Friday, December 23, 2011

Malaria deaths are down but progress remains fragile


News release
13 December 2011 | Geneva - Malaria mortality rates have fallen by more than 25% globally since 2000, and by 33% in the WHO African Region, according to the World malaria report 2011, issued today by WHO. This is the result of a significant scaling-up of malaria prevention and control measures in the last decade, including the widespread use of bed nets, better diagnostics and a wider availability of effective medicines to treat malaria.
However, WHO warns that a projected shortfall in funding threatens the fragile gains and that the double challenge of emerging drug and insecticide resistance needs to be proactively addressed.

Malaria incidence and mortality rates fall

"We are making significant progress in battling a major public health problem. Coverage of at-risk populations with malaria prevention and control measures increased again in 2010, and resulted in a further decline in estimated malaria cases and deaths," says Dr Margaret Chan, WHO Director-General. "But there are worrisome signs that suggest progress might slow."
During the past decade, malaria incidence and mortality rates have been cut in all regions of the world, according to the report. In 2010, there were an estimated 216 million cases of malaria in 106 endemic countries and territories in the world. An estimated 81% percent of these cases and 91% of deaths occurred in the WHO African Region. Globally, 86% of the victims were children under 5 years of age.
There were an estimated 655 000 malaria deaths in 2010, which is 36 000 lower than the year before.1 While this 5% year-on-year decline represents significant progress, the mortality figures are still disconcertingly high for a disease that is entirely preventable and treatable.
"With malaria deaths in Africa having fallen significantly since 2000, the return on our investment to end malaria deaths has been greater than any I have experienced in the business world. But one child still dies every minute from malaria - and that is one child and one minute too many,” says Raymond G. Chambers, the UN Secretary General's Special Envoy for Malaria.
“The toll taken by the current economic crisis must not result in our gains being reversed, or progress slowed. With Secretary-General Ban Ki-moon’s charge for near zero deaths by end of 2015, turning back now is not an option,” Mr Chambers adds.

Steady progress in malaria control measures

Long-lasting insecticidal nets have been one of the least expensive and most effective weapons in the fight against malaria. According to the new report, the number of bed nets delivered to malaria-endemic countries in sub-Saharan Africa increased from 88.5 million in 2009 to 145 million in 2010. An estimated 50% of households in sub-Saharan Africa now have at least one bed net, and 96% of persons with access to a net use it.
There has also been further progress in rolling out diagnostic testing, which is crucially important to separate malaria from other febrile illnesses. The number of rapid diagnostic tests delivered by manufacturers climbed from 45 million in 2008 to 88 million in 2010, and the testing rate in the public sector in the WHO African Region rose from 20% in 2005 to 45% in 2010.
Worldwide, the volume of antimalarial medication delivered to the public sector has also increased. In 2010, 181 million courses of artemisinin-based combination therapies (ACTs) were procured, up from 158 million in 2009, and just 11 million in 2005. ACTs are recommended as the first-line treatment for malaria caused by the most deadly malaria parasite, Plasmodium falciparum.

Projected shortfall in funding

Despite significant progress in 2010, the projected shortfall in malaria funding threatens the hard-earned gains of the last decade.
International funds for malaria control reached US$ 1.7 billion in 2010 and US$ 2 billion in 2011, but remained significantly below the US$ 5-6 billion that would be needed annually to achieve global malaria targets. According to projections in the report, despite increased support from the United Kingdom, malaria funding will slightly decrease in 2012 and 2013, and will likely drop further to an annual US$ 1.5 billion by 2015.
Triggered primarily by the reduction in available funding within the Global Fund to Fight AIDS, Tuberculosis and Malaria, this decrease will considerably alter the malaria control landscape and threaten the sustainability of the multipronged approach to fight the disease, which relies heavily on investments in bed nets, indoor residual spraying, diagnostic testing, treatment, research and innovation.
"We need a fully-resourced Global Fund, new donors, and endemic countries to join forces and address the vast challenges that lie ahead. Millions of bed nets will need replacement in the coming years, and the goal of universal access to diagnostic testing and effective treatment must be realized," says Dr Robert Newman, Director of WHO's Global Malaria Programme. "We need to act with urgency and resolve to ensure that no-one dies from malaria for lack of a 5 dollar bed net, 1 dollar antimalarial drug and a 50 cent diagnostic test."

Emerging threats

Plasmodium falciparum resistance to artemisinins, which was confirmed on the Cambodia-Thailand border in 2009, has now also been identified at additional sites in Myanmar and Viet Nam. WHO has recommended that all countries ban the marketing of oral artemisinin-based monotherapies, which have been one of the major factors fostering the emergence and spread of resistance. Despite continued international pressure, 25 countries still allow the marketing of oral artemisinin-based monotherapies and 28 pharmaceutical companies continue to market these products (down from 39 in 2010).
The problem of mosquito resistance to insecticides also appears to be growing, although to date has not been linked to widespread failure of malaria vector control efforts. According to the World malaria report 2011, which includes data on insecticide resistance for the first time - 45 countries around the world have identified resistance to at least one of the four classes of insecticides used for malaria vector control; 27 of these are in sub-Saharan Africa. Resistance has been reported from all WHO Regions except the WHO European Region. India and malaria-endemic countries in sub-Saharan Africa are of greatest concern due to widespread reports of resistance - in some areas to all classes of insecticides - combined with a high malaria burden.
Current malaria control efforts are heavily reliant on a single class of insecticides, the pyrethroids, which are the most commonly used compounds for indoor residual spraying, and the only insecticide class recommended - and currently used - on long-lasting insecticidal nets. In response to this emerging threat, WHO is currently working with a broad group of stakeholders to develop a Global Plan for Insecticide Resistance Management in malaria vectors, which will be released in early 2012.

Notes to editors

The World malaria report 2011 is an annual publication from WHO. It summarizes information received from malaria-endemic countries and malaria control partners, and analyses prevention and control measures according to a comprehensive set of indicators. This year's report builds primarily on data received from countries for the year 2010. For the first time, the report contains individual profiles for 99 countries with ongoing malaria transmission.

For more information, please contact:

Zsofia Szilagyi
Mobile: +41 79 500 6538
Samantha Bolton
Mobile: +41 79 239 2366

1 The total number of estimated malaria deaths presented in World malaria report 2011 (655 000 deaths) is substantially lower than the number presented in the World malaria report 2010 (781 000 deaths). This is partly because of an actual decrease in the number of malaria deaths (36 000), and partly because of a downward revision of child mortality estimates for all causes and diseases - for the past decade - by the UN Inter-agency Group for Child Mortality Estimation. This revision reduced malaria mortality estimates in the WHO African Region by approximately 11%.

Tuesday, December 06, 2011

New farming technolgies putting money into onion farmers pockets

By Ochieng’ Ogodo
Journalist-Kenya
[NAIROBI] In his two-acre farm in West Kieni in Nyeri County, Central Kenya, Simon Nderitu stooped as he scrutinised his red bulb onions crop for the season.
“Before the project, I was farming because it was what everybody else did here to get food. But things have changed significantly for small-holder farmers who embraced a farming project led by Farm Concern International,” he said. 
Nderitu is among participants in an initial pilot project spearheaded by Farm Center International (FCI) started with 2,000 people in 2007 but has since been scaled up to include 10,000 farmers in Kieni site.
A combination of holistic extension and advisory approaches, it instills good agro-practices for higher quality production, treats agriculture as means to social integration, brings farmers and traders together in mutual business understanding, and ensures government agricultural officers deliver service at the point of need.
It fosters new technologies adoption and advises farmers on sound financial practices like savings. Ultimately, it aim at value addition from the farm to consumers.
Nderitu now knows how to prepare his land, secure affordable right seed varieties and plant based on seasonal projections and market demand. 
Yields trebled
The project has enabled him to more than treble his farm yields.  “Before 2008, I used to cultivate open pollinated varieties, which gave me on average 4,500 kilograms in a good season. But after adopting hybrid variety in 2008 and employing other good farming practices, the same piece of land yielded for me 7000 kg in my first harvest under the project,” said Nderitu.
An onion farm
Convinced by this huge gain, he dedicated two thirds of an acre to hybrid onion in 2009, and the yield shot up by 2000 kilograms. Today, the father of three is a proud owner of an eight-roomed decent timber house, dairy cattle and his children have been moved from public schools to a private academy for quality education.
Coming from a laid-back peasantry economy in a semi-arid area, he now knows how to space seeds when planting and what varieties will fetch good returns. “I have learnt how to identify the right fertilizer and the amount to apply, when to start weeding and how to cure the onions to prevent them from rotting after harvesting,” he added.
From the nursery to maturation, onions take on average 120 days and a kilo middles at KSh.30 to KSh.50 (US$ 0.318-0.531) compared to four years ago when same could fetch only KSh.5 (US$ 0.053) a kilo.
Nderitu, the chairman of Embaringo Commercial Village - a consortium of farmer groups within a given administrative village-said they have seen a revolution since 2008 with farmers moving from mainly subsistence production to commercial farming.
Socio-economic transformations
“Many children are now able to go to school, good houses are coming up and the young are turning to farming instead of migrating to urban centers for the ever elusive promise of employment,” he said.
The project directly links farmers to traders eliminating crafty middlemen that dominated sale and fleeced farmers. He said some middle men are resorting to onion farming after seeing the possibility of lucrative returns and others play the role of bulking during low production within the villages
Nderitu, the personification farming revolution in the project, said opportunities have been created. Shopping centers in the once poverty stricken sleepy village of Embaringo is a clear indication.
The Embaringo Commercial Village, he explained, coordinates production, sales, collective savings, looks into the welfare of farmers as well as negotiates for bulk farm inputs at a much lower cost compared to individual purchases.
Gerald Ngatia Watoro, Market and Trade Manager for Mount Kenya Region project that combines both Kieni West and East said the pilot has made a huge impact.
“The communities then had no organised mechanism in production and market development. We, therefore, decided to focus on hybrid red bulb onion having realised that it would not only lift many out of total penury but positively impact on development in this rural setting. On average production was low at, about 1500 kg per acre and the quality of the onions was poor,” he said.
FCI launched the project with the involvement of the Ministry of Agriculture Officials, the local Provincial Administration and the farmers. “We wanted an all-inclusive process built on a consensus rather than a top-down approach. We wanted the people to own the concept for it to work,” he said.
New technologies
A key component of the discussions was technologies that could be adapted. These included right seeds, proper agronomical practices and good post harvest technologies.
The project started with administrative villages made up of 150-200 households and created groups called commercial group, which formed an umbrella consortium called Commercial Villages
These are members who have agreed to work together to form an economic bloc with common leadership
Next were well-functioning community forums with various stakeholders including agro-input dealers, agricultural extension officers, onion seeds suppliers, traders and local administration. That has continued to date
Farmers were trained in the science of small-scale commercial farming like good land tilling methods, nursery management and transplanting, weeding, use of herbicide on proper spraying methods and programmes, especially more effective and less costly preventive spraying.
It also includes lessons on natural resource management and soil fertility: how to keep soils fertile through practices like crop rotation, water management through harvesting of path and roadside water run-offs into their gardens, digging of trenches to conserve water in farms and to check soil erosion.  They have been trained on record keeping, both at individual farm level and for the village groups.
Farmers have been taught how to build ventilated onion multi-storage facilities. Onions are placed on raised wire mesh inside the building and farmers are encouraged not to stack more than four bags on top of one another.
After that you create another floor of wire mesh above and repeat the same process creating up to four different compartments in one storage area. It must have wind side not left open to avoid rain water being carried into it when it is raining. Onions must be turned every two weeks whilst in storage.
Today, project participants realise on average 10,000 kilogram of onions per acre and this fetches up to US$ 3194. Farm inputs and overhead costs averages US$ US 532 leaving a farmer with a profit of US$ 2662 from an acre of hybrid onion.
 They plant seed verities like Red pinoy FI, Jamba FI, and Red star, marketed by different seed dealers.
Commercial Village concept
Even more interesting about the project is the Commercial Village concept. It is an association of groups within a village known as Commercial Producer groups with various sub-committees and functions as a business hub.
Each sub-committee votes its nominees to the executive levels of the umbrella organ, the commercial village. The overall body comprises the production and natural resource management; Finance, Micro-insurance and Investments, Marketing and Value addition, Village Social Capital and Youth integration committees within functional and strong governance structures.
According to Watoro, the FCI market development strategy directly links farmers to traders and thus eliminates middlemen influence in the value chain.
Before planting begins, the traders will have met with farmers and discussed future market projections.  This is done under the village business forums where farmers from across the villages visit the markets for direct interaction with traders and knowing first hand what the market needs.
Traders too visit villages and farmers now have a growing database of onion traders in Nairobi, Mombasa, Karatina and Kisumu accessed easily from cell phones.
Onion traders are also trained in cash flow management, business development plans, transportation, customer selection and formation of traders associations. “What we want is sustainability, which is only possible if all the components are working efficiently and making profits,” Watoro explained.
Kieni has largely been considered developmental backwater. But Watoro said banking institutions are moved in and marked increase in those holding accounts has been seen.
According Stanley Mwangi, FCI Strategy and Partnership Director, they have focused on giving farmers the right knowledge and changing the attitude of farmers to see farming as commercial venture. They seek to make farmers develop habits like making savings and linking them with research institutions. Their new frontier in extension services will be the ICT.
Extension services still a major challenge
Providing rural people with access to knowledge and information for increased productivity and sustainability to improve life quality and livelihoods is still a major challenge in Kenya
Farmers transplant onions in Kieni West-Nyeri
Those in less-favoured areas who depend on agriculture for their livelihoods have very poor access to agricultural services, including advice and training on new products and technologies due to poorly developed systems for access of local level service providers to new knowledge and products, the private sector’s inability to deliver services, poor resourced public extension services, weak infrastructure, and limited technical capacity among certain service providers like NGOs.
The Kieni project is an outpost of how efficient target oriented extension and advisory services on an area and groups can lead to tremendous rural development.


Ochieng' Ogodo is a Nairobi journalist whose works have been published in various parts of the world including Africa, the US and Europe. He is the English-speaking Africa and Middle East region winner for the 2008 Reuters-IUCN Media Awards for Excellence in Environmental Reporting. He is the chairman of Kenya Environment and Science Journalists Association (Kensja). He can be reached at ochiengogodo@yahoo.com or ogodo16@hotmail.com.

Thursday, December 01, 2011

Vaccine Targeting Latent TB Enters Clinical Testing


One-third of the World's People have Latent TB
COPENHAGEN, DENMARK/ROCKVILLE, MD, USA, December 1, 2011 – Statens Serum Institut and Aeras today announce the initiation of the first Phase I clinical trial of a new candidate TB vaccine designed to protect people latently infected with TB from developing active TB disease.  The trial is being conducted by the South African Tuberculosis Vaccine Initiative (SATVI) at its field site in Worcester, in the Western Cape province of South Africa. Dr. Hassan Mahomed is the principal investigator.

“Two billion men, women and children live with latent TB infection,” said Jim Connolly, President and Chief Executive Officer of Aeras. “It’s daunting to comprehend that there is a vast reservoir of people with a 5-10% lifetime risk of becoming sick with TB. A vaccine that prevents TB disease in this population could save millions of lives, and this trial is a first step in assessing a vaccine candidate designed for this purpose.”

The candidate TB vaccine (SSI H56-IC31) is a subunit vaccine containing recombinant TB proteins formulated in a proprietary adjuvant IC31® from Intercell. It is being developed under a consortium of researchers led by Peter Andersen at the Statens Serum Institut (SSI) based in Copenhagen.  The consortium is supported as part of the Grand Challenges in Global Health, an initiative that fosters scientific breakthroughs needed to prevent, treat and cure diseases of the developing world. 

“The development of urgently needed new TB vaccines requires a global effort,” said Prof. Peter Andersen, the Vice President of Vaccine Research & Development at SSI. “The advancement of this candidate from an idea to the clinic working in collaboration first with the Grand Challenges consortium and now with Aeras and SATVI is an important and exciting milestone for all the researchers involved.”

This clinical trial will be the first to test this vaccine candidate in people.  It will assess the safety and immunogenicity of SSI H56-IC31 in 25 adults, including participants with and without latent TB infection. SSI H56-IC31 has been tested in several pre-clinical studies with no safety concerns and has shown efficacy in small animal models administered both before infection and to latently infected animals. The vaccine was also shown to control clinical disease and reactivation in a non-human primate model. This is the first time a South African research institute has led a first-in-human Phase I clinical trial of a new TB vaccine.

“SATVI is delighted to be part of the trial at this early stage, which is testament to the high-regard that the developers have for our TB vaccine clinical research expertise to conduct these crucial early trials in humans,” said SATVI Director, Professor Willem Hanekom.

SSI H56-IC31 is being developed for both adolescent and adult populations.  The trial has been approved by the Medicines Control Council of South Africa. Preliminary results of this trial are expected at the end of 2012.

###
About Statens Serum Institut (SSI)
SSI (www.ssi.dk) is a state owned enterprise under the Danish Ministry of Health and Prevention. The Institute is integrated in the national Danish health services. SSI´s mission is to prevent and control infectious diseases, biological threats, and congenital disorders. The institute strives to be a highly-regarded and internationally recognized research, production and service enterprise.

About Aeras
Aeras (www.aeras.org) is a non-profit product development organization dedicated to the development of effective vaccines and biologics to prevent TB across all age groups in an affordable and sustainable manner. Aeras has invented or supported the development of six TB vaccine candidates, which are undergoing Phase I and Phase II clinical testing in Africa, Asia, North America and Europe. Aeras receives funding from the Bill & Melinda Gates Foundation, other private foundations, and governments. Aeras is based in Rockville, Maryland, USA where it operates a state-of-the-art manufacturing and laboratory facility, and Cape Town, South Africa. 
 COPENHAGEN, DENMARK/ROCKVILLE, MD, USA, December 1, 2011 – Statens
Serum Institut and Aeras today announce the initiation of the first Phase I clinical trial of
a new candidate TB vaccine designed to protect people latently infected with TB from
developing active TB disease. The trial is being conducted by the South African
Tuberculosis Vaccine Initiative (SATVI) at its field site in Worcester, in the Western
Cape province of South Africa. Dr. Hassan Mahomed is the principal investigator.
“Two billion men, women and children live with latent TB infection,” said Jim Connolly,
President and Chief Executive Officer of Aeras. “It’s daunting to comprehend that there
is a vast reservoir of people with a 5-10% lifetime risk of becoming sick with TB. A
vaccine that prevents TB disease in this population could save millions of lives, and this
trial is a first step in assessing a vaccine candidate designed for this purpose.”
The candidate TB vaccine (SSI H56-IC31) is a subunit vaccine containing recombinant
TB proteins formulated in a proprietary adjuvant IC31® from Intercell. It is being
developed under a consortium of researchers led by Peter Andersen at the Statens Serum
Institut (SSI) based in Copenhagen. The consortium is supported as part of the Grand
Challenges in Global Health, an initiative that fosters scientific breakthroughs needed to
prevent, treat and cure diseases of the developing world.
“The development of urgently needed new TB vaccines requires a global effort,” said
Prof. Peter Andersen, the Vice President of Vaccine Research & Development at SSI.
“The advancement of this candidate from an idea to the clinic working in collaboration
first with the Grand Challenges consortium and now with Aeras and SATVI is an
important and exciting milestone for all the researchers involved.”
This clinical trial will be the first to test this vaccine candidate in people. It will assess
the safety and immunogenicity of SSI H56-IC31 in 25 adults, including participants with
and without latent TB infection. SSI H56-IC31 has been tested in several pre-clinical
studies with no safety concerns and has shown efficacy in small animal models
administered both before infection and to latently infected animals. The vaccine was also
shown to control clinical disease and reactivation in a non-human primate model. This is
the first time a South African research institute has led a first-in-human Phase I clinical
trial of a new TB vaccine.
“SATVI is delighted to be part of the trial at this early stage, which is testament to
the high-regard that the developers have for our TB vaccine clinical research expertise to
conduct these crucial early trials in humans,” said SATVI Director, Professor Willem
Hanekom.
SSI H56-IC31 is being developed for both adolescent and adult populations. The trial
has been approved by the Medicines Control Council of South Africa. Preliminary results
of this trial are expected at the end of 2012.
#
About Statens Serum Institut (SSI)
SSI (www.ssi.dk) is a state owned enterprise under the Danish Ministry of Health and
Prevention. The Institute is integrated in the national Danish health services. SSI´s
mission is to prevent and control infectious diseases, biological threats, and congenital
disorders. The institute strives to be a highly-regarded and internationally recognized
research, production and service enterprise.
About Aeras
Aeras (www.aeras.org) is a non-profit product development organization dedicated to the
development of effective vaccines and biologics to prevent TB across all age groups in an
affordable and sustainable manner. Aeras has invented or supported the development of
six TB vaccine candidates, which are undergoing Phase I and Phase II clinical testing in
Africa, Asia, North America and Europe. Aeras receives funding from the Bill & Melinda
Gates Foundation, other private foundations, and governments. Aeras is based in
Rockville, Maryland, USA where it operates a state-of-the-art manufacturing and
laboratory facility, and Cape Town, South Africa.


Related Stories