We have made good progress in the last two months and are now in the final stages of discussion with several significant distributions.
We have identified co-funding and distribution partners and details are being discussed with these partners and the relevant National Malaria Control Programmes (NMCPs)
We are planning new net distributions during 2015 to 2017. In several cases, where we are considering a particularly significant quantity of nets, we are looking at funding distributions in three phases:
- 2015/early 2016 - pilot distributions of between 100,000 and 200,000 nets
- 2016 - 1 to 2 million nets
- 2017 - 1 to several million further nets.
This strucutre has the benefit of allowing relationships to be established and developed with NMCPs and partners with whom we have not worked previously, and demonstrates AMF's support is long term.
It also allows us to manage risk and structure our support to provide an incentive to all parties involved to ensure the distributions run as agreed and are successful.
Reaching and finalising agreements - particularly this last stage - can take several months and there is always the possibility an individual agreement will not be finalised.
Our updates share as candidly as we can the progress made.
We consider potential distributions three years ahead as this matches the planning cycle of NMCPs and the advance period in which they seek commitments for support. There are also regions where distributions are needed on a shorter timescale, and we act to cover them. More information via Planning horizon
and Allocating donations
Dowa distribution of 396,900 nets, Weeks 1 to 3
- The distribution is currently underway, having started on 23 Mar 15
- Problems with transport delayed the distribution by a month
- The distribution is expected to be completed by the end of May
Everyone involved in malaria control has a fervent wish a malaria vaccine is found.
The following information is taken from an article that appeared in The Pharmaceutical Journal, 9/16 May 2015, Vol 294, No 7861/2, online | URI: 20068442, published online on 6th May 2015.
- The first candidate malaria vaccine to reach phase III clinical trials, RTS,S/AS01, is not as effective at protecting young African children against the disease as was hoped.
- Episodes of malaria reduced by just over a third (36%) in children who received three doses of RTS,S/AS01 plus a booster.
- Researchers who conducted the trial say the vaccine is still worth deploying because millions of children could benefit from vaccination in areas of high transmission.
- Others have said the assertion the vaccine may be worth deploying in some settings because it prevented large numbers of uncomplicated cases was controversial.
- Episodes of malaria reduced by just over a third (36%) in children who received three doses of RTS,S/AS01 plus a booster, and by 28% in children who did not receive the booster. Vaccine was less effective in infants. No significant protection against severe disease. Meningitis occurred more frequently in children given the vaccine.
- Researchers who conducted the trial say the vaccine is still worth deploying because millions of children could benefit from vaccination in areas of high transmission.
- Brian Greenwood, a researcher in tropical medicine at the London School of Hygiene and Tropical Medicine, and involved in the trial, says: “Despite the falling efficacy over time, there is still a clear benefit from RTS,S/AS01. Given that there were an estimated 198 million malaria cases in 2013, this level of efficacy potentially translates into millions of cases of malaria in children being prevented.”
- Adrian Hill, director of the Jenner Institute at the University of Oxford, says the assertion that the vaccine may be worth deploying in some settings because it prevented large numbers of uncomplicated cases was controversial. “There was no impact on malaria mortality and no significant effect on severe malaria: non-significant reductions of just 1% and 10% were observed in the children and infants studied over the full trial period using a three dose regimen. This is clearly lower than the efficacy of impregnated bed nets.”
- New evidence of a rebound in malaria susceptibility after vaccination was “worrying”, he adds. “After 20 months, vaccinated children who were not boosted showed an increased risk of severe malaria over the next 27 months compared with non-vaccinated controls. It should be possible to make the vaccine more effective in some settings, but that will probably increase delivery costs substantially.”
- The safety and efficacy of RTS,S/AS01 is being reviewed by the European Medicines Agency’s (EMA’s) Committee for Medicinal Products for Human Use (CHMP). An opinion is expected in the second half of 2015.
- If a positive opinion is obtained and the vaccine is pre-qualified by the WHO, malaria endemic countries can then decide whether to license and use the vaccine.
- The price of the vaccine has yet to be set. GSK committed to setting a price that covers costs of manufacturing the vaccine and a small return of 5% to be reinvested in R&D for next generation malaria vaccines.
The hundreds of thousands who have swum, run, skipped, knitted or jumped up and down on a pogo stick to raise funds for AMF have inspired Rob, CEO and Founder of AMF, to attempt his first marathon.
"This will be my first marathon - and at my advanced age probably my last! After a half marathon in October I am very much looking forward (I think) to doing the full distance and raising funds to buy nets to protect people from malaria. My motivation to get round all 26 miles and 385 yards is to add thousands to the millions already protected from malaria thanks to our fantastic group of donors across the world. I have set an ambitious target of £100,000 which would all be used to buy 50,000 nets to protect 100,000 people when they sleep at night. Heartfelt thanks for any support you can give."
To sponsor him or follow his progress: https://www.AgainstMalaria.com/RobsLondonMarathon2015
We have now passed the US$35 million mark - thanks to a donation from New Jersey, USA!
We are also about to achieve 110,000 donations. As always, our sincere thanks to everyone for their support and generosity.
We have updated the information describing potential and future distributions.
We are currently discussing nine distributions in eight countries. The total net requirement across these distributions is 30 million nets for distribution in 2015 to 2017. Of these 6 million are in 2015, 4 million in 2016 and 20 million in 2017. We are not in a position to fund all distributions so expect to fund all or a part of a sub-set of these distributions. For the majority of these potential distributions we have agreed co-funding partnerships in principle and for all are in discussion with National Malaria Control Programmes (NMCPs) and/or potential distribution partners regarding elements of accountability.
We are allocating US$19.6m, sufficient to cover approximately 6 million nets.
In addition, AMF has been asked by the Malawi NMCP to continue to support malaria control activities in the four districts of Ntcheu, Balaka, Dedza and Dowa in 2018. This is a 1.5 million LLIN, US$6m commitment. We have allocated a further 150,000 LLINs to support an immediate flood-related emergency need in Malawi and we have agreed appropriate elements of net tracking and accountability for these nets.
Note: We consider potential distributions three years ahead as this matches the planning cycle of NMCPs and the advance period in which they seek commitments for support. There are also regions where distributions are needed on a shorter timescale, and we act to cover them. More information via Planning horizon
and Allocating donations
We have now passed the US$32 million mark - thanks to a donation from Australia!
We have also just had our 106,000th donation. As always, our sincere thanks to everyone for their support and generosity.
Click on the image to view the GPS location of each of the 234,916 households that received nets
DRC is one of the most challenging countries in the world in which to distribute nets. Distances are vast, infrastructure is poor yet the malaria burden and the need for nets is great. More than 500 people die from malaria every day in DRC, the majority children under 5.
Bringing accountability to a distribution therefore faces additional challenges.
The most important initial ingredient is a distribution partner who shares a strong desire to distribute nets accountably. In DRC we work with IMA World Health.
A new ingredient is the smartphone. The contrast between this cutting edge technology and the environment in which it is deployed could not be more stark but the smartphone has the potential to be a powerful tool in the fight against malaria.
Its use is in data collection. Rather than using paper and pen to note down household details and record nets distributed, and then face the logistical challenge of aggregating in one place from distant locations the information on many, many pieces of paper (approximately 7,000 for a 676,000 net distribution) data can be uploaded to a computer and aggregated with relative ease for correction, verification and analysis. And sharing. This last point is important as information in electronic form can be easily shared facilitating transparent review by interested parties, including health leaders and programme funders – thereby delivering accountability.
Update on West Kasaï
The distribution of 676,000 nets in West Kasai, DRC
was completed in December 2014.
We are currently reviewing the distribution verification data and post-distribution report with our distribution partner, IMA World Health, and expect to publish a full report in the next few weeks.
This distribution is the first that both parties have undertaken using smartphones to collect household-level data. We expect teething problems, as with any new introduction of technology, especially in a country such as DRC. However, we are undeterred by this, as the benefits of improving processes in this region are so significant.
Smartphones installed with a data collection program, created using open source software, were used to collect household-level data including how many nets were given to each individual household.
GPS coordinates were recorded for each household receiving nets and these data are being reviewed as one aspect of 'distribution verification' – ensuring nets were distributed to beneficiaries as intended.
We believe these data are a promising sign that smartphones could be a powerful and practical tool to help net distributions deliver operational efficiencies and high levels of project accountability.
The New York Times recently ran an article reporting that some anti-malarial mosquito nets have been used for fishing and other purposes in a coastal village in Zambia, an area where there are no AMF-funded nets.
Potential mis-use of nets is an important issue for anyone concerned with trying to prevent malaria. It is clear some nets were being used for fishing and, anecdotally, this is familiar to all who work in malaria control so it is not a new finding.
The most important issue is scale.
In AMF’s experience over ten years in several hundred distributions across Africa, the number of nets used in ways other than as intended is extremely small.
It would be wrong to ignore these situations and we work to discourage and stop any occurrence of nets being used in this way.
However, it would also be wrong to move from anecdotal evidence of nets being misused, to suggest it is a widespread practice having a material effect on the impact of the nets in preventing malaria. Nets are the most significant mechanism for protecting people from malaria, saving hundreds of thousands of lives every year, far more from illness. We do not believe that we should deprive people of their main defence against a deadly disease because of the risk that they might misuse their net.
However, AMF takes a number of steps to stop misuse. We believe that each of them has contributed to the success of our distributions.
- Malaria education is key. We work closely with local health officials, the front line health teams and the village and community leaders, to ensure the community is fully aware of the connection between sleeping under intact nets and preventing malaria.
- AMF uses extremely rigorous pre-distribution surveys to determine precise net needs, followed by independent checks when the nets are given out to ensure no nets are diverted away from households that need them.
- AMF conducts post-distribution check-ups to ensure nets are being used as intended every 6-months during the 3 years following a distribution. People are informed that these checks will be made by random selection, and via unnannounced visits. This gives us a data-driven view of where the nets are and whether they are being used properly. We publish all the data we collect: example here. This type of follow up work is currently unique to AMF, although we hope the practice will become more widespread where it is feasible.
At AMF, the extensive data we have collected verifies that the number of nets we have distributed that are used for fishing is immaterial.
Old nets that have outlasted their effectiveness in the fight against malaria may be made into footballs or other harmless objects and we do not try to interfere with this.
The data are being entered in Malawi now and may be viewed in real-time
. As soon as all data have been entered we will publish a summary of the results.
The specific nature of the data - at the health centre level - means the District Health Officer (DHO), health centre leaders, community leaders and other health workers are able to decide what targeted malaria control intervention might be appropriate in specific areas. In circumstances where health systems and resources are stretched, information that assists with targeted interventions can help with effective use of resources and that is the aim of this information.
Background: Almost 154,230 LLINs were distributed in Balaka District
in October and November 2013.
What a great way to end the year! We have reached the 100,000th donation
thanks to a donor in Sydney, Australia.
We have received donations both large and small and every $3 matters as every net matters. 100% of the funds we have received will buy nets and all donors will be able to see exactly where the nets they fund are distributed.
Our very best wishes for 2015.
We have now passed the 25, 26, 27, 28 and US$29 million milestones, thanks to a significant US$5m grant from Good Ventures, the San Francisco based philanthropic foundation!
We are absolutely thrilled to have recently been awarded a US$5m grant from Good Ventures
, the San Francisco based philanthropic foundation.
This is the largest grant AMF has ever received (previously US$1.25m, also from Good Ventures) and it will make a huge impact on fighting malaria, saving many lives, reducing illness and boosting economic growth.
It comes at an exciting time for AMF as we work to expand the number and scale of the projects we support. We have no doubt it will be pivotal.
Every single donation is important, no matter how large, in the fight against malaria. There is a huge gap between the funding available and the net need. We never forget that every $3 buys a net and every person covered by a net is potentially a life saved. There are now over 99,000 donations to AMF. Together we have built a community that will keep the fight against malaria high on the international agenda. We are aiming to secure a further US$20+m for the projects we are currently considering. Aside the occasional marvellous large donation, the majority of AMF’s funds come from donors giving less than $100 and we are incredibly grateful for every one of them.
We have just had the 99,000th donation thanks to a family in Normal, USA and we are looking forward to celebrating the 100,000th soon.
We have received donations both large and small and every $3 matters as every net matters.
100% of the funds we have received will buy nets and all donors will be able to see exactly where the nets they fund are distributed.
Giving What We Can’s (GWWC) December update confirms its list of recommended charities remains unchanged and we are delighted to continue to be included.
GWWC comment in their review of AMF:
Ntcheu District (Population: 580,000) - Post-distribution Check-Up (PDCU) at 33-months just completed
The fourth PDCU of net use and condition
has been completed, 33 months after the mass distribution of 268,420 nets in January 2012. The PDCU data, that could be followed ‘live’ as it was being entered in Malawi, is now in the final stages of being checked. The results are good. We will publish shortly a commentary on the results.
Dedza District (690,000) - Distribution nearly complete
245,000 nets have now been distributed
protecting 440,000 people and achieving universal coverage in all distribution areas, bar one. Nets have been distributed according to household-level net need information gathered during a comprehensive pre-distribution registration survey (PDRS). The number of nets required for the final ‘mop up’ area is being determined now and they will be distributed early in 2015.
Dowa District (700,000) - Pre-distribution Registration Survey (PDRS) underway
Every household in Dowa district
, some 165,000, will be visited over the next two weeks by 440 Health Surveillance Assistants (government health service staff) to assess the number of sleeping spaces, perfectly usable nets and therefore net need for each individual household. Supervisors will make unannounced visits to randomly selected households to monitor the accuracy of the data collected. The data collected will be put in electronic database form, cleaned, checked and passed to village and community leaders for a public reading to ensure no omissions or inaccuracies. The final list will form the basis of an accurate net distribution to ensure full sleeping space coverage is achieved with no material theft of nets. This process is managed and supervised by our distribution partner Concern Universal working in close partnership with the Dowa District Health Officer, Malaria Coordinator and District Executive Committee and their teams. 396,900 LLINs have arrived in Dowa and are now in secure storage awaiting distribution in January and February 2015.
Balaka District (400,000) - Post-distribution Check-Up (PDCU) at 12-months about to start
The second PDCU of net use and condition
is in the final stages of planning and will commence shortly. 5% of the households that received the 154,230 nets in November 2013 will be randomly selected and visited unannounced to assess net use and condition. Supervisors will check 5% of households visited by each data collector to ensure data accuracy. For any PDCU we ask it be carried out within ± 1 month of the appropriate anniversary.
We are currently in detailed discussions regarding four potential distributions in four different countries (total 2.76 to 4.76 million nets), and four potential distributions are at the information stage. We will provide updates on each as meaningful progress is made or decisions are taken.
You can see more details on our Future distributions page.