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World Health Organization 19 April, 2017 Malaria Medicines & Diagnostics: trends and supply requirements Dr. Andrea Bosman Diagnosis, Treatment and Vaccines WHO Global Malaria Programme 4 November 2010, Geneva

World Health Organization 19 April, 2017 Proportion of patients seeking treatment for malaria symptoms Use of diagnostic tests in formal health sector 53% Clinical Diagnosis (355 million/yr) 28% No action 44% Formal Health Sector 8% RDT 28% Informal Private Sector 39% Microscopy Source: CHAI Analysis, global estimates for patients living at risk of malaria, based on 2008 World Malaria Report & UNICEF Intervention Coverage Reports 2

ACT procurement for public sector distribution World Health Organization ACT procurement for public sector distribution 19 April, 2017 6-24 months from adoption to implementation Millions of ACT treatment courses Cumulative number of countries WHO policy on ACTs GFappeal on ACTs Forecast

Reduction of >50% in cases: 29 countries outside of Africa and … (Source: World Malaria Report 2009)

World Health Organization Reduction of >50% in cases: …. in 9 African countries 19 April, 2017 Eritrea Rwanda Zambia Sao Tome and Principe Also: Botswana, Cape Verde, Namibia, South Africa, Swaziland 5

World Health Organization Malaria decrease in Africa due to effective control 19 April, 2017 Systematic review: 24 studies conducted between 1989 and 2005 in 15 different African countries including 15’331 patients Proportion of malaria among fevers highly variable: 2% to 81%: Median parasite rate = 26% Median PfPR 1985-19992-10 = 37% Median PfPR 2000-20072-10 = 17% D'Acrémont et. al. (2009). PLoS Med, 6 (1): e252

World Health Organization Diagnosis of malaria: % reported cases in public sector with parasitological diagnosis 19 April, 2017 Based on cases reported to WHO: African % biased upwards since countries reporting tend to undertake more case confirmation.

World Health Organization 19 April, 2017 Deployment of RDTs in Livingstone (Zambia): impact on malaria cases and ACT consumption ACT RDTs From over 25'000 ACTs in 2007 to less than 5'000 in 2008 Source: NMCC, Zambia MoH

Reduction of ACT consumption with RDT scale-up in Senegal public health services Courtesy of Dr S. Thiam, PNLP Senegal ~ 0.5 million less ACT consumed in 2008-2009

Rwanda: preliminary analysis (WMR 2010) Malaria cases & ACT annual orders % malaria positive % % malaria outpatients % malaria inpatients LLIN distribution

World Health Organization 19 April, 2017 Countries with projects on (integrated) Community Case Management PSI/TDR Malaria Consortium Save the Children IRC IRC: Uganda, Sierra Leone, Ethiopia, Ivory Coast, South Sudan, Rwanda Save: Malawi, Mozambique, South Sudan Malaria Consortium: Uganda, South Sudan, Zambia, Mozambique PSI/TDR: Malawi, Mali, Cameroon, DRC PMI/MCH: Benin, DRC, Malawi, Mali, Rwanda, Senegal, Uganda, Zambia Catalytic Initiative/PMNCH: Mali, Ghana, Niger, Burkina Faso, Ethiopia, Malawi, Mozambique Catalytic Initiative PMI/MCH Courtesy of Dr F. Pagnoni, TDR 11

Affordable Medicine Facility for malaria: Phase 1 World Health Organization 19 April, 2017 Affordable Medicine Facility for malaria: Phase 1 Ghana Madagascar Uganda Tanzania Nigeria Niger Kenya Cambodia As of Sept 2010, 92 first-line buyers are making 24 co-payment requests (equivalent to US$ 8.02 million). AMFm co-paid ACTs are on sale in Ghana and Kenya. 12

Conclusions Malaria reducing in near 40 countries due to high coverage of RDTs, ACTs and LLINs - often in combination Reduction of ACT consumption in areas with high level of use of malaria diagnostics (e.g. testing >80% of suspected cases) At global level impact on ACT needs is limited because: low use of malaria diagnostics in countries with high burden ongoing expansion of ACT access interventions, i.e. community case management and AMFm (Phase I) variable coverage of vector control (malaria resilience)