Malaria affects poor people the most

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Progress with RBM in the WHO European Region
Mikhail Ejov, Roll Back Malaria WHO Regional
Office for Europe Cairo, Egypt May 2005
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Reported number of autochthonous malaria cases in
all countries of the WHO European Region,
1990-2004
RBM programme
Between 35 and 40 million people live in areas
at risk of malaria in the Region
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Countries with reported autochthonous cases of
malaria - 1980s, 1990s, 2000s
1980s (3)
2000s (10)
1990s (5)
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Current malaria situation in the WHO European
Region

• Countries where malaria remains a major public
  health problem TAJIKISTAN, TURKEY
• Countries where malaria may assume epidemic
  dimensions KYRGYZSTAN, GEORGIA
• Countries where malaria epidemics have been
  contained and the results achieved need to be
  sustained TURKMENISTAN, AZERBAIJAN, ARMENIA
• Countries where sporadic cases are reported and
  the risk of further spread remains
  highUZBEKISTAN, KAZAKHSTAN, RUSSIAN FEDERATION
• Countries free from autochthonous malaria or
  cases rarely reported ALL REMAINING COUNTRIES

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Areas of major concern to Roll Back Malaria in
Europe

• MALARIA IS A RE-EMERGING DISEASE IN THE REGION
• HIGHLY EXPLOSIVE NATURE ONGOING MALARIA
  OUTBREAKS
• RETURN OF ENDEMIC MALARIA THE TOLL OF
  MALARIA IS UNDERESTIMATED
• SPREAD OF P. FALCIPARUM MALARIA OCCURANCE
  OF DRUG RESISTANCE
• THREAT OF THE RE-ESTABLISHMENT OF MALARIA
  TRANSMISSION IN COUNTRIES WHERE IT HAS BEEN
  ELIMINATED
• AT PRESENT, ONLY A FEW COUNTRIES IN THE REGION
  CAN BOAST OF ADEQUATE CAPACITIES TO ENSURE
  APPROPRIATE MALARIA CONTROL AND PREVENTION
• THERE IS AN URGENT NEED FOR AN INCREASE IN
  RESOURCES TO CONSOLIDATE THE RESULTS ACHIEVED AND
  TO MOVE FURTHER FROM MALARIA CONTROL TO
  ELIMINATION, AT LEAST IN SOME COUNTRIES

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COUNTRIES OF CENTRAL ASIA

• CURRENT SITUATION
• APPROXIMATELY 14 MILLION PEOPLE, OR 33 OF THE
  TOTAL POPULATION OF CENTRAL ASIA, LIVE IN AREAS
  AT RISK OF MALARIA
• RETURN OF ENDEMICITY INTO THE SOUTHERN PART OF
  TAJIKISTAN. THE TOTAL ESTIMATE OF MALARIA CASES
  IN TAJIKISTAN ALONE MAY APPROACH 200 000 250
  000
• THE SITUATION IS COMPLICATED BY THE SPREAD OF
  DRUG-RESISTANT P.FALCIPARUM MALARIA WITHIN
  TAJIKISTAN.
• HIGH TREATMENT FAILURE RATES OF CQ S-P AGAINST
  P. FALCIPARUM MALARIA REPORTED IN TAJIKISTAN
• DETERIORATION OF THE MALARIA SITUATION IN BORDER
  AREAS OF TAJIKISTAN, KYRGYZSTAN, TURKMENISTAN AND
  UZBEKISTAN. THE FIRST CASE OF AUTOCHTHONOUS
  P.FALCIPARUM MALARIA WAS REPORTED IN THE SOUTHERN
  PART OF KYRGYZSTAN BORDERING UZBEKISTAN IN 2004

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Population at risk of malaria in countries of
Central Asia and Kazakhstan,estimated by WHO
4 500 000
2 500 000
5 600 000
4 500 000
1 000 000
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Areas with reported autochthonous cases of
malaria, Central Asia, 2004



AREAS WHERE AUTOCHTHONOUS CASES HAVE BEEN
OFFICIALLY REPORTED







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Malaria strata in Central Asia
Risk of re-establishment of malaria
transmission exists
Sporadic cases reported/ Risk of outbreaks exists
Endemic type
Epidemic type
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COUNTRIES OF THE CAUCASIAN REGION

• CURRENT SITUATION
• MORE THAN A TEN-FOLD INCREASE IN THE REPORTED
  NUMBER OF MALARIA CASES WAS OBSERVED IN GEORGIA
  DURING 1999-2002, AND THE MALARIA SITUATION HAS
  SLIGHTLY IMPROVED IN RECENT YEARS
• THERE IS RISK THAT MALARIA MAY ASSUME LARGER
  DIMENSIONS IN GEORGIA, WHERE ALMOST THE ENTIRE
  POPULATION LIVES IN AREAS AT RISK OF MALARIA.
  CONDITIONS FAVOURABLE FOR MALARIA TRANSMISSION
  EXIST IN NEARLY 52 OF THE WHOLE TERRITORY OF
  GEORGIA, AN AREA IN WHICH 93 OF THE TOTAL
  POPULATION LIVES
• SUBSTANTIAL REDUCTION IN THE REPORTED INCIDENCE
  OF MALARIA IN AZERBAIJAN AND ARMENIA

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TURKEY

• CURRENT SITUATION
• A SUBSTANTIAL REDUCTION IN THE REPORTED INCIDENCE
  OF MALARIA IN TURKEY IN RECENT YEARS
• HOWEVER, MORE THAN 15 MILLION PEOPLE (23) RESIDE
  IN AREAS WHERE MALARIA IS ENDEMIC AND A RATHER
  LARGE PROPORTION (44) LIVES IN AREAS WHERE THE
  RISK OF OUTBREAKS EXISTS
• THE EXTENT OF THE MALARIA PROBLEM IS MUCH LARGER
  THAN THE INCIDENCE REPORTED, PARTICULARLY IN THE
  SOUTHEASTERN PART OF THE COUNTRY

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Population at risk of malaria in Caucasian
countries and Turkey, estimated by WHO
2 000 000
Georgia
Armenia
1 500 000
Azerbaijan
5 500 000
Turkey
15 000 000
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Areas where autochthonous malaria cases reported,
TransCaucasian countries, 2004
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Areas where autochthonous cases of malaria
reported, Turkey 2004
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GoalsROLL BACK MALARIA IN EUROPE

• Short and medium term goals are
• TO PREVENT DEATHS DUE TO MALARIA
• TO PREVENT LARGE-SCALE MALARIA EPIDEMICS
• TO CONTAIN MALARIA OUTBREAKS
• TO REDUCE THE INCIDENCE/PREVALENCE OF MALARIA
• TO PREVENT THE RE-ESTABLISHMENT OF MALARIA
  TRANSMISSION AND MAINTAIN THE
  MALARIA-FREE STATUS IN COUNTRIES WHERE MALARIA
  HAS BEEN ERADICATED

• Long term goals are
• TO INTERRUPT P.FALCIPARUM TRANSMISSION (BY
  2010)
• TO INTERRUPT MALARIA TRANSMISSION (BY 2015)

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Priority Actions, 2004-05Roll Back Malaria in
Europe

• Providing technical guidance and assistance in
  planning, implementing and evaluating RBM
  activities

• Coordinating RBM partnership actions at
  sub-regional and country levels

• Strengthening technical and managerial
  capacities at country level

• Improving capacities for timely response and
  prevention of outbreaks and epidemics

• Promoting integrated vector control

• Reinforcing surveillance mechanisms

• Supporting research related to malaria

• Strengthening cross-border coordination and
  cooperation

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Recent AchievementsRoll Back Malaria in Europe

• THE REGIONAL RESOLUTION SCALING UP THE RESPONSE
  TO MALARIA IN THE WHO EUROPEAN REGIONWAS
  ENDORSED BY ALL MEMBER STATES (2002)

• COMMITMENTS ARE PRESENTLY TRANSLATED INTO REAL
  RBM ACTIONS
• RBM HQ AND RBM EURO ASSIST IN GUIDING RBM
  ACTIONS, STRENGHENING TECHNICAL AND MANAGERIAL
  CAPACITIES AT COUNTRY LEVEL, AND IMPROVING
  EPIDEMIC RESPONSE, SURVEILLANCE AND CROSS-BORDER
  COOPERATION (2003-2005)
• USAID CAR HAS SUPPORTED THE WHO RBM INITIATIVE IN
  CENTRAL ASIA, AND A SUB-REGIONAL RBM PARTNERSHIP
  ACTION IS BEING ACTIVELY PROMOTED BY WHO, USAID,
  CDC, UNICEF, WFP, MERLIN, ACTED AND OTHERS
  (2003-2005)
• RBM EURO AND USAID CAR SUPPORT OPERATIONAL
  RESEARCH RELATED TO MALARIA IN CENTRAL ASIA
  (2003-2005)
• THE GFATM HAS GIVEN GEORGIA UZBEKISTAN A GRANT
  TO SUPPORT ITS NATIONAL RESPONSE TO MALARIA OVER
  NEXT YEARS (2004-2010)
• RBM EURO AND USAID CAR HAVE ASSISTED TAJIKISTAN,
  TURKMENISTAN, KYRGYZSTAN, AZERBAIJAN, ARMENIA AND
  TURKEY IN DEVELOPMENT OF THEIR MALARIA PROJECT
  PROPOSALS TO BE SUBMITTED TO THE GFATM (5th
  ROUND) (2005)

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ProspectRoll Back Malaria in Europe

• THE DEMONSTRATED FEASIBILITY OF MALARIA
  ELIMINATION IN THE PAST,
• THE VISIBLE IMPACT ON MALARIA OF RBM
  INTERVENTIONS AT PRESENT,
• THE STRONG POLITICAL COMMITMENTS TO MOVE FROM
  CONTROL TO ELIMINATION AT NATIONAL LEVEL,
• THE AVAILABILITY OF EFFECTIVE CONTROL
  TECHNOLOGIES AND TOOLS
• HAVE CREATED A SOLID EVIDENCE FOR FUTURE
  DECISIONS TOWARDS UNDERTAKING NEW ELIMINATION
  EFFORTS IN THE REGION
• THE MAIN OBSTACLE FOR ALL ELIMINATION PROGRAMMES
  IS THEIR COST, WHICH IS MUCH BEYOND THE RESOURCES
  AVAILABLE

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THANK YOU