Rotarians Against Malaria Conference

19th to 20th August 2017, Sydney

The 2017 annual RAM Conference was held at Rowers on Cook’s River adjacent to Sydney International airport over the weekend of 19th and 20th August 2017. This was the first RAM Conference to be held in Sydney and was attended by 71 delegates representing 16 Rotary Districts. This was the first RAM Conference to be held in Sydney following the policy of rotating the Conference venue through the major eastern seaboard cities to make it easier for more Rotarians to attend and be inspired by RAM’s programs and mission. The Conference agenda included updates on progress in the countries where RAM has active programs, reports on the progress of malaria research, the RAM AGM and discussion sessions where future directions for RAM were planned.

 

Conference Opening:

Delegates were welcomed to the Conference by host District 9675 Governor Steven Britten and the National Chairman of RAWCS PDG Michael Perkins. The Conference commenced with a review of RAM’s progress in 2016/2017 by National RAM Manager,  PP Dave Pearson, who welcomed delegates and summarised RAM’s achievements over the previous twelve months including ongoing programs in PNG, Solomon Islands and Timor Leste . Dave also introduced the invited speakers including representatives from the Ministry of Health in Timor Leste, Dr Merita Monteiro, and from the Solomon Islands Health Promotions Dept. Mr Ben Rickie, distinguished researchers, RAM Sponsored PhD candidate Edgar Pollard and the team of RAM Volunteers recently returned from Timor leste.

Dave recognised the recent sad loss of past RAM National Chairman and long term RAM Funding Coordinator  PDG Richmond Manyweathers whilst also reporting on the presentation of RAWCS Humanitarian Service Awards to RAM pioneers Wayne Morris and Ron Seddon. He noted that the RAM Annual report had now been printed as part of the published RAWCS 2017 Annual Report .

 

Summaries of progress in countries where RAM has been active:

Papua New Guinea: report from Tim Freeman RAM PNG.

Tim reported that RAM PNG is currently undertaking the third round of universal bed net distributions to households. He described the process as a three year rolling cycle with teams moving systematically from province to province. Persistent malaria still exists in West Sepik and Milne Bay Provinces and despite an overall reduction in malaria incidence of 70% there are indications that incidence is starting to increase.

Tim said that the cause of increased incidence was not clear and speculated that people might be staying up later and spending less time protected by bed nets or that perhaps it was related to persistent stock-outs of anti-malarial drugs in local clinics supplied by the NDOH. On a positive note Tim reported that the Bougainville “Healthy Island” program, similar to ‘Healthy Villages”, appears to be helping in malaria control and that perhaps this could be a future area for RAM assistance.

Tim also reported that Global Fund grants for PNG continue to decline and although RAM PNG will be the sole Principal Recipient for the 2018 grant the US$4.5 M will only fund distribution costs however the Against Malaria Foundation has agreed to fund the net procurement along with local corporate funding.

Tim described progress in the RAM funded “Chasing Malaria” program which maps positive diagnosed malaria cases in NCD and Central province, identifies malaria case clusters and follows up with Community based interventions. This includes more village disease education, identifying and dealing with mosquito breeding areas, ensuring all local people are using LLINs and encouraging alternate ongoing use of superseded LLINs e.g. as window screens.

Tim also reported that the Private Sector Retail initiative, where RAM was seeking to sell LLINs and Mosbar at affordable rates, is back on track following agreement with the Government over GST treatment.

Solomon Islands: RAM report by PDG Wayne Morris presented by Dave Pearson.

Wayne reported that to date a total of 160 villages had been supplied with tools under the RAM ‘Healthy Villages’ program at a cost of AUD$200,000. The RAM program in the Solomons has benefited from regular transfers of funds from RAM in Australia, direct contributions, e.g. a grant from RC Benalla of AUD$8,500; as well as local corporate funding. These funds have enabled RAM to provide tools for a further 29 villages.

The provision of bed nets and spray control is continuing to be funded under the Global Fund, the funding of the program has been changed with the SI Government having to provide the funding first before being reimbursed. Malaria elimination programs are continuing in Temotu and Isabel Provinces with funding from DFAT (Australia) and a similar program is planned for Western Province.

Timor Leste:  report by PDG Phil Dempster.

Phil told delegates that RAM’s support for the Timor Leste NMCP was continuing and evolving. The latest bed net distribution is taking place in the Oecusse enclave with 40,000 nets funded by the Global Fund and logistical costs met by RAM. He also noted that this year RAM has commenced funding the Rotary Club of Dili Lafaek “Healthy Villages” project in Dili and Liquica districts. To date twelve villages have participated in this trial project which encompasses Community health and hygiene awareness training, establishing Community Committees, planning health interventions and building permanent rubbish disposal facilities, aimed at reducing mosquito breeding as well as improving village hygiene.

These developments were covered in more detail by the report from the RAM Volunteer team recently returned from assisting RCDL. (see below)

Presentations from Target Countries Department of Health Officials:

Mr Ben Rickie Kiokimo; Director Health Promotions Dept. Solomon Islands MOH&MS.

Ben described the Healthy Village Settings program, that he supervises, which is supported by RAM. He told delegates that to date 200 villages and 30 schools had benefited by developing and enacting self-help programs to improve the general health and wellbeing of these communities. He noted that the Solomons MoH&MS with help from RAM and the Global Fund had been so effective in controlling malaria that it was no longer rated in the top 10 dangerous diseases and that now non-communicable diseases related to metabolic and behavioural risk were the main concern.

Ben reported that the 658,000 population was 78% rural based and had variable access to Health Services, mostly clinics staffed by Nurse-Aids as the patient Doctor ratio was 1:5,098. Ben told us that there was competition amongst Villages to secure “Healthy Villages” support which his Department attempted to distribute on a fair basis. He noted that the risk of a renewed malaria epidemic was understood and that the ‘Healthy Village Settings’ program was a good point of entry to discuss health and disease prevention with villages. Ben said he was open to helping to facilitate future RAM Volunteer teams to assist with the program.

Dr Merita Monteiro; Head of Communicable Disease Division Timor Leste MoH.

In her presentation Dr Merita tracked how the Timor Leste National Malaria Control Program (NMCP) had taken the country from Control to Elimination in 10 years and was now changing its name to the National Malaria Elimination Program. In 2006 malaria incidence was 1 in 4 people and the NMCP had only 2 staff. Recent statistics show an incidence of less than 1 in 10,000 and the focus is now on achieving WHO malaria free certification. She reported that 98% of recent cases occurred on or close to the borders with Indonesia.

Dr Merita reviewed the robust evidence based approach to the malaria campaign conducted by the NMCP showing how the elements of this approach as well as regular follow-up of vector control and close Government support had enabled the success. However she also noted that the Global Fund was also significantly reducing their funding now that the disease incidence was so low and so there was a worrying short fall in funding to achieve elimination. She expressed the gratitude of the NMCP for RAM’s support and expressed the hope that RAM could assist with meeting the shortfall of funds to maintain bed net protection of at risk population and vulnerable groups as well as assisting in replacing worn-out residual indoor spraying (IRS) equipment.

 

Presentations by Researchers on the fight against Malaria.

Associate Professor Harin Karunajeewa; WEHI:

With a local goal of malaria elimination in the next 13 years Harin noted that the most successful interventions to date have been LLINs(best control), drug treatment followed by IRS. He added to concerns expressed that when malaria prevalence is driven down then local health authorities relax and focus on other pressing health issues. Indeed he presented an up dated malaria epidemic history graph for the Solomons showing a worrying recent up-tick in cases. Previous significant falls in malaria incidence have mostly been Pf and as a result the ratio of Pf to Pv frequency is rising rapidly with Pv now representing 2/3 of new cases and 4 out of 5 of these are relapses from previously introduced hypnozoites.

Harin noted that current drug treatments were only 50% effective at resolving Pv infections and described the field study he is conducting at Tetere, which is currently one of the most malarious places in the Solomons due to the concentration of oil palm workers. Harin highlighted the risks of Drug Drug Interactions (DDIs) in the current best practice treatment employing Primaquine and ACTs and went on to outline his research aimed at investigating the degree of DDIs in current treatments and identifying the optimal drug combination and dosage for radical cure of Pv infections.

Professor Denis Shanks; Australian Army Malaria Institute:

In his talk titled “How we are going to eliminate malaria.” Denis reviewed recent successful control and elimination cases including the Amazon basin where very little Pf remained and rates of Pv are falling. He praised the work under way in China where most cases these days were infected Chinese workers returning from Africa and attributed the effective elimination of local transmission to massive administration of Primaquine.

He noted that progress was threatened by drug and insecticide resistance, mostly in Asia, but that it seemed under control for now whilst work on a replacement for permethrin was progressing. He also reference exciting progress in gene shearing (CRISPR), mosquito specific baits and drug developments including Tafenoquine to replace Primoquine and the use of Ivermectin in breaking the mosquito borne part of the parasite life cycle.

Other developments, that would be needed, included better diagnostics as evidence suggested that RDTs were missing some low level Pf infections as well as some Pv. Denis stated that if an anti-transmission vaccine was going to be available in time to assist global eradication programs then it would need to be in advanced trials now, given the long regulatory lead times.

Dr Danielle Stanisic; Institute for Glycomics, Griffith University:

Dr Stanisic presented an update of progress towards producing a chemically attenuated whole parasite vaccine based on Plasmodium falciparum called PlasProtecT®. She noted that the vaccine must be simple, cheap, effective and well tolerated and that so far all indications were positive. She noted that the production of ‘T’ cells triggered by application of the vaccine was particularly encouraging and that early indications suggested that the induced immunity would be effective on multiple species of plasmodium.

Proposed human trials will involve three sets of ten volunteers who will be give different dose rates and closely monitored. Each volunteer would have to possess sixty required attributes to be selected.

Dr Stanisic reviewed the track record of the only currently registered malaria vaccine, RTS S₁ which is currently undergoing a huge trial involving 300,000 children in Ghana, Kenya and Melawi. Recent long term trials indicate that RTS S₁ only retains 7% efficacy after 7 years and only had a peak efficacy of 38% against Pf only, following the required four treatments. Despite these poor results the huge development sunk cost and long lead time had severely cautioned potential supporters who now required far more advanced data before committing to fund other vaccine candidates.

 

Associate Professor Bayden Wood; Monash University:

Bayden described his research into the application of Attenuated Total Reflection Spectroscopy as a novel method for detecting very low level malaria parasite infections in people from blood prick samples. The aim was to develop a new highly accurate field test for asymptomatic malaria carriers that could contribute to elimination programs. He described field trials conducted in Thailand, Laos and PNG where each patient’s blood was tested by three different techniques but voiced concern that the subjects that had been selected did not include many asymptomatic carriers and so he was looking for further trial sites.

He noted that results to date had been very encouraging and that preliminary patent protection was being sought and that it was hoped that further trials would help develop an instrument and routine that enable local health workers to use the technique in remote locations.

RAM sponsored PhD student Edgar Pollard; Australian Institute of Tropical Health & Medicine:

Edgar reported that he had completed his field work and was now relocated to Cairns to conduct further laboratory studies and data analysis. He displayed a very well-produced video tracking the movement of a mosquito around a typical Solomons village setting. Edgar noted that most mosquito biting occurred after dark and that changing human behaviour was contributing to increased risk.

 

Edgar reported that there was currently a higher proportion of younger people who stayed outside to socialise after dark and so were vulnerable to bites even though later in the evening they slept under LLINs (86% of people surveyed used LLINs). He noted that new vector control such as repellents, mosquito baits and screening might be require to maintain low infection rates.

 

Report by RAM Volunteer Team: Timor Leste,  June 2017.

The team reported that they had enjoyed a busy and productive time in Dili and Arturo Island. They had met with officials from the Global Fund, WHO and NMCP and participated in a bed net distribution with the NMCP. They had met with the Rotary Club of Dili Lafaek and assisted with ‘Healthy Village’ activities including installation of steel rubbish bins and village clean-up. On Arturo Island they had inspected a RAWCS water purification project and sanitation requirements.

 

The team reported that they were deeply impressed by the NMCP. The team was also very impressed by the enthusiasm and hospitality of the RC Dili Lafaek members and their ability to involve other young people in volunteering (for the good of their nation) on their project. They proposed that RAM should seek closer collaboration between RC Dili Lafaek and the NMCP as well as improving guidelines to increase the malaria focus of the project.

 

RAM AGM.

A brief AGM was held at the commencement of conference sessions on 20th August.

National Chairman Dave Pearson reported that RAM had had a strong year for both fund raising and awareness raising with a 60% increase in donations received whilst at the same time the fund raising project in support of the vaccine development at the Institute for Glycomics was well underway. The RAM Executive Committee had met on the morning of 19th August and determined that the 2017/2018 budget would be $200,000 to be distributed in the following proportions:  50% to PNG, 5% to Solomons, 20% Timor Leste, 12.5% to the PhD scholarship and that 7.5% would be held unallocated (for new initiatives) and 5% for administration and Conference costs.

Dave reported that the aspirational target for fund raising of $20,000 per Australian Rotary District, agreed at the 2015 Conference, had been exceeded in D9810 during the past year confirming that it was a realistic goal for most Districts.

The revised RAM Procedures Document had been previously circulated to all RAM District Chairs and given tacit approval by the RAWCS Ltd Board. The document was then unanimously endorsed by delegates at this AGM.

Nominations for Executive Committee positions of Deputy National Manager, Funding Coordinator and Scientific Committee Coordinator had been called for prior to the Conference and again on the floor; Mr Bill Oakley was elected unopposed as Funding Coordinator, Dr Bruce Anderson was elected unopposed as Scientific Committee Coordinator. No nominations were received for Deputy Manager and Dave commented that this position must be filled urgently if there is to be a reasonable induction and hand-over period prior to his term of 3 years as National Manager expiring on July 1st 2018.

RAM District Chairs Training session.

In this session Dave covered the history of RAM, it’s achievements to date, organisational structure and communications as well as reviewing RAM’s current vision and increasing focus on malaria elimination. The use of personal stories as well as the free access to all existing RAM PowerPoint slides was emphasised in the important role of presenting RAM and our goals to Rotarians and the public. The basic aspects of the role of RAM District Chairs were discussed and the pro-forma annual report, with it’s embedded benchmarks, was described. Dave noted that basic job descriptions for RAM people were included in the Procedures Document and that a more complete discussion of the role of district Chairs would be circulated after the conference. (all the documents mentioned and Conference presentations will be posted on the RAM website.)

RAM’s PR and Media Coordinator Holstein Wong conducted a thorough demonstration of RAM’s new web site and the RAM Facebook page was displayed. Holstein highlighted the Contacts listing, Reports and Newsletters section along with photo galleries, presentations, videos, documents, leaflets and other resources all available on the site for RAM Chairs and Committee members to assist in preparing presentations and getting the message out. Delegates were asked to look for opportunities to post RAM activity short reports on the RAM Facebook page (contact Holstein to post) and prepare reports for their District enews and RDU magazine. Dave added that he was more than happy to have RAM presentations plagiarised by RAM Chairs in developing their own presentations.

 

 

Reports on RAM related activities in Australia.

Rotaract Project: Michael Shields: Chairman -Rotaract Australia Against Malaria.

Michael reminded delegates that RAM had been adopted as a National project of Rotaract at the 2013 National Conference and had raised $30,000 for RAM’s programs over three years including $8,567 over the past 12 months. He noted that with the annual turnover of office bearers new Rotaractors inspired by RAM’s work would be required to maintain the interest and enthusiasm in Rotaract.

Michael encouraged RAM District Chairs to engage local Rotaractors in their District programs as well as seeking to speak at Rotaract meetings. He noted that across Australia there are 60 Rotaract Clubs and about 1,000 Rotaractors .

Schools Video Competition.

The two short videos prepared by Victorian Primary School students as a pilot for a future National competition were screened after the Conference dinner and a winner determined by show of hands. Inaugural winners were the students at Brighton Primary School. The videos will be available to be viewed on RAM’s web site and Facebook page.

Malaria Awareness Day (MAD) and World Malaria Day Activities.

2017 MAD activities from around the Nation were briefly reviewed as examples of successful awareness raising and fund raising opportunities.

Project to Support human trials of the Institute for Glycomics Vaccine candidate.

Speaking straight after Dr Danielle Stanisic’s presentation PDG Graham Jones presented a report on progress of D9640 Project (RABS 16-2016-17) aimed at raising $500,000 to support the next phase of human trials for PlasProtecT®. Graham reported that in little over six months the project had raised $212,000 and now had it’s first corporate sponsor in Zarraffa’s Coffee. He added that now that the $200,000 had been achieved Professor Good had sufficient assurance of funding to commence preparations for the trials.

Graham noted the successful launch of the Project by Governor General Sir Peter Cosgrove, who had commented that the combination of “Whitecoats and Rotarians working together” was a powerful model. Graham reported that a presence at the RI Convention had opened possibilities for more support from Rotary in the USA.

 

 

PP David Pearson.

National Chairman: Rotarians Against Malaria.

Rotarians Against Malaria Conference

 20th to 21st August 2016, Melbourne

 

The 2016 annual RAM Conference was held at Ciloms Airport Lodge at Tullamarine Melbourne over the weekend of 20th and 21st August 2016. This was the first RAM Conference to be held in Melbourne and was attended by 58 delegates representing 12 Rotary Districts. The idea of holding the Conference in Melbourne was to encourage more local Rotarians to attend and experience RAM as well as providing an opportunity for the Melbourne based Walter & Eliza Hall Institute for Medical Research (WEHI) and the Burnet Institute to showcase their malaria research programs. The Conference agenda included updates on progress in the countries where RAM has active programs, reports on the progress of malaria research, the RAM AGM and discussion sessions where future directions for RAM were planned.

Conference Opening.

The Conference was opened by National RAM Chairman Dave Pearson who welcomed delegates and summarised RAM’s achievements over the previous twelve months including ongoing programs in PNG, Solomon Islands and Timor Leste . Dave also reviewed notable RAM activities in Australia including promotion of World Malaria Awareness day, DG’s Partner fund raising in D9820, the great work of Rotaract’s malaria project and the developing project arising from the Rotary Ride Around Australia Against Malaria (RRAAAM) fund raiser conducted by Steve and Doreen Carroll. These achievements are also detailed in the RAM Annual report to RAWCS which will be posted on the RAM web site and published by RAWCS.

Summaries of progress in countries where RAM has been active:-

Papua New Guinea: report from Tim Freeman RAM PNG.

Tim reported that RAM PNG is currently distributing Long Lasting Insecticidal Nets (LLINs) at a rate of about one million per year. In the last 5 years 7M LLINs have been distributed to households in all 89 districts in all 22 provinces and a further 1M LLINs have been distributed to vulnerable groups. By mid-2016 LLINS have been distributed by RAM twice in every province except Enga in addition to a previous distribution by Government.

Recent problems include a lack of malaria treatment drugs at local clinics due to poor stock control by the Health Dept. and ongoing tribal fighting in some areas making it impossible to deliver LLINs direct to villages. In this case the LLINs are distributed at schools.

Tim described progress in the RAM funded “Chasing Malaria” program which maps positive diagnosed malaria cases in NCD and Central province, identifies malaria case clusters and follows up with Community based interventions. This includes more village disease education, identifying and dealing with mosquito breeding areas, ensuring all local people are using LLINs and encouraging alternate ongoing use of superseded LLINs eg as window screens. Data collected in some clusters displays a uniformity of cases across all age groups indicating local reinfection and loss of adult immunity.

Tim also reported that the Private Sector Retail initiative where RAM was seeking to sell LLINs and Mosbar at affordable rates is currently on hold due to ongoing GST negotiations with Government. Once again Tim brought sample LLINs, Mosbar and Colouring in books (used to help malaria awareness in kids) to the Conference to distribute to RAM Chairs as demonstration items.

Solomon Islands: report by PDG Wayne Morris Presented by Dave Pearson.

At the 2015 conference it was agreed to allocate AUD$30,000 for the Healthy Village tools program. The funds together with other NGO funding was used to provide tools for 22 villages in the Russell Islands, Central Province. The DG partners project in D9820 raised AUD$22,291 for Healthy Villages and these funds together with further funds from RAM, making up to AUD$30,000 have recently been transferred. Funding has also been secured from the Solomon Forest Association of AUD$16,000 per year for the next three years. These funds together with the funds recently transferred will provide tools for a further 25 villages.

The provision of bed nets and spray control is continuing to be funded under the Global Fund, the funding of the program has been changed with the SI Government having to provide the funding first before being reimbursed. Malaria elimination programs are continuing in Temotu and Isabel Provinces with funding from DFAT (Australia) and a similar program is planned for Western Province starting in 2017.

Timor Leste:  report by PDG Phil Dempster.

Phil reported on the progress of a request from the Timor Leste NMCP for RAM to assist by funding the distribution of LLINs previously supplied by the Global Fund. After careful consideration of the request RAM has offered to fund distribution costs on a dollar for dollar basis with contributions from the MoH up to a maximum of US$20,000. The timing of this program is still being worked out.

Phil then outlined a new project proposed by the newly chartered RC Dili Lafaek to implement a “Healthy Villages” project in Dili and Liquica districts. The proposal encompasses Community health and hygiene awareness training, establishing Community Committees, planning health interventions and building permanent rubbish disposal facilities, aimed at reducing mosquito breeding as well as improving hygiene. These two Timor projects represent an opportunity to send Rotary Volunteers to assist and observe.

Vanuatu project of RRAAAM: report by Steve Merritt.

Steve described the search for a suitable project to invest the $30,000 raised by the Rotary Ride Around Australia Against Malaria being undertaken by Steve and Dorene Carroll. After considering PNG and Solomons where RAM already has active programs Steve and Dorene have based themselves in Vanuatu and had numerous meetings and observation visits to understand what is needed by the local malaria program and where they can best assist. They have determined that rebuilding LLIN storage facilities is the current best fit and are negotiating an MOU with the Vanuatu Government.

 

 

Reports on RAM related activities in Australia.

Rotaract Project: Michael Shields: Chairman -Rotaract Australia Against Malaria.

Michael related that eliminating malaria was a goal that was considered achievable in the lifetimes of most Rotaractors and resonated as a tangible practical outcome that they could help achieve. Using slides and U-Tube Michael and Rotaractor Ben Hill showed the passion and creative thinking that can be applied to fund and awareness raising including enlisting corporate sponsors such as Westpac and holding an up-coming Rotaract Ball at Melbourne Zoo.

Michael described Rotaract’s ongoing fundraising approach noting that $8,100 had been raised over the past 12 months and that a personal donations portal had been set up and was available to anyone to use. Funds are tracked through a dedicated RAWCS project account before being transferred to RAM.

Forum Discussion Topics.

A series of discussion points aimed at assisting in developing future strategy for RAM were suggested prior to the conference and following a brief introduction of the topic on Saturday Forum discussions and consultations were led by selected delegates who reported the outcomes on Sunday morning.

1) Is the effort and expense in attempting to control mosquitoes by draining stagnant water around villages as in “Healthy Villages” worthwhile or should RAM concentrate on more direct vector control?              Led by: Milton Lewis

Milton reported that the consensus was that the “Healthy Villages” program had an important role in ongoing disease education and action at village level and would contribute to reducing infective mosquito biting when people were outside and not protected by LLINs. It was also agreed that it represented an ongoing role for RAM in the Solomon Islands and that it was important for RAM to remain active there especially whilst elimination programs were being developed.

2) Should RAM fund raise and use some of our reserved funds to support Vaccine development at the Institute for Glycomics?         Led by: Sam Doumany

Sam pointed out that Australian RI President Clem Renouf had convinced RI to accept the challenge of eliminating polio even though the disease had long been eliminated in Australia and the US. Sam reported support from the delegates for fund raising as a separate but parallel program to RAM and that most considered that the two projects would be mutually beneficial in awareness raising without the need for RAM to contribute funds.

3) Should RAM work towards a National coordinated awareness and fund raising project for Malaria Awareness Day 2017? If so what form should this take?                        Led by: PDG Ian Sayers

Ian reported strong support for a two part national  project culminating in local clubs staging activities highlighting that mosquitos are the most dangerous animal on earth with a sausage sizzle on MAD day in conjunction with a national retailer selling outdoor products. The suggested part of the project would be to sponsor a national competition for school kids to prepare a short video about mosquitos and malaria.

4) How should RAM best lobby Rotary International to be a major contributor to a future global malaria immunisation program?                               Led by: PDG John McLaren

John reported that the few suggestions received encouraged a continuous multi-level lobbying approach and noted that a substantial business case would be needed before a formal submission was put before the RI board.

RAM AGM.

A brief AGM was held at the commencement of conference sessions on 21st  August.

National Chairman Dave Pearson reported that the RAM Executive Committee had met on the evening of 19th August and determined that the distribution of donated funds for 2016 / 2017 would be 40% to PNG, 35% to Solomons and Timor Leste, 15% to the PhD scholarship and that 10% would be held for new initiatives with disbursements based on an AUD$150,000 budget.

Dave reported that although an aspirational target for fund raising of $20,000 per Australian Rotary District had been agreed at a previous Conference there was much work to do to achieve that. Total fund raising for 2015/16 had been $125,000 or less than $5,000 per District after the D9820 DG’s partners project and Rotaract contributions were subtracted. Further he reported that the Executive Committee had determined to review the Manual of Procedures to align it with RAWCS Committee requirements and that proforma annual reports with indicative benchmarks for District RAM activity would be circulated for completion by all District Chairs.

The Executive Committee position of Publicity and Media Coordinator was declared vacant and nominations called for. No nominations were received.

Presentations by Researchers on the fight against Malaria.

RAM sponsored PhD student Edgar Pollard; Australian Institute of Tropical Health & Medicine:

Edgar reported that the latest statistics from the Solomons included 18,404 confirmed cases and 23 deaths from malaria in the past year. LLINs are working well and continuing to reduce the case load but that the nets only protect people when they are covered by them and that it is estimated that 13% of mosquito biting occurs outdoors. Edgar described his research on the flight characteristics of mosquitos and intended methodologies. Intended research outcomes include:-

  1. Best design for barrier screens.
  2. Understanding environmental effects on mosquito flight.
  3. Define local mosquito biting habits.
  4. Determine which human behaviours expose people to mosquito bites.

Edgar thanked RAM for supporting his research and looks forward to reporting interim results at the next RAM Conference.

 

 

 

Associate Professor Harin Karunajeewa; WEHI:

Harin was happy to acknowledge that some of his early research had been sponsored by Rotary in Perth. He told us that WEHI’s malaria research programs were focussed on the Pacific nations featuring a bench to bedside approach identifying best practice protection from, and treatment of malaria. He noted that future disease interventions must be prepared for changes in the behaviour of both humans and mosquitos.

Despite significant reductions in malaria cases in the Pacific, and a pleasing fall in the death rate, much of the progress had been achieved in reducing the incidence of Pf whilst Pv rates had been mostly static since 2008.This is a challenge to future elimination programs as Pv often exists in asymptomatic infected humans in the form of hypnozoites in the liver which are problematic to detect and treat with current methods.

Harin highlighted the risks of Drug Drug Interactions (DDIs) in the current best practice treatment employing  Primaquine and ACTs and went on to outline his new research project in the Solomons focussed on investigating the degree of DDIs in current treatments and identifying the optimal drug combination and dosage for radical cure of Pv infections.

Professor Denis Shanks; Australian Army Malaria Institute:

Prof Shanks presented a talk titled “Why malaria elimination is not a dream” He concluded that malaria elimination is “possible but difficult” and that although a goal of 2030 has been set for elimination there are already weaknesses in national resolve showing up. He demonstrated some significant successes including Chinese elimination programs moving ahead of schedule and several countries (e.g. Argentina) recently being declared malaria free. Prof Shanks emphasised that elimination is about “killing the last parasite” but that this goal was complicated by changing patterns of human and vector behaviour and parasite adaptations including drug resistance.

He classified the challenges into Scientific and Logistical. Scientific problems currently include Drug Resistance, Latent infections (e.g. Pv  hypnozoites) and Insecticide Resistance. Under Logistical he included: Inefficient local health systems, Governance of donated funding, competing demands for Govt.  resources and landscapes in endemic regions. He highlighted the paradox that ‘the more disease control works the less the apparent problem and hence the less funding is applied’ and noted that this needs to be overcome if elimination is to be successful. On the up-side it has been demonstrated that post elimination there is no epidemic outbreak following the inevitable natural or manmade disasters that beset the formerly endemic countries.

Prof Shanks highlighted the following needs for elimination:-

  1. New drugs to clear and cure
  2. New insecticide (low human toxicity)
  3. Vaccine
  4. People to trust Government interventions, believe and support.

He noted that island by island progressive elimination programs in the Pacific should provide confidence for the 4th point.

 

Dr Danielle Stanisic; Institute of Glycomics, Griffith University:

Dr Stanisic presented an update of progress towards producing a chemically attenuated whole parasite vaccine based on Plasmodium falciparum. She reported that human trials where the safety, tolerability and stability of the vaccine had been evaluated were largely successful and that rodent trials testing induced immunity had provided encouraging results.

The next development stage will examine the protective efficacy of the vaccine in humans by conducting a broad based human trial in a non-endemic country (Australia) . Interestingly she reported that initial results in mice and human blood trials suggest that the vaccine, although based on falciparum, will induce immunity to other plasmodium species as well.

Following Danielle’s technical presentation D9640 RAM Chairman Sam Doumany then presented a strong case for Rotary to support these next stage human trials and reported that RC Southport is in the process of registering a RABS project to be a vehicle for fundraising throughout our Rotary Region(40,000 Rotarians) to raise the estimated $500,000 trial budget. Fund raising would include Rotary crowd funding as well as seeking the direct support of major philanthropists. Following Sam’s presentation National RAM Chair Dave asked for a show of hands in support for this initiative which returned overwhelming support.

Dr Jack Richards; Burnet Institute:

Dr Richards described the Burnet Institute as both an NGO as well as a research facility with 400 staff and students with malaria projects in Vietnam, Myanmar and PNG. Their experience has shown that elimination programs will have to pay special attention to vulnerable groups including children and pregnant women, poor and remote border populations and mobile and migrant populations and workers. Jack noted that through work, men are more often exposed to infection.

Dr Richards discussed the importance of natural immunity and the concern that people in areas where infection rates had been significantly reduced were losing immunity and hence becoming more vulnerable to outbreaks. In these areas he stressed the importance of strong (or strengthened) health systems with community engagement, good person focussed response to disease and good surveillance including well planned and monitored vector control.

In this context, Jack reviewed the current global momentum towards eradication of malaria including the WHO’s Global Malaria Action Plan (GMAP2) supported by the Global Technical Strategy (GTS) with their emphasis on the 3 pillars of :-

  1. Universal access to malaria prevention, diagnosis and treatment
  2. Acceleration of local elimination programs
  3. Transforming surveillance into a core intervention

He emphasised the need for development of a high sensitivity test to detect difficult to diagnose cases and infections in asymptomatic patients if pillars 1&2 were to be achieved and noted a recent success at Burnet was development of a field assay for the G6PD enzyme deficiency which would help avoid complications in some patients during future mass administration of Primaquine to remove latent infections. Unfortunately the test only applies to males.

Another area of Burnet research is in identifying targets for new blood stage vaccines as more effective vaccine than RTS,S will be required for elimination programs. This work currently involves identifying susceptible parasite proteins, developing and accessing new human antibodies and determining which vaccine adjuvants assist in inducing the strongest and longest immunity.

Jack also highlighted the importance of sustainable funding for these programs in some of the poorest countries of the world and noted the significant reduction in Australian overseas aid since the 1970’s.

Rebecca Feldman; Victoria Govt. Health and Human Services:

Rebecca gave us a fascinating insight into the active surveillance and outbreak control activities conducted by her team in keeping Australia free of imported vector borne disease. She described the monitoring and detection programs in place around sea and air ports and emergency response procedures required to control and eliminate out-breaks.

She pointed out the irony of RAM supporting programs like “Healthy Villages” giving people in endemic areas the means of reducing mosquito breeding sites when conversely, modern urban planning in Australia appears to encourage water features that frequently become very effective mosquito breeding zones.

 

RAM District Chairs Training session.

Immediate past RAWCS Chairman PDG John McLaren commenced this session describing the extensive reorganisation and governance strengthening work that had been completed by the RAWCS Ltd Board over the past few years. RAWCS is a facilitating organisation making it simple for Rotary Clubs to develop and complete overseas aid projects. RAWCS currently receives and manages >$30 million in donations for Australian overseas aid projects. RAM and DIK are the only national projects of RAWCS.

Then followed a short presentation on ‘Branding’ , that had been produced by RDU, to explain the benefits to RAWCS and large projects like RAM of consistent brand identification. This provided context to discuss the new RAM leaflets and promotions in RDU.

RAM’s website was displayed and delegates were informed that the site would be upgraded during the year to be phone and tablet friendly and better integrated with the new RAWCS website. Project descriptions, the current home page video and the donations routine were all demonstrated. Delegates were asked to look for opportunities to post RAM activity short reports on the RAM Facebook page and prepare reports for their District enews and RDU.

The ‘RAM Chairs Information Kit’ developed for last year’s Conference was revisited, demonstrated and explained as were the RAM Annual Report and a briefing paper developed for lobbying high level RI decision makers. All of this material and the Conference presentations will be circulated to RAM Chairs and Committee members via USB storage sticks or Dropbox post Conference.

 

PP David Pearson.

National Chairman: Rotarians Against Malaria.

2015 Report: (Download complete pdf Version)