The Schistosomiasis

Control Initiative Summary for 2012/13

and strategic direction for 2014/20

Professor Alan Fenwick OBE

a.fenwick@imperial.ac.uk

What is involved What is involved to upscale to country level we need to:to upscale to country level we need to:

– Mobilise political willMobilise political will– Define disease distribution – collect Define disease distribution – collect

mapping and base line datamapping and base line data– Develop a national plan with strategies Develop a national plan with strategies

at each district levelat each district level– Define drug needs and order drugsDefine drug needs and order drugs– Develop local advocacy toolsDevelop local advocacy tools– Conduct training for teachersConduct training for teachers– Deliver the drugsDeliver the drugs– Monitoring and evaluationMonitoring and evaluation

Treating school children is easy

And adults at high risk are offered treatment

Phase One SCI started with funding from Bill and Phase One SCI started with funding from Bill and Melinda Gates FoundationMelinda Gates FoundationMinistries of Health and Education in 6 countries with SCI support Ministries of Health and Education in 6 countries with SCI support delivered over 43 million cumulative Schistosomiasis treatments delivered over 43 million cumulative Schistosomiasis treatments and over 100 million albendazole (purchased)and over 100 million albendazole (purchased)

0.13 m

12 m

26 m

43 m

0

5

10

15

20

25

30

35

40

45

50

2002/3 2003/4 2004/5 2005/6 2006/7

SCI Treatment Years

Nu

mb

er

of

Tre

atm

en

ts (

million

s)

2002/32003/42004/52005/62006/7

Phase Two - Ministries of Health and Education Phase Two - Ministries of Health and Education with SCI support and USAID fundingwith SCI support and USAID funding

Treatments delivered 2007-2010 shown below

6 m

3 m

>40 m >40 m >40 m

0

5

10

15

20

25

30

35

40

45

50

Rwanda/Burundi

Yemen Burkina Faso

Niger Uganda

SCI supported countries

Nu

mb

er

of

Tre

atm

en

ts (

million

s)

4 drugs 4 drugs 4 drugs (RTI)

Pzq and albPzq and alb

Phase Three – expansion - Ministries of Health Phase Three – expansion - Ministries of Health and Education with SCI support and DFID and Education with SCI support and DFID funding +++funding +++

Treatments delivered in 2012/13

1m/6m 10 m

2 m

8 m1 m

0

5

10

15

20

25

30

35

40

45

50

Rwanda/Burundi

Yemen Tanzania Malawi Cote D’Ivoire

SCI supported countries

Nu

mb

er

of

Tre

atm

en

ts (

million

s)

Pzq/alb

75 million treatments to 8 countries planned for 2011 – 2016 funded by DFIDCould be doubled with a new award

UgandaNiger

1 m3 m

Mozambique

8 m

Phase Four 2013-2020Phase Four 2013-2020

Consolidate in existing countriesConsolidate in existing countries– DFID – reach national coverage in all 8 DFID – reach national coverage in all 8

countriescountries– DFID – move towards elimination in Zanzibar, DFID – move towards elimination in Zanzibar,

Uganda and NigerUganda and Niger– DFID expand into Ethiopia and DRCDFID expand into Ethiopia and DRC– Move towards elimination in Rwanda and Move towards elimination in Rwanda and

Burundi (SCORE and ENDFUND and Private)Burundi (SCORE and ENDFUND and Private)– Expansion of coverage in YemenExpansion of coverage in Yemen– Use donations to move into new countries Use donations to move into new countries

(Mauritania, Madagascar, Zimbabwe, Senegal)(Mauritania, Madagascar, Zimbabwe, Senegal)

Phase Four 2013-2020Phase Four 2013-2020

A More holistic approachA More holistic approach

– Maintain and increase income (more Maintain and increase income (more proposals, maintaining status with proposals, maintaining status with givewell and GWWC)givewell and GWWC)

– Strengthen staff (management, new Strengthen staff (management, new disciplines, more local staff Ethiopia, DRC)disciplines, more local staff Ethiopia, DRC)

– Water and sanitation – what shall we do ?Water and sanitation – what shall we do ?– Behaviour change – is this feasibleBehaviour change – is this feasible– Snail control – when and whereSnail control – when and where

Phase Four 2013-2020Phase Four 2013-2020

Operational researchOperational research

– Monitor drug efficacyMonitor drug efficacy– Improving coverageImproving coverage– Gaining and maintaining controlGaining and maintaining control– Possibility of eliminationPossibility of elimination– Water and sanitationWater and sanitation– Snail controlSnail control– CysticercosisCysticercosis

DirectorManaging Director

Finance Manager

ICOSA Project ManagerICOSA M and E

Programme Manager(Rwanda, Burundi, Senegal)

Director of Monitoring and

Evaluation

Senior Biostatistician

Health Economist

Mathematical Modeller

Finance Officer

Office Manager

Programme Manager (Yemen and Ethiopia)

Africa Capacity Building Liaison

Africa country coordinators

Long and Short Term Technical Assistants

Liverpool CNTD Sub-Contract

3 Programme Managers

DFID (8 Countries)

RESEARCH UNITIMPLEMENTATION UNIT

FINANCE AND ADMINISTRATION

UNIT

Programme Manager UGA (Niger, Mozambique)

PR and fund raising

SCI ORGANOGRAM

NigerMali

Burkina Faso

Uganda

Tanzania

Zambia

SCI coverage 2003 - 2016

Burundi and Rwanda

With support from the Gates FoundationUSAID/NTD, Geneva Global and DFID, UK

And YemenWith World Bank funds

Malawi andMozambique

Cote D’Ivoireand Liberia

Proposed expansion into DRC, Ethiopia

Senegal. Mauritania and

Zimbabwe

Senegal

Zim

DRC

Ethiopia

Mauritania

With the new WHA With the new WHA resolution calling for global resolution calling for global schistosomiasis schistosomiasis elimination: what is the elimination: what is the WHO strategy, the WHO strategy, the feasibility and what are the feasibility and what are the major challenges?major challenges?How does this affect SCI ?How does this affect SCI ?

Proportion of PC for schistosomiasis, soil-transmitted helminthiases, lymphatic filariasis, onchocerciasis and trachoma, 2011

Population requiring preventive chemotherapy

Pro

port

ion

, %

Schistosomiasis Soil-transmitted helminthiases

Lymphaticfilariasis

Onchocerciasis

~ 243 million ~ 873 million ~ 1 410 million ~ 127 million

13

.3

31

.1

41

.8

77

.1

Trachoma

~ 281 million

13

.7

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

National Programmes

GSKEisai J&J

ALBDECMBD

Joint Virtual Review Panel

MerckKGaA

PZQ

SHIPMENT

Joint Request + Joint Report

+ Annual work plan

ORDER

IVM AZI

MDP ITIApplications

Shipments

WHO

Joint drug request, review & reporting mechanismBut with pzq there are other sources DFID and USAID

Regional review groups

Merck KGaA's expanded commitment of praziquantel supply for unlimited period

Likely future praziquantel Likely future praziquantel availabilityavailability

(millions of tablets)(millions of tablets)

2013 2014 2015 2016

USAIDAnnual

commitment 100+ 100+ 100+ 100+

DFID Confirmed 47 47 47 47

DFID Not yet

confirmed 23 23 23 23

Other NGO’s 10 10 10 10

Merck Incremental 25 75 120 250

Total 205+ 255+ 300+ 430+

Treatments 80 million 100 million 120 million 170 million

The US GovernmentThe US Government

Launched in 2006 by USAID Launched in 2006 by USAID

The Neglected Tropical Diseases Cooperative Agreement - Initially $100 The Neglected Tropical Diseases Cooperative Agreement - Initially $100 million, million, and in 2010 a new commitment of $450 million $250 m to “ENVISION”and in 2010 a new commitment of $450 million $250 m to “ENVISION”

The British GovernmentThe British Government

£50 million over 5 years for NTD control announced in 2008

A new £200 million 4 year commitment in January 2012

Other donors to/through SCIOther donors to/through SCI

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

How much can we reach out to the countries with How much can we reach out to the countries with maximum requirements -maximum requirements - the 10 highly endemic AFR the 10 highly endemic AFR countries, 2010countries, 2010

10 Countries Estimated Infected

population, 2010

Population received

treatment, 2010

2013 status

Nigeria 36,728,013 2,297,282 Carter C, CIFF, DFID and USAID

United Republic of Tanzania 23,189,294 1,298,263 USAID, CNTD and SCI

Democratic Republic of the Congo

19,157,807 - Starting 2013/14

Ghana 17,644,805 1,739,837 Ongoing USAID/ CNTD

Mozambique 16,326,177 488,359 Expanding 2012/13

Madagascar 11,087,896 - SCI in 2013/14

Kenya 9,396,937 - Ongoing CIFF

Côte d'Ivoire 8,628,298 657,967 Expanding SCI

Malawi 6,725,050 938,999 Expanding SCI/ CNTD

Ethiopia 6,026,639 - Starting 2013

10 Countries 154,910,915 7,420,707

GLOBAL 243,598,854 33,642,598

Proportion of global 63.6% 22.1%

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

<5%

Prevalence of heavy intensity infection

<1%

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

WHO Strategic Plan Milestones

20122013

• 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 M&E available

• A resolution on SCH elimination is adopted

WHO Strategic Plan Milestones 201320142015

• 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

Challenge Strategy Questions Lack of political commitment/WHO

USAID and DFIDRTI/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

The importance of advocacy The importance of advocacy

The UK Coalition against Neglected Tropical Diseases (NTDs)

is acollaborative partnership between UK

organisations actively engaged inthe implementation, capacity building

and research of neglected tropicaldisease control at scale

London Centre for NTD London Centre for NTD ResearchResearch

Launched on January 30Launched on January 30thth 2013 2013 (Sir Roy Anderson)(Sir Roy Anderson)

Partners includePartners include

PCDPCD

SCISCI

London School of Hygiene and Tropical London School of Hygiene and Tropical MedicineMedicine

Natural History MuseumNatural History Museum

Where we are nowWhere we can get with

existing tools and strategies 2020Goals

Diseases Targeted For Elimination

Diseases Targeted For Control

Schistosomiasis

River blindness

Soil-Transmitted Helminthes

VisceralLeishmaniasis

Chagas

Guinea worm

Leprosy

Lymphatic filariasis

Blinding trachoma

Sleeping sickness

Where we can get with new tools and strategies