1
|
Kollipara A, Moonasar D, Balawanth R, Silal SP, Yuen A, Fox K, Njau J, Pillay YG, Blecher M. Mobilizing resources with an investment case to mitigate cross-border malaria transmission and achieve malaria elimination in South Africa. Glob Health Action 2023; 16:2205700. [PMID: 37158217 PMCID: PMC10171117 DOI: 10.1080/16549716.2023.2205700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023] Open
Abstract
South Africa's effort to eliminate malaria is significantly challenged by a large number of imported malaria cases, especially from neighbouring Mozambique. The country has a funding gap to achieve its malaria elimination goals (prior to 2019) and is ineligible to receive a national allocation from the Global Fund. The findings of an IC were utilised to successfully mobilise resources for malaria elimination in South Africa in 2018. A five-step resource mobilisation strategy was implemented to highlight financing challenges and leverage the economic evidence from an IC for malaria elimination in South Africa. South Africa's malaria programme implements control and elimination activities in three malaria-endemic provinces (KwaZulu Natal, Limpopo, and Mpumalanga). Driven by the IC findings, the South African government took an unprecedented step and increased total domestic malaria financing by approximately 36%, from the 2018/19 to the 2019/20 financial years through the creation of a new conditional grant for malaria. The IC findings predicted that malaria control in southern Mozambique is a prerequisite to eliminate malaria in South Africa. Based on this, the South African government also allocated funding towards a co-financing mechanism to support malaria control efforts in southern Mozambique. The IC findings assisted the South African National Department of Health to make a convincing case to key government decision-makers to invest in national malaria elimination and maximise economic returns in the long run. The South African government is the first in Southern Africa to mobilise a significant increase in domestic malaria financing to address the financial sustainability of both national and regional malaria elimination efforts. Continued surveillance activities will be required to prevent the re-establishment of malaria transmission even after malaria elimination is achieved in South Africa. Information sharing and close collaboration with provincial and national government officials were key to the successful outcome.
Collapse
Affiliation(s)
- Aparna Kollipara
- San Francisco Global Health Group, Malaria Elimination Initiative at the University of California, San Francisco, CA, USA
| | - Devanand Moonasar
- National Department of Health, Malaria Vector and Zoonotic Disease Directorate, Pretoria, South Africa
- School of Public Health and Health Systems, University of Pretoria, Pretoria, South Africa
| | - Ryleen Balawanth
- South Africa Regional Office, Clinton Health Access Initiative, Inc. (CHAI), Pretoria, South Africa
| | - Sheetal P Silal
- Modelling and Simulation Hub, Africa (MASHA), Department of Statistical Sciences, University of Cape Town, Cape Town, South Africa
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, Oxford University, Oxford, UK
| | - Anthony Yuen
- South Africa Regional Office, Clinton Health Access Initiative, Inc. (CHAI), Pretoria, South Africa
| | - Katie Fox
- San Francisco Global Health Group, Malaria Elimination Initiative at the University of California, San Francisco, CA, USA
| | - Joseph Njau
- JoDon Consulting Group, Health Economist, Lilburn, GA, USA
| | - Yogan G Pillay
- National Department of Health, Malaria Vector and Zoonotic Disease Directorate, Pretoria, South Africa
- Affiliate Center for Innovation in Global Health, Georgetown University, Washington, DC, USA
| | - Mark Blecher
- Public Finance Division, National Treasury, Pretoria, South Africa
| |
Collapse
|
2
|
Njau J, Silal SP, Kollipara A, Fox K, Balawanth R, Yuen A, White LJ, Moya M, Pillay Y, Moonasar D. Investment case for malaria elimination in South Africa: a financing model for resource mobilization to accelerate regional malaria elimination. Malar J 2021; 20:344. [PMID: 34399767 PMCID: PMC8365569 DOI: 10.1186/s12936-021-03875-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 08/05/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Malaria continues to be a public health problem in South Africa. While the disease is mainly confined to three of the nine provinces, most local transmissions occur because of importation of cases from neighbouring countries. The government of South Africa has reiterated its commitment to eliminate malaria within its borders. To support the achievement of this goal, this study presents a cost-benefit analysis of malaria elimination in South Africa through simulating different scenarios aimed at achieving malaria elimination within a 10-year period. METHODS A dynamic mathematical transmission model was developed to estimate the costs and benefits of malaria elimination in South Africa between 2018 and 2030. The model simulated a range of malaria interventions and estimated their impact on the transmission of Plasmodium falciparum malaria between 2018 and 2030 in the three endemic provinces of Limpopo, Mpumalanga and KwaZulu-Natal. Local financial, economic, and epidemiological data were used to calibrate the transmission model. RESULTS Based on the three primary simulated scenarios: Business as Usual, Accelerate and Source Reduction, the total economic burden was estimated as follows: for the Business as Usual scenario, the total economic burden of malaria in South Africa was R 3.69 billion (USD 223.3 million) over an 11-year period (2018-2029). The economic burden of malaria was estimated at R4.88 billion (USD 295.5 million) and R6.34 billion (~ USD 384 million) for the Accelerate and Source Reduction scenarios, respectively. Costs and benefits are presented in midyear 2020 values. Malaria elimination was predicted to occur in all three provinces if the Source Reduction strategy was adopted to help reduce malaria rates in southern Mozambique. This could be achieved by limiting annual local incidence in South Africa to less than 1 indigenous case with a prediction of this goal being achieved by the year 2026. CONCLUSIONS Malaria elimination in South Africa is feasible and economically worthwhile with a guaranteed positive return on investment (ROI). Findings of this study show that through securing funding for the proposed malaria interventions in the endemic areas of South Africa and neighbouring Mozambique, national elimination could be within reach in an 8-year period.
Collapse
Affiliation(s)
- Joseph Njau
- JoDon Consulting Group, 4501 Forest View Court, Lilburn, GA, 30047, USA
| | - Sheetal P Silal
- Modelling and Simulation Hub, Africa (MASHA), Department of Statistical Sciences, University of Cape Town, Cape Town, South Africa.
- Nuffield Department of Medicine, Centre for Global Health, Oxford University, Oxford, UK.
| | - Aparna Kollipara
- Health Economist and Health Financing Specialist, California Public Health Department, Sacramento, USA
| | - Katie Fox
- Department of Global Health at the School of Medicine and Packard Foundation, University of California San Francisco, San Francisco, CA, USA
| | - Ryleen Balawanth
- Clinton Health Access Initiative (CHAI), South Africa Regional Office, Pretoria, South Africa
| | - Anthony Yuen
- Clinton Health Access Initiative (CHAI), South Africa Regional Office, Pretoria, South Africa
| | - Lisa J White
- Big Data Institute, Nuffield Department of Medicine, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, UK
| | - Mandisi Moya
- Modelling and Simulation Hub, Africa (MASHA), Department of Statistical Sciences, University of Cape Town, Cape Town, South Africa
| | - Yogan Pillay
- Center for Innovation in Global Health, Georgetown University, Georgetown, USA
- Malaria Vector and Zoonotic Disease Directorate, National Department of Health, Pretoria, South Africa
| | - Devanand Moonasar
- Malaria Vector and Zoonotic Disease Directorate, National Department of Health, Pretoria, South Africa
- School of Health Systems and Public Health, University of Pretoria, Pretoria, South Africa
| |
Collapse
|
3
|
O'Meara CP, Armitage CW, Kollipara A, Andrew DW, Trim L, Plenderleith MB, Beagley KW. Induction of partial immunity in both males and females is sufficient to protect females against sexual transmission of Chlamydia. Mucosal Immunol 2016; 9:1076-88. [PMID: 26647717 DOI: 10.1038/mi.2015.125] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2015] [Accepted: 10/22/2015] [Indexed: 02/04/2023]
Abstract
Sexually transmitted Chlamydia trachomatis causes infertility, and because almost 90% of infections are asymptomatic, a vaccine is required for its eradication. Mathematical modeling studies have indicated that a vaccine eliciting partial protection (non-sterilizing) may prevent Chlamydia infection transmission, if administered to both sexes before an infection. However, reducing chlamydial inoculum transmitted by males and increasing infection resistance in females through vaccination to elicit sterilizing immunity has yet to be investigated experimentally. Here we show that a partially protective vaccine (chlamydial major outer membrane protein (MOMP) and ISCOMATRIX (IMX) provided sterilizing immunity against sexual transmission between immunized mice. Immunizing male or female mice before an infection reduced chlamydial burden and disease development, but did not prevent infection. However, infection and inflammatory disease responsible for infertility were absent in 100% of immunized female mice challenged intravaginally with ejaculate collected from infected immunized males. In contrast to the sterilizing immunity generated following recovery from a previous chlamydial infection, protective immunity conferred by MOMP/IMX occurred independent of resident memory T cells. Our results demonstrate that vaccination of males or females can further protect the opposing sex, whereas vaccination of both sexes can synergize to elicit sterilizing immunity against Chlamydia sexual transmission.
Collapse
Affiliation(s)
- C P O'Meara
- Department of Infectious Diseases, Institute of Health and Biomedical Innovation (IHBI), Queensland University of Technology (QUT), Brisbane, Queensland, Australia.,Department of Developmental Immunology, Max Planck Institute of Immunobiology and Epigenetics, Freiburg, Baden-Wüttemburg, Germany
| | - C W Armitage
- Department of Infectious Diseases, Institute of Health and Biomedical Innovation (IHBI), Queensland University of Technology (QUT), Brisbane, Queensland, Australia
| | - A Kollipara
- Department of Infectious Diseases, Institute of Health and Biomedical Innovation (IHBI), Queensland University of Technology (QUT), Brisbane, Queensland, Australia
| | - D W Andrew
- Department of Infectious Diseases, Institute of Health and Biomedical Innovation (IHBI), Queensland University of Technology (QUT), Brisbane, Queensland, Australia.,Department of Infectious Diseases, Centre for Biomedical Research, Burnet Institute, Melbourne, Victoria, Australia
| | - L Trim
- Department of Infectious Diseases, Institute of Health and Biomedical Innovation (IHBI), Queensland University of Technology (QUT), Brisbane, Queensland, Australia
| | - M B Plenderleith
- Department of Biomedical Sciences, Neuroscience Laboratory-School of Biomedical Science, Queensland University of Technology (QUT), Brisbane, Queensland, Australia
| | - K W Beagley
- Department of Infectious Diseases, Institute of Health and Biomedical Innovation (IHBI), Queensland University of Technology (QUT), Brisbane, Queensland, Australia
| |
Collapse
|
4
|
Kollipara A, Bryan E, Trimm L, Carey A, McLaughlin E, Johnston S, Beagley K. Chlamydia infection in males; an underappreciated problem. J Reprod Immunol 2016. [DOI: 10.1016/j.jri.2016.04.160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
5
|
Blecher MS, Meheus F, Kollipara A, Hecht R, Cameron NA, Pillay Y, Hanna L. Financing vaccinations - the South African experience. Vaccine 2013; 30 Suppl 3:C79-86. [PMID: 22939027 DOI: 10.1016/j.vaccine.2012.04.042] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2011] [Revised: 03/14/2012] [Accepted: 04/10/2012] [Indexed: 11/24/2022]
Abstract
South Africa provides a useful country case study for financing vaccinations. It has been an early adopter of new vaccinations and has financed these almost exclusively from domestic resources, largely through general taxation. National vaccination policy is determined by the Department of Health, based on advice from a national advisory group on immunisation. Standard health economic criteria of effectiveness, cost-effectiveness, affordability and burden of disease are used to assess whether new vaccinations should be introduced. Global guidelines and the advice of local and international experts are also helpful in making the determination to introduce new vaccines. In terms of recent decisions to introduce new vaccines against pneumococcal disease and rotavirus diarrhoea in children, the evidence has proved unequivocal. Universal rollout has been implemented even though this has led to a fivefold increase in national spending on vaccines. The total cost to government remains below 1-1.5% of public expenditures for health, which is viewed by the South African authorities as affordable and necessary given the number of lives saved and morbidity averted. To manage the rapid increase in domestic spending, efforts have been made to scale up coverage over several years, give greater attention to negotiating price reductions and, in some cases, obtain initial donations or frontloaded deliveries to facilitate earlier universal rollout. There has been strong support from a wide range of stakeholders for the early introduction of new generation vaccines.
Collapse
Affiliation(s)
- Mark S Blecher
- National Treasury, Private Bag X115, Pretoria, South Africa.
| | | | | | | | | | | | | |
Collapse
|