Malaria is on the rise in Africa, killing close to one million people– mostly children – on the continent every year. The disease accounts for 30% to 50% of hospital admissions and drains an estimated $12 billion annually from African economies. Many factors contribute to the resurgence of the disease, but high resistance levels of the most deadly malaria parasite, Plasmodium falciparum, to classic drug treatments – chloroquine and sulfadoxine-pyrimethamine – have contributed to rising mortality rates.
However, artemisinin derivatives, when used in combination with other drugs, have shown remarkable effectiveness in treating malaria. The World Health Organization has recommended artemisinin-based combination therapy (ACT) to replace the failing drugs in order to reduce mortality and delay further development of resistance. Yet, progress has been slow in getting these new medicines to patients.
Alfred Lerner Hall
Columbia University, New York
April 29-30, 2004
RSVP: firstname.lastname@example.org or (212) 763-5705
The "ACT NOW" symposium will bring together a wide range of experts in the field of infectious diseases as well as drug manufacturers, economists, rapid-diagnostic manufacturers, health experts from malariastricken countries, policy makers, and donors to discuss practical ways of making ACT accessible to the millions of people infected with malaria on the African continent and elsewhere.
Founded in 1971, Doctors Without Borders/Médecins Sans Frontières (MSF) delivers emergency medical care to people in crisis in nearly 80 countries worldwide. An independent, international humanitarian organization, MSF works primarily with victims of armed conflict, epidemics, and natural and man-made disasters, as well as with people excluded from health care services. In 1999, MSF was awarded the Nobel Peace Prize.
COLUMBIA UNIVERSITY’S CENTER FOR GLOBAL HEALTH AND ECONOMIC DEVELOPMENT AT THE MAILMAN SCHOOL OF PUBLIC HEALTH
The Center for Global Health and Economic Development (CGHED) is a joint venture of the Columbia University Mailman School of Public Health and the Earth Institute at Columbia University to mobilize global health programs that help resource-poor countries address the burden of disease. CGHED is based at the Mailman School.
The World Health Organization (WHO), the United Nations specialized agency for health, was established on April 7, 1948. WHO's objective, as set out in its Constitution, is the attainment by all peoples of the highest possible level of health. Health is defined in WHO's Constitution as a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.
For nearly 60 years UNICEF has been the world's leader for children, working on the ground in 158 countries to help children survive and thrive, from early childhood through adolescence. The world's largest provider of vaccines for poor countries, UNICEF supports child health and nutrition, quality basic education for all boys and girls, and the protection of children from violence, exploitation, and AIDS. UNICEF is funded entirely by the voluntary contributions of individuals, businesses, foundations and governments.
"ACT NOW" MALARIA SYMPOSIUM CO-ORGANIZERS
In April 2001, the World Health Organization (WHO) issued new recommendations for malaria treatment, and this new approach was widely communicated in 2002:
"WHO, on the advice of international experts, recommends the introduction of combinations of drugs to replace single drugs in the treatment of Plasmodium falciparum malaria. WHO recommends in particular the use of drug combinations containing artemisinin compounds-artemisinin-based combination therapy-ACT for short." This change is particularly critical in countries where resistance to currently used drugs is rising, leading to increased mortality. Today, over two years since expert consensus was reached on ACT, the implementation of this recommendation remains limited, and ACT is available only to a fraction of the people who need it. As a result, vast numbers of malaria patients, particularly in Africa, continue to receive ineffective treatment and many die unnecessarily. Malaria continues to be the leading cause of death among children under five in Africa.
Doctors Without Borders/Médecins Sans Frontières (MSF), the Mailman School of Public Health of Columbia University, WHO, and UNICEF are co-organizing a symposium at Columbia University in New York City, April 29-30, 2004, to address the challenges of implementing ACT. The meeting focuses on how to make ACT a reality for the people who live in parts of the world where malaria continues to claim the lives of more than one million people each year. The event will bring together policy makers, researchers, medical care providers, suppliers, and buyers of ACT, from both endemic and donor countries, to help overcome remaining barriers and speed up the use of ACT.
Despite consensus on the need to implement ACT, important barriers to the widespread use remain:
- the lack of adequate funding to ensure a sufficient supply of ACT and access for patients to this more expensive treatment;
- the lack of urgency and political will among international and national policy makers, donors, intergovernmental institutions, and non-governmental organizations to help implement more expensive malaria treatment;
- the long lead times involved in scaling up production of ACTs.
These obstacles can and must be surmounted with a sense of urgency commensurate with the magnitude of the malaria crisis.
Participants at this symposium have an important role to play in helping to provide more effective malaria treatment to those in need, particularly recognizing that most people are treated for malaria at home or in their communities. By working cooperatively to better identify and understand the nature of the existing barriers to ACT implementation and by developing strategies to overcome them, the co-organizers hope this symposium will contribute to turning the tide against this preventable and treatable disease. Urgent solutions need to be found to support changes in national protocols in endemic countries, to fund effective treatment, and to ramp up the production of ACTs. The co-organizers of this event recognize that expanding access to ACT is increasingly a matter of life or death for people at risk of malaria, and therefore are committed to discontinuing support for the use of ineffective medicines and actively working toward the implementation of ACT as quickly as possible.
It is time to ACT NOW.
Médecins Sans Frontières (MSF), the Mailman School of Public Health of Columbia University, WHO, and UNICEF
DAY 1: Assessing ACT Implementation to Date
8:00 am: Registration
8:30 - 9:00 am: Welcome and Introductions
Dr. Ronald Waldman
Professor of Clinical Population & Family Health and Deputy Director of the Center for Global Health and Economic Development, Mailman School of Public Health, Columbia University
Dr. Fatomata Nafo-Traore
Director, Roll Back Malaria, World Health Organization
Dr. Pascal Villeneuve
Chief, Health Section, UNICEF
Dr. Jean-Marie Kindermans
President, MSF Belgium and Malaria Coordinator for MSF's Access to Essential Medecines Campaign
9:00 - 10:30 Session 1: The Need for Change
Chair: Dr. Allan Rosenfield, Dean and Director of the Center for Global Health and Economic Development, Mailman School of Public Health, Columbia University
WHO Policy on ACT
Dr. Kamini Mendis, Senior Advisor, Roll Back Malaria, World Health Organization
MSF's Experience Changing Policy on Diagnosis and Treatment Protocols in the Field
Dr. Christa Hook, Chair, MSF Malaria Working Group
10:45 - 12:15 Session 2: Current Approaches of Donor Community Towards Implementation of ACT
Chair: Prof. Nick White, Professor of Tropical Medicine, Mahidol University
Burundi Policy Revision: Lessons for International Partnership From a Successful Experience on the Ground
Dr. Dennis Carroll, Senior Health Advisor, United States Agency for International Development
DFID Support of the Uganda Transition Strategy and Plans for Moving Toward ACT
Dr. Stewart Tyson, Deputy Head of Health, Department for International Development, United Kingdom
Global Fund Strategy to Support Introduction of Improved Malaria Treatment
Dr. Vinand Nantulya, Senior Advisor, Global Fund to Fight AIDS, Tuberculosis and Malaria
How to Address the Significant Increase in Price of Malaria Treatments
Olusoji Adeyi, Lead Health Specialist, World Bank
12:15 - 1:30 - LUNCH
1:30 - 2:30 pm - Designing Development Assistance to Create Incentives for Rational Use of Antimalarial Drugs
Dean Jamison, Professor of Education and of Public Health at UCLA, Fellow at the Fogerty International Center of the National Institutes of Health, and Chairman of Institute of Medicine's Board on Global Health
2:45-4:00 Session 3: How Countries are Changing Policies
Chair: Dr. Awa Marie Coll-Seck, Executive Secretary, Roll Back Malaria Partnership
Zambia: A High-Prevalence Country Undergoing Transition to ACT
Ms. Masela Sekeseke-Chinyama, Parasitologist, Zambia National Malaria Control Program
Phased Introductions: The Case of Southeast Asia
Dr. Le Dinh Cong, Former Director, Vietnam National Malaria Control Program
4:15 - 5:45 Session 4: Home-Based Care and Community-Based Intervention
Chair: Dr. Awash Teklehaimanot, Center for Global Health and Economic Development, Mailman School of Public Health, Columbia University
Co-Chair, Dr. Christa Hook, MSF
Overview of Home-Based Care and Community-Based Intervention Strategies and Experience
Dr. Lulu Muhe, Medical Officer, World Health Organization
UNICEF's Approach to Community-Based Intervention
Dr. Kopano Mukelabai, Senior Medical Advisor, UNICEF
Using Rapid Diagnostic Tests in Community-Based Intervention in Ethiopia
Dr. Tedros Adhanom Ghebreyesus, Head of Tigray Health Bureau, Ethiopia
Integrating Community Health Workers for Community-Based Treatment
Dr. Richard Allan, Director, MENTOR Initiative
Day 2: Workshops: Practical Implementation Issues
Two simultaneous 2-hour interactive sessions to map issues and progress:
9:00 - 11:00 Workshop 1: Production Challenges to Increasing Capacity and Supply of ACT
Moderator: Dr. Dennis Carroll, United States Agency for International Development
Report from Copenhagen Meeting
Steve Jarrett, Deputy Director, Supply Division, UNICEF
Raw Materials: What Are the Dynamics of Cultivation, Extraction and Production? What Would It Take to Increase Capacity?
Nelson Tan, Holleykin
Finished Product: What Are the Commercial Considerations for Scaling Up Production?
Pradeep Nambiar, Ipca
Philippe Baetz, Sanofi
Daniela Currie, Novartis
Proposals to Insure Timely Scaling Up
Margriet den Boer, MSF
9:00 - 11:00 Workshop 2: Availability, Production, and Cost-Effectiveness of Rapid Diagnostic Tests
Moderator: Daniel Berman, Coordinator, Access to Essential Medicines Campaign, MSF-France
Role of Clinical, Microscopy and Rapid Diagnostic Tests in High Transmission Zones: Emerging Evidence for Targeted Use of Diagnostic Tools
Allan Schapira, Coordinator, Malaria Policy and Strategy Team, World Health Organization
Diagnosis in Practice; Initial Scale-Up of ACT in Zambia
Ms. Masela Sekeseke-Chinyama, Parasitologist, Zambia National Malaria Control Program
Current Availability and Development of New RDTs
Martine Guillerm, MSF
Are RDTs Robust Enough for Widespread Scale-Up?
David Bell, World Health Organization, Manila
Economic Aspects of Introducing RDTs
Chantal Morel, London School of Hygiene and Tropical Medicine
Discussion: What Will the Ideal RDT Look Like for the Introduction of RDTs? Is there a need for financial subsidy or will the market drive development?
11:00 - 11:30 Final Keynote
Jeffrey Sachs, PhD, Director, Earth Institute, Columbia University
11:30 - 12:30 Report Back and Conclusions
Simultaneous workshops present results of their discussions.