GESPAM had the pleasure to interview Mr. Jorgen Stassijns as malaria advisor and specialist in tropical disease at the Belgian branch of Médecins SansFrontières (MSF). Mr. Stassijns is a medical doctor, working for MSF since 1998. He did missions in different countries, covering different medical fields: refugee projects in South Sudan and Guinea, TB project in Russia, access to health care project in Sierra Leone and migrant project in Belgium. Since 2007, Mr. Stassijns is working in the headquarters, first as medical-operational coordinator for projects in Eastern Africa, then as malaria expert
Interview
Jorgen Stassijns
Malaria Advisor and Specialist in Tropical Disease at the Belgian branch of Médecins Sans Frontières
Background information from WHO 2012 Malaria Report:
..... International disbursements for malaria control rose steeply from less than US$ 100 million in 2000 to US$ 1.71 billion in 2010 and were estimated to be US$ 1.66 billion in 2011 and US$ 1.84 billion in 2012.....
.....The enormous progress achieved appears to have slowed recently. International funding for malaria control has levelled off, and is projected to remain substantially below the US$ 5.1 billion required to achieve universal coverage of malaria interventions......
....There were an estimated 219 million cases of malaria (range 154-289 million) and 660 000 deaths (range 610 000-971 000) in 2010......Country level malaria estimates available for 2010 show that 80% of estimated malaria deaths occur in just 14 countries and approximately 80% of estimated cases occur in 17 countries. Together, the Democratic Republic of the Congo and Nigeria account for over 40% of the estimated total of malaria deaths globally. The Democratic Republic of the Congo, India and Nigeria account for 40% of estimated malaria cases.
.....millions of people continue to lack access to preventive therapies, diagnostic testing and quality-assured treatment.....
......resistance to artemisinins - the key compounds in artemisinin-based combination therapies - has been detected in 4 countries of the South-East Asia Region, while mosquito resistance to insecticides has been found in 64 countries around the world......
.....There is a critical need to strengthen malaria surveillance......
.....There is an urgent need to identify new funding sources to maintain and expand coverage levels of interventions so that outbreaks of disease can be avoided and international targets for reducing malaria cases and deaths can be attained.....
– GESPAM: Mr.Stassijns, as regards progress so far, how to maintain momentum and do the utmost to hold back malaria resurgence?
– Jorgen Stassijns: Over the past years, some successes have been achieved in malaria control, and in some countries, the numbers are going down. However, huge challenges remain in high burden countries such as DRC or Niger, contexts where MSF is active in the fight against malaria. In 2012 for example , the malaria burden in these countries has been higher than previous years. For some other contexts, reliable data are lacking. Clearly, all efforts to control malaria should continue and funding should be increased if we want to reduce the malaria burden.
– GESPAM: Do MSF functions include partnerships and collaboration with counterparts for malaria action?
– Jorgen Stassijns: In its projects, MSF always works in close collaboration with or in support to the National Malaria Programs in the countries. We don’t have formal agreements or partnerships with other actors.
– GESPAM: Pending or already made cuts in foreign aid expenditure are threatening the gains achieved in malaria control and prevention. Relevantly, adding to a December 2012 call by the Executive Director of Roll Back Malaria Partnership for “….new financing mechanisms..” including “.. financial transactions taxes..”, ALMA (African Leaders Malaria Alliance) recently asked for “…innovative financing mechanisms, including introducing levies on financial transactions…” to further scale up and sustain malaria control efforts.
Do you share that revenues from a Financial Transaction Tax (FTT) would be a suitable resource for the European Union to partly allocate to Global Fund needs for malaria fight?
– Jorgen Stassijns: I am a technical expert, not involved as such in financing mechanisms, so I can’t give a relevant opinion on that topic.
– GESPAM: What about MSF position regarding cheap for malaria medicines currently being rolled out by emerging countries’ industries?
– Jorgen Stassijns: MSF position has always been clear: patients suffering from malaria should have access to good quality antimalarial medicines. As MSF, we have put in place a system of quality control and work with validated manufacturers, some of them based in emerging countries.
– GESPAM: Do MSF functions include partnerships and collaboration with counterparts for malaria action?
– Jorgen Stassijns: In its projects, MSF always works in close collaboration with or in support to the National Malaria Programs in the countries. We don’t have formal agreements or partnerships with other actors.
– GESPAM: Parasite resistance to artemisinins (the key compounds in artemisinin-based combination therapies) has now been detected in 4 countries of the Greater Mekong subregion: Cambodia, Myanmar, Thailand and Viet Nam.
What extent are counterfeit and substandard medicines accountable for resistance?
– Jorgen Stassijns: This is probably one of the causes of the emerging resistance, together with other factors such as the availability of monotherapies. However, considerable efforts are being done to ban monotherapies and substandard drugs. In Cambodia for example, mechanisms have been put in place to provide the private sector – treating the majority of malaria cases – with quality antimalarial drugs. In Africa, resistance to artemisinin has not been documented (yet), but similar risk factors are present and everything should be done to avoid that resistance spreads to Africa.
– GESPAM: As per recent WHO release, “…Tracking progress is a major challenge in malaria control. At present, malaria surveillance systems detect only one-tenth of the estimated global number of cases. In as many as 41 countries around the world, it is not possible to make a reliable assessment of malaria trends due to incompleteness or inconsistency of reporting over time…”.
As such, how to strengthen malaria surveillance and ensure that interventions are delivered to areas where they are most needed?
– Jorgen Stassijns: Putting in place a performing surveillance is challenging and requires resources, but is a key intervention that allows to monitor the progress in malaria control.
– GESPAM: As recently stressed “…children with no immunity who have been protected over the past three years are beginning to get exposed, and the number of malaria cases among young children is expected to increase significantly this year if replacement nets do not come..”.
What about in your experience?
– Jorgen Stassijns: Long Lasting Insecticide Treated Nets (LN) are considered as one of the most effective tools for the prevention of malaria, but their lifetime is about 3 years. Therefore, regular replacement of the LN is needed. In some of the countries we’re working (Niger, DRC), funding for LN is insufficient and this could indeed have a negative impact on the malaria burden, and increase the number of cases.
– GESPAM: Thank you Mr. Stassijns for your insightful answers.