1. The majority of malaria funding, greater than 95% at a global level, is focused in Africa and Asia; however, malaria in Latin America has skyrocketed since 2010. Why has Latin America been largely ignored by global malaria initiatives?

Answer: According to the most recent World Malaria Report, the WHO Region of the Americas has seen a reduction in malaria cases of 40% (from 1.5 million to 0.9 million). Currently, 94% of malaria cases are in Africa, which, combined with Latin America’s generally more developed health infrastructure, aid money for malaria tends to focus on areas around the world that have more immediate needs.

While Latin America experienced another very concerning surge in 2010 that the global has stayed focused on mitigating, fifteen countries have been declared malaria free in Central and South America, with Paraguay joining the list in 2018 and Argentina in 2019.  El Salvador has completed three years without local transmission, meaning it could be certified malaria free soon. Belize, too, had no local transmission in 2019, putting it ever closer to malaria-free status. Hispaniola, the last malaria endemic island of the Caribbean, has reduced cases by more than half since 2015. The region continues to show significant progress towards elimination.

Where progress has been offset has been mainly in Venezuela and the surrounding areas of Brazil and Colombia. Much of the increase in incidence has been since 2016 and tracks closely with the conflict in Venezuela. Even with fewer aid dollars, Latin America has been working hard to maintain progress. In 2017 Malaria No More co-led the organization of a two-day working session at the Inter-American Development Bank headquarters and coordinated with key partners (such as Global Fund, CHAI, PAHO, and the Gates Foundation) to develop the Regional Malaria Elimination Initiative (RMEI) for Latin America. RMEI is playing a role in accelerating the fight against malaria by increasing cross-border collaboration in surveillance, attracting new and pooling existing resources, creating efficiencies, and improving primary health care along boarders.

  1. Rotarians work through projects -how can a club break down the big concepts to participate in the remote area timely interventions?

Answer: For Rotarians interested in this issue, we suggest finding a project on the ground that interests you and is showing strong results and then, determining the best way to support that project. This could be through individual donations, fundraising for an organization/project, or offering technical or in-kind assistance.

  1. I am interested to India experience and will ask him to share best practices to mitigate climate impact on malaria activities.

Answer: Best practices to mitigate climate impact on malaria begin with best practices to monitor weather patterns, monitor, detect and treat cases of malaria and reduce mosquito proliferation and mosquito-borne disease transmission. Strong surveillance programs with up-to-date data for malaria program managers to make important, real-time decisions are crucial for allocating resources and issuing early warnings and alerts to ensure timely provision of services. Ensuring that malaria outbreaks are predicted, detected and prevented early requires sufficient numbers of trained health staff – from field and clinic staff to technical, administrative and ministerial officials- who are focused on early detection and treatment of malaria and then deployed according to the epidemiological and geographical situation. Continued focus and funding — even as malaria cases approach zero — will ensure there’s no resurgence. Campaigns, such as indoor residual spraying, mass screen and treat, bed net distribution, and communications that are appropriate to the area and type of malaria are also important.

Strong systems will enable new innovations and technologies to build on proven interventions and have a greater impact. In India, Malaria No More is building partnerships with various government agencies such as the National Institute of Malaria Research and the Indian Meteorological Department to work together and create new pathways and programs.

  1. Could you please share any documents related to intersection between malaria and climate?

Answer: Mosquito-borne diseases, including malaria, denguechikungunya, yellow fever and Zika, are a major global health challenge that disproportionately affect the world’s most marginalized populations. These diseases are also climate-sensitive: changing weather patterns are introducing new complications in efforts to effectively prevent, control and eliminate them. Some initial resources are:

  1. Question for Dr. Sanjeev: 1) how far out (days/weeks/months?) are you trying to predict malaria cases using weather data and 2) have you published any of your work?

Answer: The dashboard and algorithms are still under development but predictions will be based on both historical trends along with upcoming weather reports. As weather prediction is uncertain, malaria predictions will likely only be a few weeks out. However,  as the dashboards are strengthened with additional data and verified against real outcomes, the algorithms will also become stronger and may be able to predict outbreaks further out. Our work has not yet been published, but we will consider doing so once we are further along.

  1. Changing climates create a situation where places that were previously unsuitable for malaria transmission may now be at high risk. However, the reverse must also be true as the climate changes in areas that currently have an ideal climate for malaria transmission, making them unsuitable. Will we face a situation where we have to shift malaria programs/infrastructure/resources/etc. away from areas that have traditionally been high priority to ones that have traditionally been low priority or not a priority at all? How do we prepare for that in terms of political and logistical challenges, preparing naive communities, etc.?

Answer: The changing climate will make new areas (such as those that are warming or at higher elevations) susceptible to malaria and other mosquito-borne disease transmission, while other areas (such as those in the Sahel, where it’s becoming more arid) may be at reduced risk. However, even though climate conditions may be reducing risk of endemic malaria in certain areas, it is unclear that the risk would be removed entirely, especially for epidemic malaria.

We will likely face a situation in which, rather than having to shift focus from established programs to new areas of risk, we actually need to expand our focus to include new areas of risk while still continuing to focus on areas currently at risk.

Prevention is key to ensuring malaria isn’t able to grab a foothold in these new areas, which will require advocacy on a global level and key decision makers in areas of risk. Strong data surveillance will be necessary to stop malaria outbreaks early. If malaria can be eliminated in countries and regions that may face risks due to the changing climate, the risks may be mitigated altogether.  Through innovative technology, programs and advocacy, Malaria No More and the malaria community are working tirelessly to not only reduce –  but eliminate – these risks.

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