High-Level Roundtable on Accelerating Elimination of Malaria in the South-East Asia Region

29 November 2017, New Delhi, India

Minister of Health, Nutrition & Indigenous Medicine, Sri Lanka, H.E. Dr Rajitha Senaratne, H.E. Dr Aishath Rameela, Minister of State for Health, Maldives, Distinguished participants from countries of South-East Asia Region, My long-time colleague, Dr Mirta Roses, Regional Director Emeritus from AMRO, The world experts on malaria, Friends of malaria control from around the world, Colleagues from WHO-Geneva, region and countries, Ladies and gentlemen,

As we convene today for this regional malaria roundtable, we have before us a unique opportunity to improve the health and wellbeing of future generations. Indeed, we have the chance to take action to eliminate malaria across the South-East Asia Region.

The opportunity to eliminate malaria would have astonished previous generations. Throughout history, the 11 countries of our Region have struggled under malaria’s deadly burden. Even today, with greater momentum and more efficacious tools than ever, the South-East Asia Region has the second highest malaria burden of any region in the world. An estimated 1.35 billion people in the Region are at risk of acquiring malaria.

Honourable Ministers,

The last time we discussed the Region-wide battle against malaria was in 2007, when ministers endorsed a revised malaria control strategy. That strategy prioritized the need to scale-up malaria prevention measures, intensify focus on vulnerable populations, integrate malaria control into broader public health programmes, adopt multisectoral approaches and partnerships, and reform malaria control programmes. The strategy also recognized the need for malaria control to be pushed higher on the regional political agenda.

I am delighted to report that in the past decade malaria control in our Region has been completely transformed. Between 2010 and 2016 estimated malaria cases fell by 44%, and malaria deaths declined by 36%. Two countries in our Region – Maldives and Sri Lanka – have been certified by WHO as having eliminated malaria. Two other countries – Bhutan and Timor-Leste – had fewer than 100 reported malaria cases in 2016 and zero malaria deaths.

Though India and Indonesia continue to account for the bulk of the Region’s malaria burden, in recent years both countries have made important progress in reducing malaria incidence and mortality. Indeed, across the Region momentum is strong, as witnessed by the fact that all nine countries with endemic malaria have transitioned their control strategies to elimination strategies, with the aim of eliminating the disease by latest 2030.

I am pleased to note that strong national leadership has played a critical role in getting us to this stage. Not only has political leadership empowered national malaria control programmes, allowing them to make the remarkable progress just mentioned, but it has also facilitated the cross-border collaboration needed to make lasting gains.

WHO has worked to support these efforts. As you are aware, the World Health Assembly endorsed a new technical strategy for malaria for 2016-2030. WHO has aided and facilitated cross-border collaboration, such as in the Greater Mekong Subregion, where international action is focused on reversing drug resistance. New malaria tools, such as low-dose primaquine for elimination settings and diagnostic tools to aid in the treatment of vivax malaria, have been rapidly assessed by WHO and translated into policy guidance. Research fostered by WHO has led to the rapid discovery of molecular markers for artemisinin resistance, which are now being used to guide and strengthen malaria control efforts in the Greater Mekong Subregion.

Medical innovations have been similarly impactful. Rapid diagnostic tests have enabled community-based diagnosis. A three-day course of highly effective artemisinin-based combination therapy (short: ACT) has dramatically reduced malaria mortality. And long-lasting insecticidal nets are now offering life-saving protection for at least three years.

It is inspiring to see these innovations being utilized so effectively. Six countries in the Region have achieved at least 50% coverage of either long-lasting insecticide nets or indoor residual spraying – Bhutan, Democratic People’s Republic of Korea, Indonesia, Myanmar, Nepal and Timor-Leste. And in 2016, 25 million rapid diagnostic tests for malaria and more than 900 000 courses of ACT were distributed Region-wide.

Nevertheless, scientific innovations and political commitment alone will not eliminate malaria.

The active engagement and leadership of affected communities is crucial. To this end, I commend you for the fact that in each of the Region’s countries a strong community-based malaria network is operating. Indeed, in several countries, more than 50% of malaria cases are detected and treated at the community level.

Honourable Ministers,

International partners have been indispensable to our success in fighting malaria over the last decade. Support from the Global Fund and many bilateral and other agencies have made possible the rapid introduction and scale-up of innovative tools for malaria prevention, diagnosis and treatment, especially in hard-to-reach areas and among what are often marginalized communities. The Asia Pacific Leaders Malaria Alliance has helped ensure that malaria is a regional political priority, as reflected in the commitment of leaders at the East Asia Summit in 2014 to take steps to achieve a malaria-free Asia Pacific Region.

I nevertheless take this opportunity to provide a word of caution. History has shown that in a short time malaria can bounce back from very small numbers to a huge resurgence once efforts are relaxed. We will fail to achieve our goals if we do not build on our momentum and sustain political commitment. Indeed, though we can surely congratulate ourselves on how far we’ve come in recent years, we must do so with full knowledge that the hardest part – the most taxing and demanding work – is ahead of us.

Distinguished participants,

We are here to today to renew and strengthen our efforts to accelerate malaria elimination in the South-East Asia Region. We must take on board the lessons we have learned from our successes over the past 10 years, address shortcomings and gaps, and determine once and for all to leave no one behind. We must face head-on the serious threat posed by multi-drug resistance, especially in the Greater Mekong Region, as well as mosquito resistance to insecticides. We must follow through on eliminating malaria where it remains endemic and prevent the reestablishment of malaria in areas or countries that are currently malaria-free.

As Ministers endorse today’s declaration on accelerating malaria elimination in the South-East Asia Region, let us reflect on the immensity of the undertaking and the critical importance of staying true to our word. We have the tools needed to eliminate malaria. We know from the past decade that rapid progress against malaria is possible. When regional leaders reassemble with regard to this issue in 2030 at the latest, let us make sure they have little to say other than, “Job well done!”

Thank you very much. I wish you a productive and engaging meeting.

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