved reduction of >50% in either confirmed malaria cases or malaria admissions and deaths  The reported number of cases decreased by more than 50% in 32 of 56 malaria-endemic countries outside Africa  8 countries in pre-elimination stage in 2009  10 countries implementing elimination programs  9 countries have interrupted transmission and are focusing on preventing reintroduction  Morocco and Turkmenistan certified malaria free in 2010 © 2010 Bill & Melinda Gates Foundation | 5 1 WHO World Malaria Report 2010

Ethics, Autonomy, and Priorities  Malaria eradication is most equitable The poorest and most rural suffer the highest burden of malaria Treating malaria interventions as global public goods achieves the highest equity Studies have linked malaria to poverty and economic stagnation  National and community autonomy are required Countries must develop their own strategic and execution plans Communities must be engaged and responsible Most endemic countries will need international assistance through effective, long-term partnerships  Malaria must remain a priority as its burden declines Malaria will resurge if we don’t maintain prevention and treatment Must avoid previous previous cycles of boom and bust Sustain political and financial commitment © 2010 Bill & Melinda Gates Foundation | 6

Addressing Challenges  We will need new tools for global eradication Available tools will not work indefinitely because of resistance Current tools are not sufficient in all malarious areas We need to increase our financing for research and development  Other critical issues Health services must be able to deliver needed interventions The role of communities should be better understood We must understand and justify the costs of eradication  Without the goal of eradication, we will not persevere Doubtful that countries can or will sustain control indefinitely Doubtful we will invest in adequately in new tools needed to interrupt transmission © 2010 Bill & Melinda Gates Foundation | 7

Eradication is an ethical, equitable, and feasible goal 8 © 2010 Bill & Melinda Gates Foundation |