Malaria elimination and the Asia Pacific Leaders Malaria Alliance
Malaria is a key health security issue for the Asia Pacific region — it crosses borders and challenges stretched health systems. The World Health Organization's World Malaria Report (released December 2018) notes that while the burden of malaria continues to decline in some Indo-Pacific nations, in others malaria is resurging. During 2017, there were an estimated 219 million cases of malaria worldwide resulting in 435 000 deaths. Although Australia was declared malaria free in 1981, close to 500 Australians contract malaria overseas each year. Pertinent to the broader health security interests of our region, the Greater Mekong Sub-region has seen a rise in resistance to current treatments and prevention measures which, unless addressed, could set back decades of progress.
Australia has played a lead role in mobilising political support in our region to support malaria control and move towards malaria elimination. Following on from the Malaria 2012 conference held in Sydney, the Asia Pacific Leaders' Malaria Alliance (APLMA) was established at the 8th East Asia Summit (EAS) in October 2013. The APLMA membership consists of 23 heads of government of Asian and Pacific countries affected by malaria. At the 10th EAS (2015) held in Malaysia, the leaders of these 21 countries committed to eliminating malaria from the Asia-Pacific region by 2030 and endorsed the APLMA Malaria Elimination Roadmap as a means to achieve this goal. Australia is providing $12 million from 2013-19 to directly support the work of the APLMA Secretariat, which also manages the associated Asia Pacific Malaria Elimination Network (APMEN) – a country-led network of 18 countries and 46 partner institutions committed to realising malaria elimination in the region.
Australia also finances regional and global malaria initiatives, and funds malaria research at home:
- In 2018, Australia will invest to strengthen health security capacity links and partnerships and to support malaria elimination with particular focus on the Indo-Pacific region. Australia will offer a targeted Australia Awards Fellowships (Health Security) round to fellows from Greater Mekong Sub-region (GMS) countries, which will focus on promoting health security, in particular the management of drug-resistant malaria in the GMS. Australia will also supported for the first Malaria World Congress (MWC) held in Melbourne in 2018 which will brought together multi-sectoral representatives to discuss issues including research, drug development and implementation, policy, funding and advocacy, with the goal of malaria elimination in the Indo-Pacific by 2030.
- A number of investments under the Australian Government's $300 million Health Security Initiative for the Indo-Pacific region (2017-2022) are likely to contribute to the control and elimination of malaria, including drug-resistant forms of malaria. The Initiative includes a focus on antimicrobial drug resistance with respect to malaria and tuberculosis, and will seek opportunities to build on existing malaria control and elimination work in order to strengthen epidemic preparedness more generally. Building on past support to Product Development Partnerships (PDPs), the Initiative's $75 million PDP Fund will expand Australia's support for the development of diagnostics and therapeutics for malaria and tuberculosis, and will also support the development of vector control technologies. The Initiative is also supporting a partnership between DFAT and Australia's Therapeutic Goods Administration to build regional capacity for the registration and regulation of new malaria and TB drugs and diagnostics.
- In September 2016, Australia increased its contribution to the Global Fund to Fight HIV/AIDS, Tuberculosis and Malaria to $220 million for 2017-19, up 10 per cent. The Global Fund will spend close to US$1 billion on malaria in the Indo-Pacific during 2017-19, making it a critical partner for Australia. Included in this figure is US$242 million for the Regional Artemisinin Resistance Initiative, combatting drug-resistant malaria in the Greater Mekong Sub-region. Australia has worked successfully with colleagues in the Global Fund Board to secure ongoing support for this initiative and other malaria elimination activities. The Global Fund is the world's largest financier of anti-AIDS, tuberculosis and malaria programmes, for example having distributed an estimated 795 million mosquito nets since 2002.
- The Australian Government invests substantially in research on tropical diseases including malaria, primarily through the National Health and Medical Research Council. Under the Tropical Disease Research Regional Collaboration Initiative, DFAT provided $2 million directly to the Darwin-based Menzies School of Health Research to support collaborative research into the prevention, detection and treatment of multi-drug resistant malaria and tuberculosis.
World Bank Multi-Donor Trust Fund for Integrating Donor Financed Health Programs
In Australia's region, weak health systems and low vaccine coverage puts many countries at risk of outbreaks of infectious diseases, including polio. Australia is investing in a World Bank Multi-Donor Trust Fund to address two of the most pressing issues in health and development facing countries in Southeast Asia and the Pacific: how to make progress towards Universal Health Coverage while effectively managing the transition from externally-financed health programs; and how to establish financially-sustainable systems that enhance health security. This investment assists countries in Southeast Asia and the Pacific to strengthen their health systems and ensure essential disease and immunisation programs are sustainably financed and managed. The Mid-term review of this investment recommended that DFAT and the World Bank rebrand the trust fund as an instrument to support countries’ broader policy objectives in relation to Universal Health Coverage (UHC). DFAT has contributed a total of $57.7 million to three 'windows' of the Trust Fund:
- Window 1 ($13.7 million from 2015-2025), to support the institutional and financial sustainability of national disease programs that are currently dependant on external financing (for example from the Global Fund to fight AIDS, TB and Malaria), in Cambodia, Laos, , Indonesia, Kiribati, Papua New Guinea, Samoa, Solomon Islands, Timor Leste, Tonga and Vanuatu.
- Window 2 ($36 million from 2015-2025), to strengthen and sustainably finance routine immunisation systems, in Cambodia, Indonesia, Lao PDR, Myanmar, Papua New Guinea, Philippines and Vietnam.
- Window 3 ($8 million from 2016-2025), to support sustainable financing for health security in Cambodia, Indonesia, Laos, Myanmar and Vietnam.
Transformative Agenda for Women, Youth and Adolescents in the Pacific
$30 million 2018-2022 ($7.5 million in 2017-2018)
Australia has committed $30 million through the UNFPA for a new four year partnership to improve access to quality sexual and reproductive health in six priority countries in the Pacific. Access to sexual and reproductive health services are vital to improving women’s and girl’s health, helping them to remain in education longer and enabling them to participate equally in the economy and society. It also helps contribute to more sustainable and inclusive social and economic development. The partnership will support the governments of Fiji, Kiribati, Samoa, Solomon Islands, Tonga and Vanuatu to transform lives by ensuring more women and young people in the Pacific have improved information, and quality services, with a focus in increased access to family planning information and services. The program will also support an improved policy development and regulatory frameworks by working with relevant ministries and assisting with to obtain, analyse and disseminate data to support public policy. The Transformative Agenda will be complemented through Australia’s new $10 million global contribution for UNFPA Supplies, which will help to ensure essential reproductive and maternal health commodities are available in health service delivery points across Pacific countries.