This is the first in a series of interviews with the Senior Disease Coordinators at the Global Fund to Fight AIDS, Tuberculosis and Malaria. In this Q&A, Friends spoke with Dr. Scott Filler, the Senior Disease Coordinator specializing in malaria, about the opportunities to fight malaria covered in our report, “At the Tipping Point: U.S. Leadership to End AIDS, Tuberculosis and Malaria”.
Thank you for joining us Dr. Filler. We are now seeing countries fall into two categories, those making progress towards malaria elimination and those suffering setbacks in their disease response. Looking at these groups, what do you think has been a primary factor in determining which category they fall in?
For those countries where we have seen the most success in the fight against malaria, political leadership and commitment is clearly very important. Political leadership is important because it can drive domestic investments in a country’s malaria response. Additionally, political leadership is also important in aspects such as acknowledging the rise of insecticide resistance in a country and ensuring that a country takes the necessary steps to prevent backsliding on the progress that has been achieved.
For those countries that are experiencing setbacks, financing is critical. In many of these countries, financing for their malaria response has plateaued. This means that as populations in these countries grow, the per capita investments in malaria programs have actually decreased over time.
The Global Fund has several regional grants to help in the fight against malaria. Can you explain the importance of a regional approach, and why the Global Fund has regional grants in addition to its specific country allocations?
Regional coordination and collaboration can be very important in achieving malaria elimination. One example at the Global Fund is the MOSASWA Cross-Border Initiative in Mozambique, South Africa and Swaziland (now called eSwatini). While the other two countries are on the road towards elimination, Mozambique still has a higher disease burden. The challenge though is that Mozambique’s highest burden is in the north of the country, but malaria transmission in southern Mozambique is a factor preventing malaria elimination in South Africa and Swaziland. So a Global Fund regional grant, like MOSASWA, allows Mozambique to focus its country response on its highest burden areas in the north while still working to achieve malaria elimination in South Africa, Swaziland and the southernmost province in Mozambique.
Insecticide resistance is a major challenge to ending malaria, and as a result, we have seen the rise of next-generation nets that use new classes of insecticide. What is the Global Fund doing to help ensure that we have the new tools needed to combat insecticide resistance?
At the Global Fund, working with PMI (the President’s Malaria Initiative), one of the things we want to ensure is that there is no gap between creating a policy and implementing that policy. Right now, these [next generation] nets have not yet been officially recommended by the WHO so we want to ensure that there is no delay between these nets receiving a policy recommendation and beginning to distribute them in countries. Therefore, first the Global Fund is using its catalytic funding to help build the evidence for these next-generation nets to receive a WHO policy recommendation. At the same time, we are also using this catalytic funding to help next generation nets enter the marketplace by signaling to manufacturers that the Global Fund wants to stimulate these types of innovation as a way to help keep prices down.
For more on opportunities for the U.S. and partners to work toward ending the epidemics of AIDS, TB and malaria, see Friends’ Tipping Point report.