Report: Paris Meetings on Malaria
20 September 2008
By Esther Tallah
Manager, Cameroon Coalition Against Malaria
The Friends of Global Fund Europe organized high level series of meetings and events were organised in Paris with the slogan “To decide is to win, together let us make malaria a disease of the past”. This was in favour of the fight against malaria from Sept 9 – 11, 2008.
The overall objective of the events and meetings was to raise awareness among stakeholders and the general public at large on the malaria burden and the importance of mobilizing towards the burden reduction, elimination and eventual eradication of malaria. Friends of Global Fund Europe is an independent organization which was co-founded by Mrs. Michele Bazarch, former French Minister of Health and Executive Director of the organisation.
Malaria Consortium staff as well as affiliate organizations from Head Office, Mozambique, Ethiopia, Benin, Burkina Faso, and Cameroon, participated at these events in Paris.
Key activities were as follows:
1. Meeting with the European Parliamentarians, at the French National Assembly, Sept 9, 2008, 15H00 – 17H300
The theme, “A bridge between the North and South to eradicate malaria, from political will to results” animated a series of round tables during the first day of the series of events. The session was introduced by Hon. Henriette Martinez, MP of Hautes-Alpes, Chair of the All Party Parliamentary Group on Population & Development.This event was made up of two round tables which were animated by Patrick Pipen, a journalist, under the themes: “Why invest in the fight against malaria”, and “How to contribute to the generalization of successful experiences”. For these a series of invited speakers made presentations under different topics as follows:
Round Table One
Theme: “Why invest in the fight against malaria”. Five speakers made presentations under this theme. Prof Awa-Marie Coll-Seck, the Executive Director of Roll Back Malaria (RBM) Partnership spoke on “The worldwide impact of malaria”. This was a befitting manner to start discussions under the theme “Why invest in the fight against malaria” as she informed participants on the impact of malaria in our world today. Up to 40% of the world’s population lives in malaria endemic areas she said. One million deaths result from the 300 to 400 million cases of clinical malaria in the world annually with 90% of deaths occurring in sub-Saharan Africa. At the individual level, malaria affects mostly children and pregnant women with one child dying every 30 seconds due to malaria, at the household level, 25 – 40 % of household money is spent on malaria. National level multi-sectoral impact which hinder the achievement of the MDG of which 6 are malaria dependent. Also 30 – 49% consultations are due to malaria and 40% health budget are drained by malaria. Absenteeism from school due to malaria hinders the education of youth and 12 billion USD drained from our economies annually by malaria. With the above, she pointed out that there is real need and urgency to invest in the fight against malaria. Particular as the means to prevent and treat malaria efficaciously are known. She edified participants on the work that the RBM partnership, which includes donors, multilateral organisations, UN, and Special Envoy as well as Civil Society Organisations. Successes recorded so far include among others countries like Eritrea, Ethiopia and others, that have shown when measures are applied effectively, palpable results can be achieved in reducing the malaria burden. She concluded by announcing the upcoming Global Malaria Action Plan which is a necessity for the world today and which will only be successfully implemented if the political will of RBM partnership is manifested.The next three speakers made presentations on the “Millenium Development Goals – Health – Malaria & Poverty”.
Hon Stephen O’Brien, chair of the All Party Parliamentary Group on Malaria, Shadow Minister for Health and Member of Parliament to Eddisbury. He used the meeting slogan “United to win” as applied to the All Party Parliamentary Group, where party politics is superseded by the common interest to invest in the fight against malaria. He insisted the MDGs are focused on health and poverty essentially. Tools to combat these are known, he said, though he recognized that the key challenge laid in social issues, with fragile democracies being in the centre of it. There is need therefore, for the North to step in for war against malaria to be worn. Considering that the MDG is on health, (malaria) and poverty, there is a cause for which funds are to be mobilized, need for action in endemic countries and an effect with political mobilization. He also highlighted on the importance of success stories which will guide the way forward. He called on politicians equal malaria with votes. He concluded by saying there was need for the Northern coalitions to be united in concerted effort to contribute more efficiently to the fight against malaria.
Hon Fidel Lopez Alvarez, Spanish MP and EU Delegate highlighted the impact of malaria on endemic countries and informed the audience on the engagement of the Spanish Government to contribute funds in the fight against malaria. Thanks to the influence of the Spanish Parliament, the government of Spain had seen her financial contribution in the fight against malaria increase substantially within the last couple of years. CCAM contributed to a small extent to this as we hosted the EPF field tour on malaria and a dynamic Spanish Parliamentarian was among the parliamentarians. Her feedback to her peers on the observed needs in the field contributed in the deliberations which resulted in the resolve to increase malaria funding.
Third speaker His Excellency Louis-Charles Viossat, French Ambassador in charge of the Fight Against AIDS and Communicable Diseases highlighted France’s interest and political engagement in the fight against the three key diseases. France contributes substantially to health in European Development Fund, and the Global Fund to fight HIV TB and Malaria. He indicated that France is the third highest contributor of funds to the GFATM. He pointed out some bottlenecks limiting access to funds such as complex procedures which make it difficult for CSOs to access funds. He also regretted the inadequate representation of France on the GFATM board as compared to other countries that contribute less to the funds.
The last speaker of this round table was Prof Michel Kazatchkine, the Executive Director of the Global Fund to Fight AIDs TB and Malaria (GFATM). His presentation was on “Financing malaria and its successes”. He indicated the GFATM alone contributed 2/3 of world funding for malaria (64%). He considers the GF as a global coalition of member organizations that contribute to fight the three key endemic diseases impacting heavily on the poor countries of the world. The GF gives countries the latitude to decide for themselves what they want to do and how they want to go about it and proposals are submitted through the CCMs. So far there has been 7 calls for proposals, 78 countries are funded in 146 components. Then funds are provided based on the results. He shared a personal experience where he visited a hospital in Zanzibar and found there were no cases of malaria where hospital beds in a previous visit had been filled with malaria cases. He further discussed a resent study which showed that malaria medications in the private sector had less than 5% represented by ACTs with the bulk made up of monotherapy contrary to the public sector where the bulk of malaria medications are ACTs. This finding justifies the Affordable Medicines Facility for malaria which aims at getting ACTs of good quality to the private sector at affordable cost. The GFATM has accepted to manage the AFMm at the request of the RBM partnership. He concluded by saying that 97 countries submitted proposals for the Round 8 GFATM call for proposals and there is substantial increase in funds requested as compared to previous years. The first roundtable was concluded following a question and answer session where participants were clarified on issues in which they required more information and clarification.
Round Table TwoThe second round table was under the theme: “How to contribute to the generalization of successful experiences” The first speaker was His Excellency Kessile Tchalla, Benin Health Minister. His topic was “Southern countries and building on successful stories” The Minister indicated that malaria is not only a disease to be treated but requires that the population should change their behaviour in favour of the fight against malaria. It is for this reason that in Benin, they have engaged all 5000 villages to participate actively in the fight against malaria. The key challenge was the scarcity of bed nets which the population had access to only during mass distribution campaigns but however they were not available neither in the markets nor in parmacies. One other key challenge is the presence of marches or swamps in his country which constitute suitable breeding grounds for mosquitoes and they are at a loss on how to manage this aspect.
Philippe Duneton, Executive Secretary, UNITAID spoke on “Access to treatment and the challenges facing AMFm. He said UNITAID is an organization that was started in France, Brazil, and couple other countries to increase access to treatment. Today up to 27 countries are contributing funds to UNITAID by imposing a minima tax on air tickets without it having a felt effect neither on the individual nor at the country level. In malaria UNITAID has engaged in increasing access to ACTs which have been shown to be efficient and rapid in reducing symptoms and clearing parasites, no resistance so far of plasmodium, slow occurrence of resistance, reduce transmission of plasmodium due to its effect on gametocytes. They also advocate for access to diagnosis with rapid tests which can be used at all levels. UNITAIDS funds essentially treatment.
The last speaker of this round table was Mrs Michele Barzach, former Health Minister, President of the Friends of the Global Fund Europe and organizer of the event. Her presentation was under the topic “Partnerships and political mobilization”. She indicated that coalitions currently exist both in the Northern and Southern countries and that many more northern countries have shown interest and are in the process of starting their coalitions. She emphasized on the role of women in being effected. Women’s groups should be relied upon, she said. Clinical, treatment and other fields of research should be supported in order to generate evidence to support policies. She pointed out vaccine research is in progress and said that malaria elimination and/or eradication will be difficult without a vaccine. However, she said, a good vaccine or if not so good, combination of IRS and bed nets will help in the eradication of malaria. She concluded by saying that there is need to ensure sustained funding for nets as they must be replaced once they outlive their usefulness.
2. Opening the Photo Exhibition, Pont des Arts Paris, Sept 9, 2008
All the participants of the above round table were transported to meet other invited dignitaries at the Pont Des Arts to participate at the inauguration ceremony of a photo exhibition titled “Mauvais Air”. The photo gallery by William Daniels is from various horizons in the world and aims at edifying visitors with the reality of malaria from different malaria endemic parts of the world. The gallery called “Mauvais Air” is inspired by the name given to malaria by the Romans when they believed that malaria resulted from the bad air of marshy areas. This exhibition was rewarded by several awards in 2008. The photographs of Williams were presented as telling the audience with feeling, tenderness, realism and harshness moments which speak eloquently of malaria in Africa. Dignitaries who were presented each of the photos from one end of the bridge to the other, included the personal representative of His Excellency the French President, the former President of France, the Executive Directors of GFATM and RBM Partnership, His Excellency the Special UN Envoi for Malaria, and many others. It was a highly mediatised event which was covered by both written and audio-visual media.
The opening was concluded with key speeches by the Personal Representative of the French President, the Executive Directors of GFATM, RBM Partnership and others.
3. Meeting with the North and South Coalitions Sept 10, 2008
A workshop during which the North and South Coalitions had the opportunity to exchange experiences and get to know what each other was doing. Several round tables during which the representatives of the coalitions from France, UK, the EPF, Mozambique, Ethiopia, Cameroon each presented their organization, member organizations, activities and key achievements. There was consensus that there is a lot of funds available in the world today for malaria but unfortunately the coalitions don’t have access to these funds. How could the coalitions position themselves to have access to existing funds? Advocacy is a new concept which unfortunately is not understood by many reasons for which there is need to strategise how to access the funds for advocacy in favour of the fight against malaria.
4. Meeting with the private sector for public-private partnership in the fight against malaria
I did not participate at this meeting which was with the private sector and was reported as a highly successful meeting.
5. Meeting on AMFm at the Centre, Sept 11, 2008
The meeting took place at the “Academie des Sciences, Salle Martin Chauffeur, Paris” and about 15 participants followed presentations and discussed issues around the Affordable Medicines Facility for malaria. This is a new phenomenon developed by the RBM partnership in order to increase access of poorest population to recommended malaria medications due to reduction of cost, and by reducing the price, making it available at all levels in order to knock out mono-therapy which is not indicated anymore for malaria treatment.
The key focus of the AMFm are:
- Access: Render the cost of ACTs (presently 10 – 40 times the cost of monotherapy such as chloroquin) accessible to the public and private sectors equally. Presently, 20% treatment administered is made up of ACT and they are distributed essentially via the public sector.
- Availability: ACTs represent 5% treatment administered at the private sector, meanwhile 60 – 80% of patients seek medical care from the private sector. The aim here is to obtain up to 65% penetration of ACTs in the public section.
- Resistance prevention: Facilitate access to ACTs is an adequate means to fight against resistance. It is important to rapidly increase access to good quality first line ACTs.The AMFm is, above all, a financial mechanism to be applied at various levels with the objective to favour access to ACT by the poorest population heavily impacted by malaria.
During the 4 hour meeting on AMFm which was chaired by Mrs Michele Barzach, Former Minister, President of Friends of Global Fund Europe, presentations were made by renowned scientists and researchers.
A brief word of welcome by the chair of the occasion led to a rundown of the series of high level and successful activities to raise awareness and mobilize stakeholders in favour of the fight against malaria, introduced the topic of the day which was essentially the Affordable Medicine Facility for malaria.
The first presentation was on the principal stakes surrounding the AMFm by Jan Van Erps, Senior Advisor, RBM. Then, Jean-Paul Moati, Special Advisor to the ED GFATM presented on AMFm: “Is it only about price?” The third presenter was Lean-Yves Lehesran on “Informal market and drug access”. And the last presenter was Philippe Guerin on “AMFm and resistance to treatment”. All presentations were followed by discussion points and clarification on key issues. Key discussion during this meeting focused on the hypothesis of the AMFm which is to regulate private monopoly at all levels and at the same time. The influence of monopolies is existence of few who do wholesale and with retailer monopoly even at the local levels. This would result in shortage in medications giving rise to black market with medications of doubtful quality and frequent intentional stock outs. Boarder trafficking could also constitute a danger to flow and availability of medications especially when available in one country and not in the neighbouring country. Certain organizations like UNITAID whose sole interest is to facilitate access to medications could intervene in ensuring rapidity of flow of good quality medicines with good monitoring tools necessary to determine proper functioning of the drug flow system. There is absolute need to ensure removal of monotherapy from the market and one best way to achieve this would be by ensuring a good flow of good quality affordable ACTs through the AMFm. Chloroquin will then have to be buried nationwide with a lot of publicity and campaign. Sanitary police could work with the national police to block flow of monotherapy. Quality control could be ensured by putting in place quality control laboratories all over the country. This is the case of Benin where Chirack Foundation has put in place quality control for medications since 7 years. UNITAID has the intention to implant quality control laboratories in 5 countries essentially for malaria medicines. It was highlighted that informal market of medications is closer to the populations than the formal one. The informal market can bring goods to the heart of the village where the formal ones cannot reach and even in towns. The advantage of this informal market is its nearness to the people and the economic advantage where they don’t need to pay transport to get there. Through this route there is multiplicity of drugs from diverse origins, no consultation nor prescription guide uptake of medications. It promotes auto-medication and you can never be sure that the right doses are taken. All above are some of the risks linked to AMFm. For these reasons there is absolute need to be cautious with the implementation of AMFm, to test the tool first and evaluate system functionality before scaling up. Discussions lead to the conclusion that there will be need to careful implementation with adjustments to suit local specificity. National surveillance systems will have to be redynamised, world anti-malaria network needs to be supported and RBM, WHO need to be supported as well.
Some key challenges for scale up in Africa include: inefficient health systems, difficulty to change behaviour as people are still very attached to their chloroquin, inadequacy of pharmaco-vigilence systems, quality control and surveillance systems. Malaria could be considered as equivalent to 3 Tsunamis with more than one million deaths and lots of neurological sequelea. There is urgent need to act and get life saving tools to the populations in need.
6. Meeting with the European Parliamentary Forum, Brussels, Sept 12, 2008
On Friday Sept 12, 2008 I made a trip to Brussels to have a working session with Silvia and Neil to further explore possible collaboration with EPF. Our first encounter had been quite fruitful as mutual benefit was recorded by both parties. During the first ever European Parliamentary study visit on malaria hosted by CCAM in Aug 2007, the European Parliamentarians met with their Cameroon counterpart with the aim to provoke an interest in the fight against malaria. This had resulted in putting in place an all party parliamentary group for the fight against malaria in Cameroon. Our discussion culminated in the following axis of possible action and collaboration in support of the Cameroon Parliamentarians.
The following 4 key points were retained in answer to the question: “What is the Role of MPs?”
What is the role of MPs?
4 big areas:
1) MPs are law makers (they can introduce laws, motions, resolutions etc.):
- Idea to work with the MPs on a law on the exoneration of taxes and tariffs on Insecticide Treated Nets and other malaria related materials and/or equipment
- Usually in regional parliamentary meetings: elaboration of model law so that when MPs go back to their countries, they try to have the law passed..(USAID has funded this type of initiatives on HIV/AIDS why not on malaria?)
2) Budget:
- 15% Abuja Targets
- More funding for malaria
- MPs to get engaged in the decisions between Government and Donors (Cf. triangle: Government/NGOs/MPs). Need to increase the role of NGOs and MPs in the negotiations of the Country Strategy Papers to secure “Health” as a key priority
- Role of MPs on the CCMs – necessity to be more engaged
3) Visibility:
- MPs to generate visibility for malaria (they can organise events around World Malaria Day (WMD), meetings, roundtables, conferences in the Parliament etc.)
- Necessity to give visibility to the MPs for their commitment (publish articles, interviews, press releases with pictures, etc)
4) Oversight (linked with the budget)
- MPs play a key role in holding their Governments accountable to their commitments
- Role of monitoring policies’ implementation
- MPs to ensure/advocate for more transparency (Parliamentary questions, etc)
- Idea to train MPs about the GFATM
There is need to organise a mini follow-up study tour on Malaria to Cameroon in March/April 2009 (before WMD). It would allow MPs from the North and from the South to present what they’ve done so far since August 2007. Idea to have 1 or 2 site visits (trip to Douala/Buea) and mainly meetings MPs/ EC Delegation, key Ministries…but maybe also a meeting with the Malaria Researchers’ Community.
