MARCEL TANNER: My name is Marcel Tanner.
I'm from the Swiss Tropical and Public Health institute in Basel, Switzerland,
and I'm also Professor of Epidemiology, Medical Parasitology,
and Public Health at the University of Basel,
as well as President of the Swiss Academy of Sciences.
Today we would like to talk a little bit about how we reach elimination
of malaria by looking on what information we have to collect
and how we have to use this information swiftly in order to cut transmission,
means eliminate malaria in the different parts of the world.
Therefore, our learning objectives are to start with how we are monitoring
and evaluate our malaria control and elimination programs,
but how we also do, more specifically, out of this classic remedy
malaria surveillance.
We would like to explain a little bit on the different strategies of malaria monitoring
and evaluation and how we reach out of these concepts really
to surveillance-response approaches.
And we then understand how the surveillance-response approaches are
not only theoretically propagated, but really put
into a specific endemic setting in order to serve
our programs of malaria elimination.
And how, at the end, these parts of surveillance and response
are part of the overall public health response in our malaria elimination
and, finally, eradication programs.
We will have the strategies for surveillance-elimination
in different settings that we look at, and then we
have an in-depth look on the data collection
and on how we make decisions out of this data that we collect,
and how we actually move from collecting data, monitoring and evaluation,
to it's surveillance-responsive approaches.
As well as we will look at specific case studies
that have used this approach successfully
to reach malaria elimination.
And of course, the final aim is to understand
that with these surveillance-response approaches,
we not only achieve elimination, but also
we really tackle the problem when it is worse
and where we actually look for the best equitable approaches in reaching
elimination.
The first part will be really to look at strategies for surveillance systems
in different elimination settings.
The basis of this is that we have in our population
in any malaria endemic area three types of populations.
We have the not infected asymptomatic people.
We have the infected asymptomatic people.
And we have infected symptomatic people.
And for each of the three population groups we have to do the same thing.
We have actually to see that the not infected asymptomatics do not
get infected.
We have to see that the infected asymptomatic cannot continue
to transmit.
So that means we treat them so that the reservoir of the infection
is eliminated.
And we have the infected symptomatic people,
where the goal is that, first of all, they are not getting sick
or if they are sick they actually are cured,
and we also prevent that they further transmit to the mosquitoes.
And if we do this to all the three population groups,
then we can achieve the interruption of transmission.
And that's the aim.
Elimination means interruption of transmission.
It does not just mean reducing of morbidity.
And in order to reach eradication, you must actually
bring three building blocks together.
First of all, you have to detect all the people who
have parasites-- the reservoir.
Secondly, you have to cure the people, so you have to eliminate the reservoir.
And of course, you have to prevent that any parasites are taken up
by the mosquitoes.
And it's only if the three building blocks
are put together that we can achieve elimination and eradication.
The key issue on this whole thing is that it occurs concurrently.
You cannot do a little bit of detection, a little bit of cure,
and a little bit of prevention of transmission.
You must do these three things together in a given endemic area--
in a given transmission pocket.
Surveillance is key in order to detect the parasite.
Surveillance is key in order to detect people who carry the parasites
or could transmit malaria.
And here is a graph from the malaria report of 2015 already.
And it said actually that surveillance systems are unfortunately weakest
where the highest burden is there.
And we just take this as a reminder to say
that where surveillance is not functioning,
our control and elimination efforts are not functioning.
That's the take-home message.
And after having not just published this information,
WHO has published a new version of the surveillance manual.
The surveillance manual is not just a book with recipes.
It just emphasizes how important it is to really detect parasites,
to understand what a transmission pocket is, in order to really act,
as we said, simultaneously on asymptomatic and symptomatic people
in order to cut transmission.
This has been launched in 2012, and unfortunately,
we must say today this message of having rigorous surveillance
and having followed it by an adequate public health response
is still not translated into action in many, many places.