Reductions in malaria cases have stalled after several years of decline globally, according to the new World malaria report 2018.
To get the reduction in malaria deaths and disease back on track, World Health Organisation, WHO and partners are joining a new country-led response, launched today, to scale up prevention and treatment, and increased investment, to protect vulnerable people from the deadly disease.
For the second consecutive year, the annual report produced by WHO reveals a plateauing in numbers of people affected by malaria: in 2017, there were an estimated 219 million cases of malaria, compared to 217 million the year before. But in the years prior, the number of people contracting malaria globally had been steadily falling, from 239 million in 2010 to 214 million in 2015.
“Nobody should die from malaria. But the world faces a new reality: as progress stagnates, we are at risk of squandering years of toil, investment and success in reducing the number of people suffering from the disease,” says Dr Tedros Adhanom Ghebreyesus, WHO Director-General.
“We recognise we have to do something different – now. So today we are launching a country-focused and -led plan to take comprehensive action against malaria by making our work more effective where it counts most – at local level.”
In 2017, approximately 70% of all malaria cases (151 million) and deaths (274 000) were concentrated in 11 countries: 10 in Africa (Burkina Faso, Cameroon, Democratic Republic of the Congo, Ghana, Mali, Mozambique, Niger, Nigeria, Uganda and United Republic of Tanzania) and India. There were 3.5 million more malaria cases reported in these 10 African countries in 2017 compared to the previous year, while India, however, showed progress in reducing its disease burden.
Despite marginal increases in recent years in the distribution and use of insecticide-treated bed nets in sub-Saharan Africa – the primary tool for preventing malaria – the report highlights major coverage gaps. In 2017, an estimated half of at-risk people in Africa did not sleep under a treated net. Also, fewer homes are being protected by indoor residual spraying than before, and access to preventive therapies that protect pregnant women and children from malaria remains too low.
In line with WHO’s strategic vision to scale up activities to protect people’s health, the new country-driven “High burden to high impact” response plan has been launched to support nations with most malaria cases and deaths. The response follows a call made by Dr Tedros at the World Health Assembly in May 2018 for an aggressive new approach to jump-start progress against malaria. It is based on four pillars:
Catalyzed by WHO and the RBM Partnership to End Malaria, “High burden to high impact” builds on the principle that no one should die from a disease that can be easily prevented and diagnosed, and that is entirely curable with available treatments.
“There is no standing still with malaria. The latest World malaria report shows that further progress is not inevitable and that business as usual is no longer an option,” said Dr Kesete Admasu, CEO of the RBM Partnership. “The new country-led response will jumpstart aggressive new malaria control efforts in the highest burden countries and will be crucial to get back on track with fighting one of the most pressing health challenges we face.”
Targets set by the WHO Global technical strategy for malaria 2016–2030 to reduce malaria case incidence and death rates by at least 40% by 2020 are not on track to being met.
The report highlights some positive progress. The number of countries nearing elimination continues to grow (46 in 2017 compared to 37 in 2010). Meanwhile in China and El Salvador, where malaria had long been endemic, no local transmission of malaria was reported in 2017, proof that intensive, country-led control efforts can succeed in reducing the risk people face from the disease.
In 2018, WHO certified Paraguay as malaria free, the first country in the Americas to receive this status in 45 years. Three other countries – Algeria, Argentina and Uzbekistan – have requested official malaria-free certification from WHO.
India – a country that represents 4% of the global malaria burden – recorded a 24% reduction in cases in 2017 compared to 2016. Also in Rwanda, 436 000 fewer cases were recorded in 2017 compared to 2016. Ethiopia and Pakistan both reported marked decreases of more than
240 000 in the same period.
“When countries prioritize action on malaria, we see the results in lives saved and cases reduced,” says Dr Matshidiso Moeti, WHO Regional Director for Africa. “WHO and global malaria control partners will continue striving to help governments, especially those with the highest burden, scale up the response to malaria.”
As reductions in malaria cases and deaths slow, funding for the global response has also shown a levelling off, with US$ 3.1 billion made available for control and elimination programmes in 2017 including US$ 900 million (28%) from governments of malaria endemic countries. The United States of America remains the largest single international donor, contributing US$ 1.2 billion (39%) in 2017.
To meet the 2030 targets of the global malaria strategy, malaria investments should reach at least US$6.6 billion annually by 2020 – more than double the amount available today.
Botswana retailer Choppies is expanding to Ongata Rongai, taking over the space previously occupied by Uchumi Supermarkets.
Choppies will be joining Tuskys, Tumaini and Cleanshelf in the race to capture the populous Rongai as part of its Kenya expansion plan.
In its second half for 2017 results, the retailer indicated that it would invest Sh237 million ($2.27 million) on new Kenyan stores.
Uchumi’s branch in the town was shut down following a Sh21 million ($207,990) default on rent.
Choppies also opened a new store in at South Field Mall in Embakasi, Nairobi and plans another in Kiambu Mall, on the outskirts of the capital city, taking up space that was previously meant for Nakumatt.
The retailer has also put up ‘coming soon’ signs in Nanyuki as it eyes the space that hosted Nakumatt, before the latter was evicted from Cedar Mall.
Choppies’ move to replace Uchumi replicates similar actions by Naivas, Carrefour and Tuskys who have stepped in to occupy spaces from which the financially-strapped retail chains Nakumatt and Uchumi have been kicked out.
The spirited entry into Kenya by multinational chain stores is stiffening competition, pitting new players against the local family-owned retailers.
The South Africa and Botswana-Choppies in March last year said it would spend $2.5 million (about Sh250 million) in refurbishing the eight branches of Ukwala Supermarkets, which it took over in December 2016.
It currently has 12 stores in Kenya.
One time leader Nakumatt, now in administration, and cash-strapped Uchumi, have shut several of their branches in Nairobi while Tusky’s, with 63 stores, recently shut its Sheikh Karume branch in Nairobi.
Naivas has 45 outlets.
Choppies managed to enter the Kenyan market through acquisition of Ukwala Supermarkets in 2016 after a Sh946 million ($9.4m) claim by the Kenya Revenue Authority (KRA) had earlier halted the deal.
Credit: Nation Media Group
For 10,000 years, the bacterium Mycoplasma mycoides has infected goats, cows and other livestock, annihilating entire herds in days.
In sub-Saharan Africa, the disease, contagious bovine pleuropneumonia CBPP or “lung plague,” is still difficult to control. It causes more than US$60 million in annual losses to cattle owners and affects the livelihoods of 24 million cattle producers.
Although infected animals can be treated with antibiotics, they can be hard to come by. They often come from illegal sources and are of poor quality, resulting in ineffective treatments and antibiotic resistance.
The quickest and most effective way to control lung plague is to cull the infected animals. But there is another way: vaccination.
Working with researchers in Kenya, we have developed a new vaccine to help fight the spread of Mycoplasma mycoides mycoides (Mmm), an especially lethal subspecies of the bacterium that causes disease in cattle.
Lung plague was eradicated in North America in the 1890s after an eight-year campaign of quarantine, slaughter and disinfection.
Botswana successfully adopted this approach, but it will not work for other sub-Saharan countries because of the high costs of replacing cattle that are not insured.
To date, there is only one vaccine on the market to control lung plague. It is an attenuated vaccine, which means it is created from a live version of Mmm that has been altered so that it becomes harmless. The live-attenuated Mmm vaccine is injected into the tail of cattle and, after a few weeks, the animal begins to produce antibodies against the bacteria.
Although this vaccine works well, it does have drawbacks. It deteriorates quickly unless it is kept on ice — a problem in Africa where temperatures often run high — and, in some cases, vaccinated animals develop inflammation and ulcers where the vaccine is injected or even lose their tails due to extreme immune reactions.
Looking for a better solution, our team applied for and received funding from the International Development Research Centre and Global Affairs Canada through the Canadian International Food Security Research Fund to develop a new vaccine for lung plague.
Vaccines are made up of two parts: an antigen, a substance capable of inducing an immune response, and an adjuvant, a compound that improves the efficacy of the vaccine.
The new lung plague vaccine uses protein antigens from a variety of strains of Mmm found in Kenya which makes the new vaccine safer, easy to manufacture and stable at room temperature.
Our team identified these protein antigens using “reverse vaccinology.”
Reverse vaccinology uses computer programs to analyze the DNA of the bacteria and point out possible antigens, the ones most likely to cause the cattle to produce an immune response. The selected proteins are then manufactured, purified, mixed with the adjuvant and tested.
Increasingly, reverse vaccinology is being used to develop vaccines for diseases when traditional vaccine development has failed. This approach has been used for a human Meningococcal vaccine now on the market.
Out of the 66 Mmm proteins we identified, four protected cattle against lung plague. We used them to create a new vaccine that has demonstrated significant potential to be more stable and offer better protection than the current live-attenuated vaccine.
This new vaccine, which is cheaper to produce and more stable at room temperature, may solve many of the challenges faced with the current vaccine and may also protect against multiple bacterial strains. It has been licensed for production by a vaccine manufacturer in Kenya and is currently under production for testing in field trials using large numbers of cattle.
The reverse vaccinology approach could work to develop vaccines for other important livestock diseases, including Johne’s disease and bovine tuberculosis, as well as infections with Histophilus somni, Escherichia coli and Mycoplasma bovis (chronic pneumonia and polyarthritis syndrome).
CBPP has had negative impacts on livestock production in Africa, drastically reducing the contribution of the livestock industry to Africa’s gross domestic product.
This project, which benefits from a partnership between Kenya and Canada, used advanced vaccine development technologies to achieve the ultimate deliverable — a novel vaccine that has the potential to improve food security and mitigate millions of dollars in livestock losses.
This Mmm vaccine was developed in collaboration with Hezron Wesonga of the Kenya Agriculture Livestock Research Organisation (KALRO), Jane Wachira of the Kenya Veterinary Vaccine Production Institute (KEVEPAVI), Jan Naessens of the International Livestock Research Institute (ILRI), Andrew A. Potter, Volker Gerdts and Emil Berberov of the Vaccine and Infectious Disease Organization – International Vaccine Centre (VIDO-InterVac) at the University of Saskatchewan.
Kenyan President Uhuru Kenyatta’s meeting with his US counterpart Donald Trump at the White House carries symbolic as well as real value.
The two leaders have met once before – on the sidelines of the 2017 G7 meeting in Italy. But this is the first official visit to the White House since Trump’s election and since Kenyatta’s highly controversial 2017 re-election.
So why the visit, and why now?
The White House has cast it as an opportunity to deepen the strategic relationship between the two countries, and to advance mutual interests in trade, security and regional leadership by way of reaffirming
Kenya’s position as a corner stone of peace and stability in Africa.
For Kenyatta, it’s an opportunity to reset Kenya’s position as a leading regional actor and Africa’s “ambassador”.
From a strategic perspective, Kenya has been a crucial player in the war on terror given its frontier status with Somalia. It has been a central player in the UN African Union Mission to Somalia force that’s seeking defeat the Al-Shabaab terror group.
Kenya has suffered retaliatory action as a result of its role. Twenty years ago it was one of the first countries in Africa to bear the brunt of Al-Qaeda with a lethal terror attack in Nairobi. This placed Kenya firmly in the position of a strategic player, ensuring the success of the war on terror in East and Central Africa for which the US has strategic interests.
So Kenyatta’s visit will seek to consolidate continuing US military support. This will be through various channels, among them the counter terrorism partnership fund and the combating terrorism fellowship programme. He will also want a commitment to the US’s continued military at Manda Bay and Camp Simba, a Kenya naval base for anti-terrorism operations.
Kenyatta has recently played a lead role as regional broker by hosting a number of peace initiatives in the South Sudan peace process. Despite US reservations, the most recent peace accord appears to be holding, with Kenya taking some credit for the tentative success.
The US will seek to ensure that Kenya continues to play a constructive leadership role and a guarantor of the peace process in South Sudan given its tremendous leverage on that country’s leadership.
Other pressing issues will include trade and foreign direct investment. Here Kenyatta will have to tread carefully given Kenya’s increasingly close ties with China.
And Kenyatta will have his work cut out trying to navigate Trump’s world. How he manages to gain meaningful compromise from an unpredictable and beleaguered host will be keenly watched both at home and far beyond.
Banking on trade
In many ways US-Kenya relations is in uncharted territory. And given Trump’s penchant for bilateralism, Kenyatta will hope to master the art of the deal by minimising the negative impact of “America first” agenda on Kenya-US trade relations.
During Barack Obama’s presidency, imports from Kenya more than doubled . In 2015, 12.3% of US AFRICA FDI went to Kenya. But Trump’s “America first” stance has led to a review of Africa partnerships as well as a renegotiation of bilateral trade agreements.
Amid this policy uncertainty, Kenyatta will want to discuss how to boost trade relations to augment Kenya’s domestic economy given the very broad economic agenda he has set himself to transform the country. Kenya’s economy had suffered from electoral volatility and a slowdown in foreign direct investment, particularly from the US. Kenyatta will be keen to explore how to jump start this with his US counterpart in addition to ensuring the continued robustness of the African Growth and Opportunity Act (AGOA) from which Kenya has greatly benefited.
The Kenyan president can point to the fact that it remains a destination of choice for many US corporations that have established themselves in the domestic economy. These include Coca-Cola, General Electric, Google and IBM.
In addition, China has firmly developed a substantial economic and trade strategic relationship with Kenya – from manufacturing to infrastructure development. This hasn’t gone unnoticed by the US. The wide gauge railway project, among many others, has established Beijing as an indispensable developmental partner.
To reflect this importance, one of Kenyatta’s first foreign trips was to Beijing.
This growing closeness has caused concern in Washington. The US is keen to retain its traditional sphere of influence and is often wary of other players, particularly China, chipping away at it.
With the increasing trade war with China, the US will seek reassurance that its interests in the region will not be compromised by Beijing’s increasing aggressive overtures in Kenya as well as in the region more broadly.