The WHO Regional INCEPTION MEETING ON THE MALARIA ELIMINATION INITIATIVE IN THE WHO EUROPEAN REGION Office for Europe The World Health Organization (WHO) is a specialized agency of the United Nations created in 1948 with the primary responsibility for international health matters and public health. The WHO Regional Office for Europe is one of six regional offices throughout the world, each with its own programme geared to the particular health conditions of the countries it serves. Member States Albania Andorra Armenia Austria Azerbaijan Belarus Belgium Bosnia and Herzegovina Bulgaria Croatia Cyprus Czech Republic Denmark Estonia Finland France Georgia Germany Greece Hungary Inception meeting Iceland Ireland Israel Italy on the malaria Kazakhstan Kyrgyzstan Latvia elimination initiative Lithuania Luxembourg Malta Monaco Netherlands Norway Poland in the WHO European Region Portugal Republic of Moldova Romania Russian Federation San Marino Serbia and Montenegro Tashkent, Uzbekistan Slovakia Slovenia 18-20 October 2005 Spain Sweden Switzerland Tajikistan The former Yugoslav Republic of Macedonia Turkey Turkmenistan Ukraine United Kingdom Uzbekistan World Health Organization 5059447 Regional Office for Europe E87976 Scherfigsvej 8, DK-2100 Copenhagen Ø, Denmark Original: English Tel.: +45 39 17 17 17. Fax: +45 39 17 18 18. E-mail: [email protected] Unedited Web site: www.euro.who.int INCEPTION MEETING ON THE MALARIA ELIMINATION INITIATIVE IN THE WHO EUROPEAN REGION Report on a WHO meeting Tashkent, Uzbekistan 18 – 20 October 2005 ABSTRACT The rationale for organizing this meeting is that the demonstrated feasibility of malaria elimination in the past, the visible impact of Roll Back Malaria (RBM) interventions at present, the strong political commitments to move further from malaria control to elimination at national level, and the availability of effective control technologies and tools, may facilitate future decisions towards undertaking the new elimination effort within malaria-affected countries of the WHO European Region. Participants greatly appreciated the efforts made by countries, WHO and RBM partners to contain large-scale epidemics of malaria and reduce its burden. Participants reaffirmed their commitment to the declared goals and objectives of the present regional malaria control strategy, and recognized the need to consolidate the results achieved and to move further from malaria control to elimination. Participants emphasized the need to ensure that malaria-affected countries are fully supported in their endeavours to enhance national malaria control and elimination campaigns in order to achieve a greater impact on the regional malaria situation. Participants welcomed the Regional Initiative “To Move from Malaria Control to Elimination” and recommended the Tashkent Declaration to be endorsed by all the participating countries in order to make it operational and to go into effect. Keywords MALARIA – prevention and control PROGRAM EVALUATION STRATEGIC PLANNING INTERINSTITUTIONAL RELATIONS INTERNATIONAL COOPERATION GUIDELINES EUROPE EUR/05/5059447 Address requests about publications of the WHO Regional Office for Europe to: Publications WHO Regional Office for Europe Scherfigsvej 8 DK-2100 Copenhagen Ø, Denmark Alternatively, complete an online request form for documentation, health information, or for permission to quote or translate, on the WHO/Europe web site at http://www.euro.who.int/pubrequest. © World Health Organization 2005 All rights reserved. The Regional Office for Europe of the World Health Organization welcomes requests for permission to reproduce or translate its publications, in part or in full. 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The World Health Organization does not warrant that the information contained in this publication is complete and correct and shall not be liable for any damages incurred as a result of its use. The views expressed by authors or editors do not necessarily represent the decisions or the stated policy of the World Health Organization. 2 CONTENTS EXECUTIVE SUMMARY 4 INTRODUCTION 9 Scope and purpose of the meeting 9 Inaugural session 9 Organization of the meeting 10 WORLD UPDATE ON ROLL BACK MALARIA 10 PROGRESS WITH ROLL BACK MALARIA IN THE WHO EUROPEAN REGION 12 WHO European Region 12 Armenia 14 Azerbaijan 15 Georgia 15 Turkey 16 Kazakhstan 16 Kyrgyzstan 17 Tajikistan 17 Turkmenistan 18 Uzbekistan 18 Bulgaria 19 The Republic of Moldova 20 The Russian Federation 20 PROGRESS WITH ROLL BACK MALARIA IN THE WHO EASTERN MEDITERRANEAN REGION 20 WHO Eastern Mediterranean Region 20 Islamic Republic of Iran 22 The Syrian Arab Republic 22 Afghanistan 23 RESEARCH AND STRATEGY DEVELOPMENT 24 Review of malaria vectors and their biology in countries of the WHO European Region 24 Analysis of different Anopheles species in the WHO European Region using cytogenetical, molecular and genetic techniques 25 PCR detection and identification of genetic differences in malaria parasites infecting human subjects in Central Asia 25 Malaria elimination and its application to malaria affected countries in the WHO European Region 26 SCALING UP ROLL BACK MALARIA PARTNERSHIPS 27 Sharing Global Experience (by RBM WHO/headquarters) 27 Mobilizing and deploying resources (by USAID/CAR) 28 Progress with Roll Back Malaria partnership in Central Asia (by RBM WHO/Europe) 29 Progress with Roll Back Malaria partnership in Central Asia (by ACTED) 31 Progress with implementation of the Global Fund malaria project in Georgia (by GFATM) 31 CONCLUSIONS 33 RECOMMENDATIONS 34 TASHKENT DECLARATION 38 ANNEXES 42 Annex1 42 Annex 2 44 3 EXECUTIVE SUMMARY The meeting took place six years following the development of a regional strategy to roll back malaria and its successful implementation in malaria affected countries of the WHO European Region. The aim of the regional strategy, which is being implemented, is to reduce the impact of the disease on the health of the population to the lowest possible level that can be achieved with the available financial and manpower resources, existing control technologies and tools. The regional resolution “Scaling up the response to malaria in the European Region of WHO“, endorsed by all Member States in September 2002, urged countries of the Region confronting the resurgence of malaria to take all possible measures aimed at containing malaria epidemics and reducing further the burden of malaria. The reduction in the reported number of malaria cases by almost four-fold over the past six years is the most conspicuous achievement of the regional Roll Back Malaria programme so far. Each successful milestone in the reduction of a disease allows for the establishment of new and more demanding objectives along the path to achieving these goals. The rationale for organizing the meeting was that the demonstrated feasibility of malaria elimination in the past, the visible impact of Roll Back Malaria (RBM) interventions at present, the will to move further from malaria control to elimination at national level, and the availability of the efficacious tools to control and eliminate malaria in the regional context, may facilitate future decisions towards undertaking the new elimination effort within malaria-affected countries of the WHO European Region. The meeting was convened (1) to report on achievements and to share experiences with rolling back malaria between countries and regions; (2) to review existing practical modalities on dealing with malaria and identify problems encountered in participating countries; (3) to streamline mechanisms for more effective RBM partnership action at sub-regional and country levels; (4) to promote cross-border cooperation; and (5) to stimulate the flow of additional resources for malaria control and elimination, including innovative financial mechanisms (e.g. GFATM). The following countries were represented: Afghanistan, Armenia, Azerbaijan, Bulgaria, Georgia, Iran, Kazakhstan, Kyrgyzstan, Republic of Moldova, the Russian Federation, Syria, Tajikistan, Turkmenistan, Turkey and Uzbekistan. WHO was represented with staff from WHO headquarters, the Regional Offices for Europe and the Eastern Mediterranean. Representatives and experts from USAID/CAR, GFATM headquarter, Georgia, Uzbekistan, ECHO/Central Asia, ACTED/Central Asia, the Martsinovsky Institute of Medical Parasitology and Tropical Medicine/Moscow, the Central Institute for Postgraduate Medical Training/Moscow, the Vavilov Institute of General Genetics/Moscow and Vestergaard Frandsen/ Middle East attended the meeting as well. The efforts made by the countries, WHO and RBM partners to contain large-scale epidemics of malaria and reduce its burden are greatly