Science of Eradication: Malaria 2017

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Sunday June 25, 2017
3:00-5:00PM
Course Registration
5:00-5:15PM
Welcome
Núria Casamitjana, Christian Lengeler, Marcel Tanner, and Dyann Wirth
5:15-5:30PM
Introduction of Participants
course faculty
5:30-6:30PM
Ned Hayes Lecture: Translating Science into Elimination Strategies

This session provides 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:

  • To understand the transition in malaria epidemiology over the past decade, including successes, failures, and key lessons learned.
  • To appreciate the opportunities and challenges for malaria elimination in the next decade and the implications for ultimate malaria eradication efforts.
  • To understand how countries evaluate the case for eradication and the processes for translating what can be achieved into long term targets.
  • To evaluate the case for global malaria eradication.
6:30-7:30PM
Welcome Reception
Monday June 26, 2017
course faculty
8:30-9:30AM
Lessons Learned from Other Eradication Initiatives

This session will review the strategies used in the eradication of smallpox, polio, Guinea Worm, and Rinderpest and provide the lessons learned from each. It will also cover programs aimed at eliminating leprosy, onchocerciasis, and lymphatic filariasis and lessons learned in each of these programs as well. The session is intended to set the scene for discussions on potential strategies for malaria elimination and/or eradication – lessons which are also applicable to intensified malaria control.

Learning Objectives:

  • To understand the definition of eradication and the various definitions of elimination.
  • To understand the scientific basis for successful eradication.
  • To understand the various strategies used for eradication and elimination.
  • To provide background on which to base discussions of future strategies for malaria control, eradication, or elimination.
course faculty
9:30-10:30AM
Parasite Biology in the Era of Eradication

This session is an active case study discussion that builds upon “The Biology of Malaria“ pre-course MalariaX video lecture. Participants will engage in an active discussion of the biological implications of malaria eradication, including critical biological features of the parasite and current knowledge gaps. Key discussion topics include parasite biology (e.g., cell biology, parasite genetics, biochemistry of the parasite, red cell interaction, drug action, and resistance mechanisms), malaria epidemiology, and parasite-vector relationships. Participants are expected to be familiar with the life cycle and general biology of malaria parasites.

Those who do not have a background in biology or medical parasitology, or who require a primer should review the suggested reading materials and referenced website in addition to the online pre-course lecture.

Learning Objectives:

  • To understand the biology and life cycle-basis for this disease, including global public health aspects of malaria.
  • To consider the interrelationship of organisms and their environments, including identify ways of reducing the incidence and/or severity of disease within populations, obstacles, and consequences.
  • To understand the incidence and distribution of infection and disease within human populations, determinants of frequency and distribution, methods of measurement, and magnitude and consequence of disease on the population.
10:30-11:00AM
BREAK
course faculty
11:00AM-12:00PM
Challenges in the Elimination of P. vivax
Blaise Genton and Ivo Mueller

As non-African countries move toward elimination, P. vivax becomes the predominant source of malaria infections and disease. This session will explore the biological characteristics that make P. vivax more resilient to control and how these characteristics impact the effectiveness of current control methods, and will outline what tools (existing and novel) may be required to accelerate the elimination of P. vivax.

Learning Objectives:

  • To understand the central role of relapsing infection in the epidemiology of P. vivax and the importance of targeting these ‘hidden’ stages in elimination programs.
  • To explore the role of asymptomatic infections and high transmissibility.
  • To discuss challenges in diagnosing and treating P. vivax malaria cases.
course faculty
12:00-1:00PM
Tools for Transmission Measurement and Surveillance
Chris Drakeley and Ivo Mueller

This session will focus on newer molecular and serological approaches to both measure and monitor changes in malaria transmission. These will be discussed in the context of what will be useful for biological understanding of transmission and what are scalable tools that can answer questions specific to control programs. The session will also focus on contrasting how these might differ for P. falciparum and P. vivax and the need to develop and refine existing surveillance methods to optimize the data collected.

Learning Objectives:

  • To understand technological developments in molecular and serological approaches for malaria transmission.
  • To understand applications of these new approaches.
  • To appreciate the need to improve surveillance approaches for accurate monitoring of transmission.
1:00-2:00PM
LUNCH
course faculty
2:00-3:00PM
Procurement and Supply Chain Management

Designing and developing health product supply chains in developing countries requires a fundamental back-to-basics approach. There are two distinct parts: upstream from manufacturer to countries’ Posts of Entry (POE) and downstream from POE to central warehouse to regional warehouse to district pharmacy and finally to health facility. This session will highlight the difficulties experienced when engaging a developing country to improve their end-to-end supply chain.

Learning Objectives:

  • To understand that supply chain design or development starts by understanding demand.
  • To understand that supply chains must be considered end-to-end – they are only as strong as the weakest link.
  • To match the supply chain solution to the complexity of the supply chain architecture.
course faculty
3:00-4:00PM
Introduction to Case Studies and Group Work
Marcia Castro and Marcel Tanner
4:00-4:30PM
BREAK
4:30-5:30PM
Case Study and Group Work
course faculty
6:30-7:30PM
Malaria from Innovation to Eradication (Virtual Symposium)

Click here for more information.

Tuesday June 27, 2017
course faculty
8:30-9:30AM
Antimalarial Drugs and Drug Development

The current drug discovery and development portfolio is made of drug candidates expected to: 1) be efficacious against drug-resistant strains of Plasmodium falciparum; 2) have potential for intermittent treatments (infants and pregnant women); 3) be safe in very young children and in pregnancy; 4) be efficacious against Plasmodium vivax (including radical cure); 5) be efficacious against severe malaria; and 6) demonstrate transmission-blocking properties. This session will describe the historical antimalarials and the current combination therapies, new drug candidates, and their respective target product/candidate profiles. In addition, it will discuss current challenges to the eradication agenda and the urgent need to develop next-generation medicines that will be able to contain drug resistance, block transmission, and kill relapsing parasites.

Learning Objectives:

  • To understand the current situation and the place of malaria in the world.
  • To review the history of antimalarials, both benefits and limitations.
  • To discuss the discovery and development of next generation antimalarials.
  • To understand target product/candidate profiles for new antimalarials.
  • To understand innovative assays/technologies and test cascades.
  • To discuss gaps and challenges to surmount in reaching elimination and eradication.
course faculty
9:30-10:30AM
Novel Drug Strategies for Malaria Elimination

This session will provide a brief initial overview of past and current efforts to eliminate malaria through the use of drug-based strategies. Emphasis will be placed on the differences between the “control mode” vs. the “elimination mode.” Participants will be encouraged to discuss the adequacy of different drug regimens (combinations of drugs) used for elimination, as opposed to control purposes. These experiences will be contextualized in light of current World Health Organization recommendations for the use of drugs for elimination purposes.

Learning Objectives:

  • To understand the differences between the use of antimalarial drugs to control malaria and to eliminate malaria.
  • To review the different characteristics of antimalarial drugs and what would make a drug (or a combination of drugs) ideal for elimination purposes.
  • To understand the rationale for current recommendations regarding the use of antimalarial drugs in elimination efforts.
10:30-11:00AM
BREAK
course faculty
11:00AM-12:00PM
Health Systems: Orientation and Innovations

This session will focus on the fundamentals of health systems and health systems innovations, particularly on what is being learned. In addition, the session will cover health systems strengthening challenges for malaria elimination – from leadership and governance to financing and delivery.

Learning Objectives:

  • To understand the fundamental concepts of health systems.
  • To review what is being learned from ongoing innovations in health systems strengthening.
  • To review some of the key challenges for health systems strengthening for malaria.
course faculty
12:00-1:00PM
The Importance of Health Systems and Integration for Malaria Elimination

This session features a presentation and moderated discussion on the application of health systems thinking in malaria programs. The session will also cover how malaria specific interventions can be tailored to given health and social systems, while also contributing to health systems strengthening.

Learning Objectives:

  • To understand the principles of integrated approaches of malaria control and elimination interventions in different endemic settings with different health and social systems.
  • To develop and understand the key principles and practical approaches for integrated elimination efforts under health systems constraints.
1:00-2:00PM
LUNCH
course faculty
2:00-3:00PM
Diagnostics for Malaria Elimination

During this session, newly available experimental and modeling data about required parasite detection levels to accelerate malaria elimination will be presented. Participants will have the opportunity to analyze the usefulness of current and new diagnostic technologies for elimination at different endemic settings, according to levels of transmission and available resources. Research and development gaps as well as new promising technologies will be discussed.

Learning Objectives:

  • To analyze the usefulness and role of current and improved diagnostic tools in strategies to accelerate malaria elimination.
  • To identify research and development gaps for improved malaria diagnostics to accelerate elimination.
3:00-4:00PM
Case Study and Group Work
4:00-4:30PM
BREAK
4:30-5:30PM
Case Study and Group Work
Wednesday June 28, 2017
course faculty
8:30-9:30AM
Vector Biology

This session is an active case study discussion that builds upon “Vector Biology and the Dynamics of Malaria Transmission” pre-course MalariaX video lecture. The session will cover different aspects of mosquito biology that are key to parasite development and malaria transmission. Discussion will include current vector control strategies and future methods that can aid disease control.

Learning Objectives:

  • To develop an understanding of the complexity of malaria transmission by the mosquito vector.
  • To discuss present challenges facing vector control.
  • To identify novel opportunities to block malaria transmission by the mosquito.
course faculty
9:30-10:30AM
Current Tools for Large Scale Vector Control

This session will provide a review of the epidemiological and operational features of the three main vector control tools: insecticide treated nets (ITNs), indoor residual spraying (IRS), and larviciding.

Learning Objectives:

  • To understand the essential concepts and epidemiological features of ITNs, IRS, and larviciding.
  • To understand the comparative operational strengths and weaknesses of ITNs, IRS, and larviciding as malaria control interventions.
  • To understand the issue raised by the combination of different vector control approaches, and the role of modeling in this.
10:30-11:00AM
BREAK
course faculty
11:00AM-12:00PM
New Tools for Vector Control and Resistance Management

In the medium term, new tools will be required to eliminate malaria. Research and development is focused on new tools that will work in synergy with existing strategies, insecticide treated nets, and indoor residual spraying, to tackle those vectors that are resistant to tools currently in operation. In this session the behavior and physiological resistance of vectors is discussed and new technologies in the product development pipeline are introduced. These include new insecticides, new bed nets, vector traps, personal protection tools, attract and kill baits, and lethal house lures.

Learning Objectives:

  • To identify key mosquito behaviors and resistance mechanisms that reduce the efficacy of existing tools.
  • To understand the most promising new technologies in the vector control development pipeline for malaria and dengue control.
course faculty
12:00-1:00PM
Future Vector Control Tools, including Genetically Modified Mosquitos

Despite novel insecticides rotated on existing delivery platforms and the development of new delivery platforms, we will still face the challenges of transmission outside of village settings and ongoing challenges of adherence. Research and development is exploring tools with longer durations of action than existing products, or tools that expand coverage to non-traditional species. These include human and cattle endectocides, and modified insect populations (Wolbachia-infected or genetic modification).

Learning Objectives:

  • To identify key product attributes for long-term R&D solutions to prevention of transmission.
  • To describe how an endectocide works and its application to malaria vector control.
  • To define the biological control challenges with release of a Wolbachia-infected insect or genetically modified insect, and the additional challenges imposed with use of a gene drive.
1:00-2:00PM
LUNCH
course faculty
2:00-3:00PM
Behavioral and Social Sciences to Drive Individual Adherence of Prevention and Community Engagement

This session focuses on exploring the role of behavioral and social sciences in supporting adherence to and community engagement in malaria elimination interventions. The session will be interactive and unpack the concepts of adherence and engagement and then build approaches to explore and utilize these in elimination activities.

Learning Objectives:

  • To develop a framework of facilitators and barriers to individual adherence to malaria elimination activities.
  • To discuss the role of community in achieving and sustaining malaria elimination.
  • To describe the application of social science tools to support individual and community success and effective involvement in malaria elimination activities.
3:00-4:00PM
Panel: Financing Malaria Elimination: The Growing Reliance on Country Financing
Pedro Alonso, Alan Court, Quentin De Hemptinne, Bernard Nahlen, and Course Participants

The global technical and advocacy strategies have generated high level estimates of what it would cost for the world to finance eradication. The question for this panel is not how much this would cost, but what are the potential ways in which it would be financed. All estimates are that the fully loaded costs would be far higher than what is currently committed to malaria, even inclusive of integration into existing and emerging health systems. A major contributor for malaria is each country, but donor funding has also been critical, particularly for purchasing of commodities at national scale.

Learning Objectives:

  • To analyze the portfolio of options under consideration for financing malaria control/elimination.
  • To discuss how financing malaria will be managed in the context of an increasingly complex and competitive agenda in the next decade.
4:00-4:30PM
BREAK
4:30-5:30PM
Case Study and Group Work
6:30-7:30PM
Social Activity and Dinner
Thursday June 29, 2017
course faculty
8:30-9:30AM
Vaccines for Malaria Elimination

Effective vaccines have been essential in the eradication of smallpox and significant progress toward the eradication of polio. While reductions in morbidity and mortality caused by malaria have been achieved in the absence of a vaccine, it is widely acknowledged that a vaccine capable of interrupting malaria parasite transmission would significantly accelerate future elimination efforts. In recent years, two different vaccine approaches aimed at preventing mosquito-to-human transmission, namely RTS,S/AS01 (an adjuvanted recombinant protein) and PfSPZ (attenuated sporozoites), have been associated with high levels of protection in controlled human malaria infection models. Efforts are now underway to translate these encouraging findings to target populations in sub-Saharan Africa. In addition, significant progress is being made in advancing vaccine approaches targeting other invasion steps (i.e., invasion of red blood cells by merozoites and transmission of sexual-stage parasites to mosquitos) that are similarly critical in maintaining parasite transmission.

Learning Objectives:

  • To review the potential role of vaccines in accelerating malaria elimination and eventual eradication.
  • To analyze the biological, technical, and regulatory challenges, and opportunities, in developing vaccines that interrupt malaria (parasite) transmission.
  • To review the current status of the global malaria vaccine portfolio.
course faculty
9:30-10:30AM
The Role of Modeling to Inform Malaria Elimination
Melissa Penny and Marcel Tanner

This session will include a lecture with short discussion blocks to understand the potential role and principles of applied modeling for public health action.

Learning Objectives:

  • To develop and understand the position and potential role of modeling for malaria elimination/eradication.
  • To analyze the feasibility of engaging in elimination.
  • To understand elimination strategies with integrated, mixed interventions.
  • To understand the economic analysis of elimination strategies.
10:30-11:00AM
BREAK
course faculty
11:00AM-12:00PM
Combining Interventions for Malaria Elimination

This session will focus on an examination of steps toward progressing from malaria control to elimination with currently available tools. Moving forward along the continuum of malaria elimination, local epidemiology will drive implementation, monitoring, management, and choice of high impact interventions either singularly or in combination.

Learning Objectives:

  • To understand the approach to malaria elimination from the Zambian context.
  • To review epidemiological stratification and the corresponding package of interventions.
  • To analyze the importance of surveillance as a key intervention to malaria elimination.
course faculty
12:00-1:00PM
Partnering to Eliminate Malaria in Zambia

This session is an active case study discussion that builds on the “Political Analysis for Malaria” pre-course MalariaX video lecture. Participants will analyze the challenges confronting Zambia’s National Malaria Control Centre (MNCC) in collaboration with the MACEPA project in Zambia (PATH’s Malaria Control and Elimination Partnership in Africa) in preparing to scale up malaria elimination activities. The discussion will focus on how MNCC responds to positive results from a Mass Drug Administration study in the Southern Province of Zambia and the implications for national malaria policy. How can MNCC coordinate both state and non-state actors (including international non-governmental organizations, national non-governmental organizations, community- and faith-based organizations, donor agencies, traditional authorities, regional coordinating bodies, and academic institutions) in moving forward the government’s elimination targets and strategies?

Learning Objectives:

  • To analyze the landscape of both non-state and state actors in reaction to the results of the Mass Drug Administration study.
  • To assess the position and power of non-state and state actors regarding MNCC’s efforts to move towards malaria elimination in Zambia.
  • To propose specific strategies for MNCC in order to promote effective collaboration among state and non-state actors in working towards malaria elimination.
1:00-2:00PM
LUNCH
course faculty
2:00-3:00PM
Surveillance as an Elimination Tool, including District Health Information Systems

This session provides an introduction of the concept of surveillance-response and on how surveillance-response approaches/systems can and should be tailored to different transmission/elimination settings. This session is an active case study discussion that builds upon “Malaria Control and Elimination: Surveillance-Response Approaches“ pre-course MalariaX video lecture.

Learning Objectives:

  • To understand the concept of surveillance as intervention and how this leads to tailored surveillance-response approaches/systems in different transmission/elimination settings.
  • To distinguish the surveillance-response approaches that are based on the minimal essential data collected in space and time to the traditional concept of monitoring and elimination where generally maximally possible data are collected.
3:00-4:00PM
Panel: Engaging Industry in Innovation for Elimination
Nick Hamon, Christian Lengeler, Kevin Murphy, Ray Nishimoto, David Reddy, and Hans Rietveld

This panel will explore the main issues currently faced by industry in developing new malaria control and elimination tools. Representatives from companies and agencies developing new antimalarial drugs and vector control tools will introduce key topics from the industry’s point of view.

Learning Objectives:

  • To get an understanding of some of the key issues facing industry in developing new malaria control and elimination tools.
  • To discuss long-term financing and optimization of innovation.
4:00-4:30PM
BREAK
4:30-5:30PM
Case Study and Group Work
Friday June 30, 2017
course faculty
8:30-9:30AM
Malaria Elimination in the Context of Political Instability and Climate Change

This session is an active case study discussion that builds upon the “Social, Cultural, Behavioral, and Environmental Determinants of Malaria” pre-course MalariaX video lecture.

As countries plan for malaria elimination, political instability can impose major barriers for the uptake of important control strategies and for the sustainability of achieved gains. Similarly, environmental factors (e.g., natural environment: climate, land cover and/or e.g., human-made environment: housing conditions, land use), which historically were the target of control interventions, may play a particularly important role for the achievement of elimination. This session will discuss how these factors may affect elimination goals, and how countries should anticipate and plan ahead in order to mitigate the challenges that political and environmental factors impose.

Learning Objectives:

  • To identify important factors related to political instability and climate change that affect the pattern and the level of local malaria transmission, and then may impose barriers for malaria elimination.
  • To discuss the feasibility of social and environmental interventions as strategies for current efforts of malaria elimination.
course faculty
9:30-10:30AM
Program Management and Implementation - Part 1
10:30-11:00AM
BREAK
course faculty
11:00AM-12:00PM
Program Management and Implementation - Part 2
course faculty
12:00-1:00PM
Country Level Technical and Management Strategies to Support Eradication Efforts

Malaria elimination requires national programs to operate as highly efficient, effective organizations with strong systems and management. Strengthening technical, operational, and financial processes may require the support of partner organizations that can contribute specific expertise. In this session, participants will discuss areas where malaria programs may require support from external partners and consider the potential roles of these other actors in strengthening malaria elimination activities. Historical and contemporary examples of external support and best practices from recent experience will be evaluated and debated.

Learning Objectives:

  • To identify programmatic areas where national programs may require support.
  • To consider appropriate roles for non-governmental actors in supporting elimination.
  • To evaluate best practices for supporting national programs with programmatic gaps.
1:00-2:00PM
LUNCH
course faculty
2:00-4:00PM
Group Reporting and Discussion
4:00-4:30PM
BREAK
course faculty
4:30-5:30PM
Panel: What is Good Leadership in Malaria Control and Eradication?

While leaders across all varieties of fields might share certain skills, from an ability to forge strong partnerships to establishing a clear vision for their team, malaria control and eradication requires leaders with unique attributes due to the special nature of global public health in general, and the specific challenges of a disease as complex as malaria in particular.

Public health requires its leaders to operate in full view of the constituents that will benefit from their actions. Transparency is a requirement of public health efforts, increasing the visibility of leaders and their results. Because malaria is a disease intricately entwined with the environment and cultural and social conditions, solutions are not simply technical but also require multidisciplinary attention and consideration of the various contexts in which the disease occurs.

To attack the problem of malaria control and eradication, leaders must be ready to work across disciplines and in a variety of different settings. Leaders must have technical competencies but understand how to translate their technical understanding into practical recommendations. Leaders must be team builders due to the complexity of malaria prevention and control, and they must have patience because defeating malaria is a long game. Because their actions are visible and not always successful, they must be able to respond appropriately to criticism.

The panel will discuss the specific characteristics and competencies of good leaders in the field of malaria prevention, control, and eradication, and the type of experiences that are useful to develop leadership skills in the field of malaria.

Learning Objectives:

  • To identify special aspects of malaria control and eradication that are different from other public health issues that would affect the type of leaders needed in malaria.
  • To evaluate competencies that will be required of leaders in malaria control and eradication.
  • To review experiences useful for emerging leaders in malaria control and prevention.
  • To understand how the malaria community is actively identifying, shaping, and mentoring the next generation of leaders.
5:30-6:30PM
Closing
6:30-7:30PM
Closing Reception