Fogarty International Center

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Fogarty International Center
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Fogarty International Center

• promotes and supports scientific discovery
  internationally and mobilizes resources to reduce
  disparities in global health
• International Training and Research Program in
  Emerging Infectious Diseases, 1995-2004
• Actions for Building Capacity, partner with NIAID
  field research programs
• International Malaria Research Training Program,
  2001-2005
• Global Infectious Diseases Research Training
  Program, 2005

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International Malaria Research Training Program
(1)

• Johns Hopkins University Zimbabwe
• Transmission blocking immunity
• Vector biology
• Molecular parasitology/epidemiology
• Drug resistance
• University of Maryland - Mali
• Drug resistance
• Clinical trials
• Epidemiology
• Vector biology
• University of California, San Francisco - Uganda
• Drug resistance
• Clinical studies
• Epidemiology
• Molecular parasitology

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FIC Malaria Programs (2)

• Harvard School of Public Health Ethiopia,
  Senegal
• Molecular epidemiology
• HIV and malaria immunity
• Infected RBC biology
• Vector biology and control
• State University of New York, Buffalo - Kenya
• Vector biology
• University of Pittsburgh - Kenya
• Malarial anemia
• Tulane University Kenya, Mali, others
• Vector biology
• Vector ecology

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FIC Malaria Programs (3)

• Universidad del Valle, Columbia Latin America
• Malarial anemia
• Clinical malaria
• Columbia University - Thailand
• Severe malarial anemia
• Hematology
• US Army - Kenya
• Pediatric malaria
• Severe malaria
• Molecular pathogenesis, anemia and cerebral
  malaria

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Global Infectious Diseases (2004-2009)Research
Training Programs

• University of North Carolina - Malawi
• Malaria biochemistry, pathology, epidemiology
• Pennsylvania State University - Thailand
• P. vivax
• Albert Einstein global
• Malaria and other diseases
• University of California, San Diego Peruvian
  Amazon
• Parasitic diseases

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Centers for Disease Control and Prevention (CDC)
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CDC Malaria Activities

• Domestic
• Surveillance
• Investigations
• Advice to travelers
• Consultations
• Advice for blood collection
• Diagnostic assistance
• International
• Field stations (Kenya, Guatemala)
• Regional programs (Mekong Delta, Amazon River)
• Partner organizations (WHO, RBM, UNICEF, WB,
  USAID)
• Consultations
• Themes Epidemiology
• Pregnancy
• Personal protection
• Natural history

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CDC Research

• 4. Biology and immunology
• Host parasite interactions
• Immune response
• Host genetics
• Parasite genetic diversity
• 5. Clinical and control issues (Kenya, Mali,
  Malawi, Guatemala, elsewhere)
• HIV and malaria
• Methods of control
• 6. Vaccine development
• Animal testing, non-human primates
• 7. Vectors
• Insecticides (WHO Collaborating)
• Evaluating
• Resistance
• Sporozoite production
• Larval ecology
• Anopheles ecology and biology

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The Global Fund to FightAIDS, Tuberculosis and
Malaria
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The Global Fund, 2004-2005

• 6 million die yearly from AIDS, TB and malaria
• Sub-Saharan Africa hit hardest
• HIV/AIDS
• 4.9 million newly infected
• 40 million living with HIV/AIDS
• TB
• 1/3 world infected 2 billion
• 8 million developed disease
• 2 million died
• TB and HIV

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The Global Fund, 2004-2005

• Malaria
• 40 at risk 2.4 billion
• 1 to 3 million deaths
• 300 500 million cases
• 5 billion febrile episodes resembling malaria

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Estimated Cost of Malaria Control One Million
People, One Full-dose Treatment, 1999
Drug Tablets in millions (dose) Price/ 1000 tabs Total cost Cost per capita
Chloroquine (3 days) 11.25 (100 mg) 6.05 68,063 0.08
Sulfadoxine-pyrimethamine (one dose) 2.5 (500 mgS/ 25 mgP) 47.00 117,500 0.12
Quinine (7 d) 31.5 (300 mg) 41.25 1,299,375 1.30
Artesunate (5 d) 13.5 (50 mg) 365.00 4,927,500 4.93
PF Beales and HM Gilles in Essential Malariology
(DA Warrell and HM Giles, eds), 2002
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Estimated Cost of Malaria Control in an Endemic
Area One Million People, One Round of Residual
House Spraying
Insecticide One application (tons) Price/ton Total cost Cost per capita
DDT 147 3,950 580,650 0.58
Malathion 220 4,300 946,000 0.95
Deltamethrin 110 20,000 2,200,000 2.20
Pyrimiphos-methyl 220 16,000 3,520,000 3.52
PF Beales and HM Gilles in Essential Malariology
(DA Warrell and HM Giles, eds), 2002
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The Global Fund to Fight AIDS, Tuberculosis and
Malaria

• Principles
• Funding needs and support (2.3 b 2005, 3.5 b
  2006, 3.6 b 2007)
• Financial instrument, not implementation
• Leverage resources
• Program orientation (150 people in Secretariat)
• Support programs with national ownership
• Focus on different regions, diseases,
  interventions
• Balance prevention and treatment
• Grant process (patterned after NIH)
• Independent peer review process
• Simplified, rapid, grant-making process
• Transparency and accountability

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The Global Fund to Fight AIDS,Tuberculosis and
MalariaPledges 2001-2008Paid 2005
Donor Pledges billions Paid billions
Countries - 49 plus European Commission 5.973 3.295
Foundations - 2 0.150 0.150
Corporations 0.002 0.002
Individuals 0.002 0.002
Total 6.127 3.449


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Global Fund Expenditures on Malaria

• 2 billion needed yearly to achieve RBM goals
  (Commission on Macroeconomic and Health, 2002)
• 600 million/year being spent (?)
• Focus
• Finance 108 million bednets (ITN)
• Deliver 145 million artemisinin-combination-treatm
  ents (ACT)

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The Global Fund After Four Rounds

• Funding by Disease

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The Global Fund After Four Rounds

• Funding by Income of Countries

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The Global Fund After Four Rounds

• Funding by Expenditure Target

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The Global Fund After Four Rounds

• Funding by Geographic Region

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The Global Fund After Four Rounds

• Funding by Sector of Recipients

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The Global Fund After Four Rounds

• Funding by Country Coordinating Mechanisms (CCMs)

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Disbursements to Malaria (US Millions), 2004
US millions
45
1
20
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Total International 295 million
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Estimated Costs for 2007 for the Three Diseases
(US Billions)
Malaria TB HIV Total
Resource needs 2.9 2.0 14.5 19.4
Total domestic expenditure 0.3 1.2 3.0 4.5
Total international share 2.6 0.8 11.5 14.9
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Malaria Resource Needs, 2007 (1)
Specific Interventions No of Units in 2007 Cost per unit Annual resource needs in US millions
Vector control in highly endemic areas (long-lasting insecticidal nets, LLINs) for vulnerable groups 31.5 million LLINS US7 per LLIN procured and distributed to target population 220
Artemisinin Combination Therapies 1102 million doses Children lt5 US0.6 per dose Children 5-15 US0.99 per dose Adults US1.7 per dose 1,180
Rapid Diagnostic Testing 776 million tests Median cost is US0.7/patient tested 543
Intermittent preventive treatment in pregnancy 39.7 million treatment courses US0.164 per pregnant woman 6.5
Management of severe malaria cases 11.6 million cases Median cost is US24/patient 280
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Malaria Resource Needs, 2007 (2)
Source Global Fund
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United States Agency for International Development
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USAID Malaria Programs

• Prevention and control
• Treatment
• Pregnancy
• Drug-resistant malaria
• Complex emergencies
• Vaccine development
• Strategies

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USAID Malaria Country Focus

Country Programs Bolivia Honduras Peru
Regional Programs Amazon Malaria Initiative
Bolivia Brazil Colombia Ecuador Guyana Peru
Suriname Venezuela
Country Programs Angola Benin Congo,
Democratic Republic Eritrea Ethiopia Ghana
Kenya Madagascar Malawi Mali Mozambique
Nigeria Rwanda Senegal Tanzania Uganda
Zambia
Country Programs Afghanistan Indonesia Nepal
Philippines
Regional Programs, Central Asian Republics
Kyrgyzstan Tajikistan
Regional ProgramsMekong Regional Initiative
Cambodia Laos Thailand Vietnam
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USAID Malaria Funding
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United States Agency for International
Development (USAID) and Global Partnerships
Government and Private Contributions
US Government Private citizens/groups
1970 70 30
2005 20 80
Malaria dollars 2 billion 1950s-1970s 90
million in 2005
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USAID FIGHTS MALARIA BLINDFOLDEDThe Examiner,
April 20, 2005

• members of Congressexpressed concern
  (that)USAID could not account for the bulk of
  its 80 million malaria earmark.
• Only 5 is used to fund the 3 interventions.that
  workand the vast majorityon nets.
• Roger Bate
• American Enterprise Institute
• Director, Africa Fighting Malaria

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Keys to Successful Malaria Control
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World Bank ReportFour Success Stories

• Brazil
• Vietnam
• India
• Eritrea

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World Bank Success StoriesKeys to Success (1)

• Conducive epidemiological conditions
• Sound technical approach
• Package of effective tools
• Data-driven decision making

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World Bank Success StoriesKeys to Success (2)

• Strong leadership
• Political commitment
• Community involvement
• Decentralized control of finances and actions
• Overcame bureaucratic hurdles

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World Bank Success StoriesKeys to Success (3)

• Infrastructure
• Capacity
• Support from partner agencies
• Sufficient financing
• Flexible support by World Bank

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Disabilityadjusted Life Years (DALYs,
1000s),All Cause and Malaria-related, 2002
Population DALYs from all deaths () DALYs from malaria deaths () DALYs from malaria /total ()
World 6,122,210 1,467,257 42,280 2.9
Africa 655,476 357,884 (24.4) 36,012 (85.2) 10.1
Americas 837,967 145,217 (9.9) 108 (0.2) 0.07
East Med. 493,091 136,221 (9.3) 2,050 (4.8) 1.5
Europe 874,178 151,223 (10.3) 20 (0.04) 0.01
SE Asia 1,559,810 418,844 (28.5) 3,680 (8.7) 0.9
West Pacific 1,701,689 257,868 (17.6) 409 (1.0) 0.2
Adapted from WHO, World Health Report, 2002
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Coordination, Information, and Advocacy

• There is an urgent need for a non-partisan
  umbrella organ to coordinate and facilitate the
  network of alliances and programs in malaria
  research and control
• Alilio, Bygbjerg, Breman 2004

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Vision

• The goal, once again, is to promote research by
  African scientists and colleagues elsewhere to
  improve our understanding of malaria, develop new
  tools to combat it, and, ultimately, eliminate
  this scourge.