A $100-million grant to avert the spread of artemisinin resistance in five malaria endemic countries in the Greater Mekong sub-region has been signed by a full complement of stakeholders, signalling the successful achievement of a first regional application under the Global Fund’s new funding model (NFM).
The Regional Artemisinin Resistance Initiative (RAI) will support purchase of long-lasting impregnated nets, malaria case detection and provision of directly observed antimalarial treatment in Cambodia, Laos, Myanmar, Thailand and Vietnam, as well as regional and national advocacy and awareness campaigns.
A disease burden and financial gap analysis led funds to be allocated as follows: 15% to the regional campaigns; 15% to Cambodia; 5% to Laos; 40% to Myanmar; 10% to Thailand; and 15% to Vietnam.
Central to the outreach component of RAI is work to reach migrant populations living and working in border areas who are normally overlooked and often marginalized. Each country has committed to complementary national campaigns targeting these populations.
Parasite resistance to artemisinin has been detected in all of the RAI countries, which has provoked concerns among malaria clinicians and researchers that a currently small problem could multiply exponentially and become a grave danger both within the region and beyond.
The risks presented by this growing resistance to artemisinin – the primary ingredient in combination therapies that have demonstrated the greatest success in treating malaria – drove the speed and deliberation with which the RAI proposal was achieved, according to RAI program manager Izaskun Gaviria.
“Artemisinin resistance is regarded as a global threat by the international community, which allowed the team to benefit from great support from key partners,” Gaviria said in an emailed response to Aidspan questions.
The split between regional behavior change and outreach activities and national-level service delivery was also a product of wide consultations with a variety of stakeholders including civil society groups, Gaviria said. It also reflects national and international priorities to coordinate with other regional initiatives on malaria funded by donors including The Bill and Melinda Gates Foundation, AusAID and DFiD.
While the ultimate goal is to contribute to the elimination of falciparum malaria in the Greater Mekong Sub region, and to prevent the emergence or spread of artemisinin resistance to new areas, incremental success for RAI will be assessed against the progress in: :
- Reduction of malaria falciparum cases per country and progress towards national malaria elimination targets (up to 50% in some countries)
- Ensuring high coverage with vector control and treatment interventions in designated areas and in particular among mobile/migrant populations
- Elimination of oral artemisinin-based monotherapies
RAI is one of three regional early applicants under the NFM. The other two are a malaria initiative in Mesoamerica and Hispaniola, EMMIE, that will strengthen malaria surveillance in Dominican Republic, Haiti, Panama, Costa Rica, Nicaragua, Guatemala, Belize and El Salvador; and a regional HIV harm reduction initiative stewarded by the Eurasian Harm Reduction Network in Eastern Europe and Central Asia.
A total of $116 million was initially envisioned under the transition phase for these three regional initiatives.