The Schistosomiasis

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The Schistosomiasis Control Initiative Summary
for 2012/13 and strategic direction for
2014/20 Professor Alan Fenwick
OBE a.fenwick_at_imperial.ac.uk
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What is involved to upscale to country level we
need to

• Mobilise political will
• Define disease distribution collect mapping and
  base line data
• Develop a national plan with strategies at each
  district level
• Define drug needs and order drugs
• Develop local advocacy tools
• Conduct training for teachers
• Deliver the drugs
• Monitoring and evaluation

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Treating school children is easy
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And adults at high risk are offered treatment
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Phase One SCI started with funding from Bill and
Melinda Gates FoundationMinistries of Health and
Education in 6 countries with SCI support
delivered over 43 million cumulative
Schistosomiasis treatments and over 100 million
albendazole (purchased)
50
2002/3
43 m
45
2003/4
40
2004/5
2005/6
35
2006/7
30
Number of Treatments (millions)
26 m
25
20
15
12 m
10
3 m
5
0.1
0
2004/5
2002/3
2003/4
2005/6
2006/7
SCI Treatment Years
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Phase Two - Ministries of Health and Education
with SCI support and USAID funding
Treatments delivered 2007-2010 shown below
50
4 drugs
4 drugs
4 drugs (RTI)
45
gt40 m
gt40 m
gt40 m
40
35
30
Number of Treatments (millions)
25
20
Pzq and alb
15
6 m
Pzq and alb
10
3 m
5
0
Rwanda/ Burundi
Yemen
Burkina Faso
Niger
Uganda
SCI supported countries
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Phase Three expansion - Ministries of Health
and Education with SCI support and DFID funding

Treatments delivered in 2012/13
50
75 million treatments to 8 countries planned for
2011 2016 funded by DFID Could be doubled with
a new award
45
40
35
30
Number of Treatments (millions)
25
20
Pzq/alb
15
10 m
1m/6m
8 m
8 m
10
1 m
3 m
2 m
1 m
5
0
Rwanda/ Burundi
Yemen
Tanzania
Malawi
Cote DIvoire
Uganda
Niger
Mozambique
SCI supported countries
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Phase Four 2013-2020

• Consolidate in existing countries
• DFID reach national coverage in all 8 countries
• DFID move towards elimination in Zanzibar,
  Uganda and Niger
• DFID expand into Ethiopia and DRC
• Move towards elimination in Rwanda and Burundi
  (SCORE and ENDFUND and Private)
• Expansion of coverage in Yemen
• Use donations to move into new countries
  (Mauritania, Madagascar, Zimbabwe, Senegal)

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Phase Four 2013-2020

• A More holistic approach
• Maintain and increase income (more proposals,
  maintaining status with givewell and GWWC)
• Strengthen staff (management, new disciplines,
  more local staff Ethiopia, DRC)
• Water and sanitation what shall we do ?
• Behaviour change is this feasible
• Snail control when and where

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Phase Four 2013-2020

• Operational research
• Monitor drug efficacy
• Improving coverage
• Gaining and maintaining control
• Possibility of elimination
• Water and sanitation
• Snail control
• Cysticercosis

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Director Managing Director
Office Manager
PR and fund raising
SCI ORGANOGRAM
Programme Manager UGA (Niger, Mozambique)
Director of Monitoring and Evaluation
Programme Manager (Yemen and Ethiopia)
Finance Manager
Programme Manager (Rwanda, Burundi, Senegal)
Senior Biostatistician
Finance Officer
ICOSA Project Manager ICOSA M and E
Health Economist
Africa Capacity Building Liaison
Liverpool CNTD Sub-Contract
Mathematical Modeller
Africa country coordinators
3 Programme Managers DFID (8 Countries)
FINANCE AND ADMINISTRATION UNIT
Long and Short Term Technical Assistants
RESEARCH UNIT
IMPLEMENTATION UNIT
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SCI coverage 2003 - 2016
And Yemen With World Bank funds
Mauritania
Mali
Niger
Senegal
Burkina Faso
Ethiopia
Cote DIvoire and Liberia
Uganda
DRC
Burundi and Rwanda
Tanzania
Malawi and Mozambique
Proposed expansion into DRC, Ethiopia Senegal.
Mauritania and Zimbabwe
Zambia
Zim
With support from the Gates Foundation USAID/NTD,
Geneva Global and DFID, UK
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With the new WHA resolution calling for global
schistosomiasis elimination what is the WHO
strategy, the feasibility and what are the major
challenges?How does this affect SCI ?
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Proportion of PC for schistosomiasis,
soil-transmitted helminthiases, lymphatic
filariasis, onchocerciasis and trachoma, 2011
2011 Schistosomiasis Soil-transmitted helminthiases Lymphatic filariasis Onchocerciasis Trachoma
of counties reported 24 63 34 28 ND
of people treated 28,140,136 302,523,800 557,434,305 98,089,495 ND
Coverage () 10.4 30.6 39.5 77.1 ND
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Joint drug request, review reporting
mechanism But with pzq there are other sources
DFID and USAID
Regional review groups
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Merck KGaA's expanded commitment of praziquantel
supply for unlimited period
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Likely future praziquantel availability(millions
of tablets)
2013 2014 2015 2016
USAID Annual commitment 100 100 100 100
DFID Confirmed 47 47 47 47
DFID Not yet confirmed 23 23 23 23
Other NGOs 10 10 10 10
Merck Incremental 25 75 120 250
Total 205 255 300 430
Treatments 80 million 100 million 120 million 170 million
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The US Government

• Launched in 2006 by USAID
• The Neglected Tropical Diseases Cooperative
  Agreement - Initially 100 million, and in 2010
  a new commitment of 450 million 250 m to
  ENVISION

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The British Government
50 million over 5 years for NTD control
announced in 2008 A new 200 million 4 year
commitment in January 2012
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Other donors to/through SCI

• The World Bank
• The END FUND (Geneva Global and Legatum)
• Childrens Investment Fund Foundation (CIFF)
• Vitol
• The Bill and Melinda Gates Foundation
• SCORE (UGA/ BMGF)
• Global Network for NTD control (END7)
• Private Donors
• www.givingwhatwecan.org
• www.givewell.org

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How much can we reach out to the countries with
maximum requirements - the 10 highly endemic AFR
countries, 2010
2013 status Population received treatment, 2010 Estimated Infected population, 2010 10 Countries
Carter C, CIFF, DFID and USAID 2,297,282 36,728,013 Nigeria
USAID, CNTD and SCI 1,298,263 23,189,294 United Republic of Tanzania
Starting 2013/14 - 19,157,807 Democratic Republic of the Congo
Ongoing USAID/ CNTD 1,739,837 17,644,805 Ghana
Expanding 2012/13 488,359 16,326,177 Mozambique
SCI in 2013/14 - 11,087,896 Madagascar
Ongoing CIFF - 9,396,937 Kenya
Expanding SCI 657,967 8,628,298 Côte d'Ivoire
Expanding SCI/ CNTD 938,999 6,725,050 Malawi
Starting 2013 - 6,026,639 Ethiopia
7,420,707 154,910,915 10 Countries
33,642,598 243,598,854 GLOBAL
22.1 63.6 Proportion of global
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Control of Morbidity Elimination as a public health problem Interruption of transmission
PCT 100 geographical and 75 national coverage with PCT Adjusted PCT and complementary interventions recommended Intensified PCT in complementary interventions essential
Prevalence of heavy intensity infection lt5 Prevalence of heavy intensity infection lt1 Reduction of incidence of infection to zero
Up to 5-10 years from joining the group Up to 3-6 years from joining the group Up to 5 years from joining the group
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WHO Strategic Plan Milestones WHO Strategic Plan Milestones
2012 2013 Global Strategic Plan for SCH is adopted Global coordination mechanism is in place for Adequate supply of praziquantel Resources for country level implementation Harmonisation of partners activities National policies for NTD control including SCH are in place in 50 of the countries requiring PCT A school-deworming manual including ME available A resolution on SCH elimination is adopted

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WHO Strategic Plan Milestones WHO Strategic Plan Milestones
2013 2014 2015 National Plans of Action for NTD control developed by 75 of the countries requiring PCT for SCH Procedures and Guidelines for verification of interruption of transmission are established Interruption of transmission is verified in countries which request it Geographical mapping of at least 75 of countries requiring PCT is completed and PCT database updated Guidelines for snail control revised and disseminated Training for NTD programmes managers conducted SOP to monitor drug efficacy of PZQ s developed
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The importance of advocacy
Challenge Strategy Questions
Lack of political commitment/ WHO USAID and DFID RTI/SCI/CNTD Integration vs Coordination Advocacy for political commitment and country ownership of programmes increased country financial contribution High level advocacy by WHO and donor countries to ensure NTD programmes are prioritised by governments Encourage an inter sectoral approach to NTD control Advocacy for increased country and donor support for SCH in particular Improve relations between similar groups be better dialogue control Role of SCH/STH NDGO group in advocacy at different levels
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The UK Coalition against Neglected Tropical
Diseases (NTDs) is a collaborative partnership
between UK organisations actively engaged in the
implementation, capacity building and research of
neglected tropical disease control at scale
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London Centre for NTD Research

• Launched on January 30th 2013
• (Sir Roy Anderson)
• Partners include
• PCD
• SCI
• London School of Hygiene and Tropical Medicine
• Natural History Museum

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