Science of Eradication: Malaria 2013

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Sunday May 5, 2013
17:30-18:00
Welcome Remarks
Pedro Alonso, Marcel Tanner & Dyann Wirth
course faculty
18:00-18:30
Introductions
Participants
course faculty
18:30-19:30
Setting the Stage for Malaria Eradication

This session is an overview of progress in malaria control and elimination over the past decade, and the ongoing transition from a one-size-fits-all to a tailored approach.

Learning Objectives

  • Understand the progress in malaria control and elimination over the past decade, including successes, failures, and challenges.
  • Understand the WHO policy-setting process for malaria, and the public health cycle linking research, policy-setting, programme implementation, and surveillance / monitoring / evaluation.
  • Appreciate the opportunities and challenges for malaria control and elimination in the near future, and the implications for ultimate malaria eradication efforts.
Monday May 6, 2013
course faculty
09:00-10:00
History of Malaria Eradication

In this session, after a brief presentation of the development of malaria control strategies during the first half of the XX century, an analysis will be made of the history of the Malaria Eradication Campaign and its sequel during the two decades 1970-90, attempting to explore the possible causes of its decline.

Learning Objectives

  • To provide a historical perspective to the current strategies of malaria elimination.
  • To discuss how past negative developments could have been due to misconceptions or neglected aspects of the problem, which could be avoided in the future.
course faculty
10:00-11:00
Lessons Learned from Other Eradication Campaigns
Ned Hayes, Barcelona Institute for Global Health

This session will review and explore the components of disease eradication campaigns and discuss those elements most likely to contribute to success and the barriers and challenges to successful disease eradication.

Learning Objectives

  • Describe two elements of successful eradication campaigns.
  • Describe three barriers to successful disease eradication.
  • Describe how lessons learned from past eradication campaigns can be applied to the initiative for malaria eradication to improve the likelihood of successful outcomes.
11:00-11:15
Coffee Break
course faculty
11:15-12:15
Current Malaria Epidemiology: The Global Status, Trends in Distribution and Incidence

This session will outline the key features of malaria epidemiology, as relevant for both control and elimination/eradication.

Learning Objectives

  • To understand the essential concepts and measures of malaria epidemiology.
  • To understand the relevance of key malaria epidemiological features for malaria control and elimination.
course faculty
12:15-13:15
Biology of Malaria and Biological Opportunities for Eradication

 

This session will provide an introduction to malaria biology, including a rigorous approach to the basic and applied issues related to malaria. Areas covered in detail include malaria epidemiology, parasite-vector relationships, vector control, cell biology, and biochemistry of the parasite red cell interaction, drug action and resistance mechanisms, parasite genetics and cell biology.

Learning Objectives

  • To understand the biology and life cycle-basis for this disease, including global public health aspects of malaria.
  • To understand the incidence and distribution of infection and disease within human populations; determinants of frequency and distribution; methods of measurement; magnitude and consequence of disease on the population.
  • To consider the interrelationship of organisms and their environments, including identify ways of reducing the incidence and/or severity of disease within populations; obstacles; consequences.
  • To understand behavioral change as an intervention.
  • To possess a historic perspective while appreciating recent developments in the field
course faculty
14:30-15:30
Vector Biology and Dynamics of Malaria Transmission

This session will provide an overview of different aspects of mosquito biology that are essential to parasite development and transmission.

Learning Objectives

  • To gain an understanding of vector distributions and the complexity of malaria transmission.
  • To gain an understanding of the biological features shaping the vectorial capacity of Anopheles mosquitoes.
  • To gain insight and knowledge of the genetics of vector-parasite interactions.
15:30-15:45
Coffee Break
course faculty
15:45-17:30
WORKSHOP - Developing a Plan for Malaria Eradication: Pacific Islands & Zanzibar
Christian Lengeler & Marcel Tanner, Swiss Tropical and Public Health Institute

The participants will, through iterative discussions – develop an outline for elimination planning in two different (endemic setting, health and political systems) island settings.

Learning Objectives

  • Understand on how to assess the feasibility of moving from intensified control to elimination.
  • Analyze an endemic situation and understand the basics of planning elimination.
Tuesday May 7, 2013
course faculty
09:00-10:00
Socio-Cultural Determinants of Malaria Incidence

Malaria is a complex disease that requires a multidisciplinary approach to comprehensively describe determinants of local transmission. This session will go beyond the human-parasite-vector discussion to address social and cultural factors that impact the local patterns of transmission. The session will also discuss how these factors could be addressed with alternative control strategies that combine community sensitization and educational approaches (among others).

Learning Objectives

This session will:

  • Highlight key social and cultural factors that impact the pattern and the level of local malaria transmission.
  • Discuss possible strategies that could be incorporated into malaria control efforts to address these social factors.
  •  Review which of these possible strategies have been implemented in the past and the extent to which they were successful.
course faculty
10:00-11:00
Environmental Determinants of Malaria Incidence

Environmental factors play a major role in malaria transmission. They include issues related to the natural environment (climate, land cover) and the human-made environment (housing conditions, land use, urban growth patterns). To address these issues, environmental interventions played a major role in malaria control efforts in the past, but are not at center stage for current efforts. This session will review some historical cases, and then discuss the challenges, feasibility, and likely sustainability of these interventions for achieving malaria eradication at present.

Learning Objectives

This session will:

  •  Briefly review the types of environmental interventions for malaria control.
  • Offer a historical perspective of the impact that environmental interventions had on malaria control.
  •  Discuss the feasibility of environmental interventions as one strategy for current efforts of malaria eradication.
11:00-11:15
Coffee Break
course faculty
11:15-12:15
Political and Economic Determinants of Malaria

The session will provide an overview of the political and economic aspects related to malaria. It will analyze malaria in the framework of social determinants of health. It will discuss the ways in which malaria imposes an economic burden – at both households and national levels; the relationship between socio-economic conditions and malaria; the relationship between political conditions and malaria.

Learning Objectives:

  • To appreciate the socio-economic implications of malaria.
  • To discuss the relationships between malaria and the political context and economic development.
  • To discuss the economics of malaria control interventions.
course faculty
12:15-13:15
Tracking the Beast: Measuring Malaria Transmission and Modern Tools for Malaria Surveillance

This session will explore how to define and measure transmission, how to identify transmission ‘hot spots’ and how to determine who in a given population is transmitting (and when) in different epidemiological settings.

Learning Objectives:

  • Understanding the key aspects of transmission epidemiology.
  • Review traditional and new measures of transmission.
  • Explore how to integrate measurements of transmission in surveillance systems.
13:15-14:30
Lunch
course faculty
14:30-15:30
New Tools I: Diagnostics for Malaria Eradication

Diagnostic tools for case management are having a major impact on malaria control, but may not be adequate to achieve elimination. The session will provide an overview of currently-available malaria diagnostic tools for case management and elimination, their reliability, and changing needs as transmission declines. Among these changing needs is the increasing importance of population transmission screening and screening for low-density malaria infections. Various tools are available, or under development, to address these needs. Important research questions for the elimination agenda arise concerning where and when such technologies are likely to have impact, and how diagnostic strategies can be adapted to maintain a sustainable programme in which malaria is eliminated, or has ceased to become a public health priority.

Learning Objectives

  • Understand the application and limitations of main tools for malaria diagnosis, in the context of elimination programmes.
  • Be aware of tools for population and parasite screening currently available, and becoming available in the near future.
  • Understand the broad areas if uncertainty in application of screening tools for elimination, and major research questions arising.
15:30-15:45
Coffee Break
course faculty
15:45-17:30
WORKSHOP - Developing a Plan for Malaria Eradication: Mesoamerica

Participants will discuss potential approaches to develop a plan for malaria elimination in Mesoamerica.

Learning Objectives

  • To assess the possibility of implementing a proof of concept for malaria elimination in Mesoamerica, a specific epidemiological setting with particular challenges: trans-border population flow, remoteness, multiplicity of languages, strong security problems and multiplicity of actors (Global Fund, NGOs, religious leaders, traditional healers, ministries of health, the army…).
  • To identify the  strengths and weaknesses of an international public-private partnership operating in the field
Wednesday May 8, 2013
course faculty
09:00-10:00
Tools to Reduce the Entomologic Inoculation Rate

This session reviews the epidemiological and operational features of the three main vector control tools (Insecticide Treated Nets, Indoor Residual Spraying and Larviciding).

Learning Objectives

  •  Understand the essential concepts and epidemiological features of ITNs, IRS and Larviciding.
  •  Understand the comparative operational strengths and weaknesses of ITNs, IRS and larviciding as malaria control interventions.
course faculty
10:00-11:00
New Tools II: Vector Control

This discussion-based session will provide course participants knowledge of different strategies for mosquito control alternative to the use of insecticides.

Learning Objectives

By the end of this session, participants will have:

  •  A better understanding of the limitations of current vector control strategies;
  • An understanding the impact of targeting different aspects of mosquito biology on malaria transmission (i.e., repellents, attractants, confusants, and sterilants); and
  •  An understanding the feasibility and merit of using genetic and paratransgenic control methods.
11:00-11:15
Coffee Break
course faculty
11:15-12:15
Current status and Roles for Malaria Vaccines
Pedro Alonso, Barcelona Institute for Global Health

This session provides a general assessment of malaria vaccines, with a special focus in the RTS,S.

Learning Objectives

  • To understand the particularities and challenges of malaria vaccine clinical development.
  • To understand the rationale for the principal antigen targets chosen for malaria vaccine development and the potential effects on malaria infection/disease/transmission that such vaccines may confer.
  • To obtain an adequate knowledge of current development of the most advanced malaria candidate vaccine RTS,S.
course faculty
12:15-13:15
New Tools III: Opportunities for New Vaccines

The development and appropriate incorporation of a vaccine into an integrated malaria control and elimination, and ultimately eradication, program may well be the lynchpin needed to achieve the vision of a world free of malaria. A recent WHO-sponsored update to the Malaria Vaccine Technology Roadmap has highlighted two overlapping strategic goals: 1) Preventing disease and death; and 2) Malaria parasite control and elimination. These two strategic goals drive three desired outcomes: 1) Preventing infection; 2) Averting cases; 3) Blocking transmission. An overview of efforts directed at achieving one or more of these outcomes will be presented for discussion.

Learning Objectives:

  • Review the outcome of the recent WHO-sponsored update to the Malaria Vaccine Technology Roadmap as a strategic foundation for the development of new malaria vaccines.
  • Discuss the biological, technical and regulatory challenges and opportunities in malaria vaccine development.
13:15-14:30
Lunch
course faculty
14:30-15:30
Integrating Malaria Eradication with Health Systems

A moderated discussion on the basics of health systems thinking and on how disease specific interventions can be tailored to given health and social systems and in general also contribute to health systems strengthening.

Learning Objectives

  • Understand the principles of integrated approaches of malaria interventions in different endemic settings with different health and social systems.
  • Develop and understand the key principles and practical approaches for integrated elimination efforts under health systems constraints.
15:30-15:45
Coffee Break
15:45-17:30
WORKSHOP - Developing a Plan for Malaria Eradication: Southeast Asia
Maxine Whittaker and Marcel Tanner

During this session the participants will develop a plan to effectively scale up the Sabang district model of malaria elimination into the rest of Aceh province.

Learning Objectives

  • Identify the successful elements of the Sabang elimination model.
  • Undertake situational, SWOT and policy analyses for the scaling up of the model into the rest of Aceh province.
  • Develop and defend a strategic plan for the effective scaling up of the malaria elimination approaches, derived from Sabang municipality, into the rest of Aceh province.
Thursday May 9, 2013
course faculty
09:00-10:00

The session will include a brief overview of the current available drugs for malaria control, both for treatment and prevention. It will summarize the current WHO recommendations for all malaria species, and highlight the threats and challenges in drug development, including the emergence and spread of resistance. It will also describe past efforts of using drugs for the prevention of malaria in large efforts (including MDA), and set the basis for how can we move forward with the current drugs for malaria elimination.

Learning Objectives

  • To understand current treatment recommendations for malaria.
  • To understand past and current uses of antimalarial drug for the prevention and treatment of malaria (IPT, MDA etc…).
  • To set up the current knowledge around malaria control through the use of drugs and how it differs from the use of drug for malaria elimination.
course faculty
10:00-11:00
New Tools IV: Developing New Drugs and Strategies for Eradication

The session will assess the role of drugs for malaria eradication, including the concept of a Single Encounter Drug for Radical Cure and Prophylaxis (SERCAP).

Learning Objectives:

  • To understand the particularities and challenges of the use of drugs for malaria eradication.
  • To understand the current drug discovery research and development portfolio and how it relates to the objective of malaria eradication.
  • To understand current tools or technology platforms used to discover new antimalarial drugs
11:00-11:15
Coffee Break
course faculty
11:15-12:15

This session will be a lecture with short discussion blocks to generate the basis for the potential and principles of applied modeling for public health action.

Learning Objectives

  • Develop and understand the position and potential of modeling for malaria elimination/eradication with regards to:

(i)                feasibility of engaging in elimination,

(ii)              integrated, mixed interventions and

(iii)            the cost-effectiveness of the intervention mixes

  • Learn about novel tools for elimination planning (applied modeling and WHO/Elimination Scenario Planning)
course faculty
12:15-13:15
P.vivax: The Neglected Human Malaria

The recent call for malaria eradication has re-emphasized the importance of bringing Plasmodium vivax into the research agenda.  Plasmodium vivax remains the most widely distributed human malaria parasite with 2.85 billion people living at risk of infection. Noticeably, the number of yearly clinical cases seems to be increasing from 70-80 million  to 300 million cases  and these include cases of severe disease and death exclusively associated with P. vivax. Moreover, experts agree that present tools against Plasmodium falciparum will not be effective against P. vivax, reinforcing the development of control measurements for this species.

Learning Objectives

  • To reinforce the public health importance of Plasmodium vivax.
  • To review the key gaps in knowledge of this human malarial parasites.
  • To understand the difficulties in eliminating P. vivax and to review possible solutions for elimination of this species.
13:15-14:30
Lunch
course faculty
14:30-15:30
Communication, Dynamization of Science and Social media for Malaria Eradication
Alan Court, Regina Rabinovich, Maxine Whittaker and Dyann Wirth

The goal of the session is to educate the participants on the role and value of communication and social media in compelling change in behavior, first by individuals, and second, by organizations, and third, political,  involved in malaria control and elimination.  We aim to do this by covering the following:

  • Present a set of principles of advocacy and social communication – what works?  What doesn’t?
  • What are examples of use of social media and communication campaigns to compel social change.

How do communities and researchers understand and manage progress and failures in product development needed to manage resistance?

The discussion will cover some controversial topics which will fully engage the participants:

  1. How are advocacy/communication goals set?  What are the trade-offs in making these ambitious vs. realistic?
  2. How do we balance off what needs to be achieved today vs. in the future?
  3. Are there activities or approaches that must be avoided, particularly as malaria has to compete in a crowded global health space?
15:30-15:45
Coffee Break
course faculty
15:45-17:30
Communication, Dynamization of Science and Social media for Malaria Eradication (continued)
Alan Court, Regina Rabinovich, Maxine Whittaker and Dyann Wirth

The goal of the session is to educate the participants on the role and value of communication and social media in compelling change in behavior, first by individuals, and second, by organizations, and third, political,  involved in malaria control and elimination.  We aim to do this by covering the following:

  • Present a set of principles of advocacy and social communication – what works?  What doesn’t?
  • What are examples of use of social media and communication campaigns to compel social change.

How do communities and researchers understand and manage progress and failures in product development needed to manage resistance?

The discussion will cover some controversial topics which will fully engage the participants:

  1. How are advocacy/communication goals set?  What are the trade-offs in making these ambitious vs. realistic?
  2. How do we balance off what needs to be achieved today vs. in the future?
  3. Are there activities or approaches that must be avoided, particularly as malaria has to compete in a crowded global health space?
Friday May 10, 2013
course faculty
09:00-10:00
The Economics of Malaria Eradication
Fabrizio Tediosi, Swiss Tropical Public Health Institute and Elisa Sicuri, Barcelona Institute for Global Health

The session will provide an overview of the main economic questions related to malaria eradication.  It will discuss how economic theory and analysis can be used to inform decisions on malaria eradication.  Several economic aspects associated with malaria eradication will be illustrated and discussed: costs and economic benefits; affordability; coordination and incentives challenges due to the global public good nature of eradication.

Learning Objectives

  • To discuss how economic analysis can help to inform decisions on malaria eradication initiatives.
  • To identify the main economic challenges associated with malaria eradication.
  • To identify the potential economic benefits that might follow malaria eradication.
course faculty
10:00-11:00
Supply Chain Management and the Role of Industry in Malaria Eradication

This session will introduce the participants to how supply chains for delivering malaria interventions are organized in malaria endemic countries, and what are the main barriers that prevent scale-up and wide coverage of interventions. It will also provide an overview of the role of effective supply chains in malaria elimination or eradication.

Learning Objectives

  • To introduce the supply chains for malaria interventions.
  • To understand why supply chains matter in the overall strategy for elimination and eradication.
11:00-11:15
Coffee Break
11:15-12:15
The Global Architecture for Malaria Eradication
Regina Rabinovich and Alan Magill

Malaria control is driven by a diverse set of players, each with their own governance and mission.  We are in the midst of enormous change, where one challenge for the malaria field to learn while implementing against the goal of malaria control and eradication. Reaching eradication will ultimately require excellent alignment of country goals and actions, resources and political will.   What elements of the architecture must advance to ensure the success of malaria eradication?

Learning Objectives:

  • Contrast the structure of malaria architecture to other global health eradication and/or control efforts, and understand the unique requirements for malaria eradication.
  • Identify the key sectors and organizations that form the global architecture of malaria today.
  • Identify the critical factors external to malaria that impact on the impact of malaria programs.
  • Discuss the areas where the architecture for malaria eradication could evolve.
course faculty
12:15-13:15

Advocacy encompasses a diverse set of activities to compel change.  These can be directed to financing, political will, adoption of new interventions, and behavior change.  All of these are further challenged at the elimination phase:  sustaining financing for what becomes a low burden disease; leadership and political visibility for a national campaign, and sustaining community engagement to the end.  However, we must be able to confront these challenges and adapt the messages and tools as needed.

Learning Objectives:

  • What are the unique challenges as very low levels of disease are reached?
  • Do advocacy tools have to be adapted to the last phase of malaria elimination – and what are we learning about this?
  • How has social media changed the potential impact of malaria advocacy?
13:15-14:30
Lunch
course faculty
14:30-15:30
The Way Forward for Malaria Eradication
Fatoumata Nafo-Traoré, Roll Back Malaria
course faculty
15:30
Closing Remarks
Pedro Alonso, Barcelona Institute for Global Health