1. Do the presenters see COVID trending lower in Africa now? Has the peak passed?

Answer: Johns Hopkins University’s Coronavirus Resource Center maintains a dashboard of coronavirus cases.[1] The World Health Organization also provides weekly situation reports.[2] According to the WHO’s most recent External Situation Report (#32) published on October 7, the region had a “2% increase in incidence cases and a 20% decrease in deaths compared to 25,327 cases and 817 deaths registered during the previous reporting period (23 – 29 September 2020). The region observed a slight increase in case incidence in the past seven days for the first time since epidemiological week 30 (mid-July 2020).”

  1. As we continue to see dengue, chikungunya and zika fevers re-emerge in Africa and Covid-19 continues to inflict a heavy financial and emotional toll on the continent, will the Global Fund, he PMI, and Malaria Partners International support integrated mosquito control and mosquito population suppression tools that went far beyond IRS and LLINs and eradicated malaria years ago?

Answer: While there are many tools and technologies on the horizon that could prove to be game changers for malaria control, there is still insufficient data to support the implementation of these new technologies. To provide U.S. taxpayers the best “bang for their buck”, PMI continues to invest in scaling proven and cost-effective interventions. These include indoor residual spraying, insecticide-treated nets, accurate diagnosis and prompt treatment with artemisinin-based combination therapies (ACTs); intermittent preventive treatment of pregnant women; and seasonal malaria chemoprevention (SMC) in relevant areas. These malaria prevention and treatment interventions are among the most cost-effective public health interventions. They provide a consistently high return on investment, beyond the direct benefits of better health–contributing to substantial gains in education, productivity, and economic development. In addition, the capacity and systems PMI has helped partner countries put in place to combat malaria also equip them to better respond to other public health threats.

  1. Is availability of RDTs reduced due to COVID?

Answer: PMI actively engages with the global malaria marketplace to ensure access to quality malaria products at affordable prices, and to catalyze development of new products. Several of PMI’s and the Global Fund’s key suppliers have had their production impacted by COVID-19 or have indicated that they will shift production. Companies are identifying opportunities to respond to COVID-19 needs, and may decide to focus on manufacturing COVID-19 related products. While several of our key suppliers have indicated that they will shift some production to respond to COVID-19, we have been pleased to see continued commitment to meeting malaria needs. Indeed, high level engagement has been successful in securing one manufacturer’s continued participation on the malaria RDT market.

PMI’s commodity suppliers are also facing increased costs of raw materials and a reduced labor force due to social distancing. PMI and the Global Fund have worked together to coordinate our approaches and reduce stock-outs. We are working closely with suppliers and other larger procurers, like the Global Fund, to allocate our orders to meet the most urgent country requirements.

  1. Is there is any possibility by the Rotary members to extend the interventions to management of mosquito breeding sites. This is a missing link critical to malaria elimination.

Answer: See answer to question #2. PMI invests in proven, cost-effective malaria control interventions. At this time there is not sufficient evidence for PMI to support larval source management.

  1. What efforts have been made with all agencies represented to reach out to the Faith Community both large Faith Based Organizations working in health as well as well as the local faith communities particularly in advocacy, and behavior change. What has been the engagement in Ghana for example to engage with the faith community. Faith leaders have become increasingly influential globally. I work with the United Methodist Committee on Relief (UMCOR) and we are increasingly finding it important to include our faith communities in our activities and conversations regarding Malaria

Answer: Since it’s beginning, PMI has made a deliberate effort to work with faith based organizations to optimize malaria prevention and control activities and promote sustainable development. PMI recognizes that religious leaders have the potential to promote and sustain positive change in communities through their well-established networks.

For example, in Guinea PMI financial and technical assistance has brought community members, including religious leaders, together in “community dialogues” to understand the reasons why malaria was much higher in their areas, and to develop action plans to reverse this trend. In addition, more than one thousand Imams in Guinea have been trained to talk about malaria with their communities. And, in Uganda, PMI trained religious leaders on the benefits of indoor residual spraying (IRS) and using insecticide treated nets, community mobilization and advocacy techniques, and also enlisted their support in promoting IRS and supervising its implementation in their respective communities.[3]

Currently PMI is developing a toolkit to help faith and community leaders use their own strengths, community connections and resources to educate their communities on how to prevent malaria and support proper treatment in local communities. This toolkit builds on the pilot brainstorming meeting PMI held with faith and community leaders from Zambia, Tanzania, and Rwanda in August 2019 to encourage them to launch day/s of reflection on malaria in their communities.

  1. What behavioral change approach are you instituting to complement the treated beds net and IRS intervention in Ghana?

Answer: To be updated.

  1. Should does the GF think of investing in malaria vaccine in Nigeria?

Answer: To be updated.

  1. What is the likely impact of climate change on malaria?

Answer: Weather changes have several implications for malaria. First, the development of the malaria parasite in mosquitoes is temperature dependent. At lower temperatures (including at higher elevations), the parasite develops more slowly and at a certain temperature threshold will not develop fully within the life-span of the mosquito and cannot be transmitted onward. If the average temperature increases above that threshold, malaria may be transmitted where it was not previously able to be transmitted — increasing the malaria risk in that population. A high temperature along with accompanying low humidity is a risk for early mosquito death; thus in certain areas where temperatures are already high, increased temperature may contribute to reduced malaria transmission in that population. It is certainly possible that these two contrasting situations could increase malaria in some areas and decrease it in others but the overall sum of transmission could remain essentially the same. Lack of field data makes it difficult to anticipate the impact of changes in temperature.

Second, extreme weather events such as storms, rainfall, wind, etc. disrupt daily life in homes and communities (e.g., wide scale flooding and the establishment of pools of water that serve as mosquito breeding sites) and disrupt health service provision, and in turn can worsen malaria transmission and limit health services available. Data suggests that these weather calamities do lead to worse malaria; however data on the extent of their impact is limited.

PMI is using its new malaria data integration platform called M-DIVE to house, analyze, and visualize large amounts of granular, previously fragmented, malaria related data, including weather data, which will hopefully help us to better target interventions and forecast resource needs in the future.

  1. How can we move the Overton window on the appropriate level of funding for malaria?

Answer: Prior to COVID-19, the Lancet Commission on Malaria Eradication estimated an additional investment of $2 billion per year is necessary to eradicate malaria, which will need to come from increased development assistance from a range of external donors as well as increased financial commitment by countries. Opportunities exist for new and smaller donors to step in and fill the gap. Rotary members can make a critical difference by engaging their local Rotary Clubs in-country and building awareness and support among their organizations in both the USA and in malaria endemic countries. In particular, local Rotary clubs should work closely with the National Malaria Control Programs in their countries to understand the country’s priorities and identify ways that they can provide support. For example, we’ve seen Rotary members in PMI countries provide support to insecticide treated net campaigns and train community health workers and advocate for additional funding for malaria to their governments and the local private sector.

[1] https://coronavirus.jhu.edu/map.html

[2] https://www.afro.who.int/health-topics/coronavirus-covid-19

[3] https://pmivectorlink.org/2020/08/12/faith-leaders-promote-uptake-of-irs-amidst-covid-19/

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