Interview with Dr. Lawrence Barat: President's Malaria Initiative launches new six-year strategy

The UCSF Global Health Group's Malaria Elimination Initiative (MEI) got the chance to interview Dr. Lawrence Barat, a Senior Technical Advisor for the President's Malaria Initiative (PMI). PMI is led by the U.S. Agency for International Development (USAID) and implemented together with the Centers for Disease Control and Prevention (CDC). Find out how PMI's new six-year strategy (2015-2020) will impact malaria elimination efforts, below:

The new President's Malaria Initiative (PMI) strategy 2015-2020 was launched this week. What are the main features of the strategy and how does it differ from the previous strategy?

The PMI Strategy for 2015-2020 builds on the successes and lessons learned through PMI's support to countries and working with key partners and stakeholders. The strategy goal focuses on further reducing mortality from malaria in PMI-supported countries, but also puts an increased focus on reducing malaria cases. In a subset of its supported countries, those that have made significant progress in reducing mortality and morbidity, PMI will assist countries to move towards pre-elimination.

The new PMI strategy has a renewed focus on malaria elimination. Could you briefly describe any new approaches or work in PMI target countries that will impact malaria elimination efforts? How does PMI's strategy and work align with global strategies, including the new Global Technical Strategy for Malaria (2016-2030), that emphasize the acceleration of malaria elimination efforts?

First and foremost, in those countries moving towards elimination, we must sustain coverage of key malaria control interventions. Failure to do so will almost certainly result in a resurgence of malaria. In some situations, some control measures may be applied in a more targeted manner, but those decisions must be evidence-based and tailored to specific country context. In addition, increased focus must be placed on strengthening disease surveillance and monitoring systems, to ensure that all malaria cases are identified and those cases followed up. We also anticipate that new tools and approaches will be needed. PMI will play an important role in piloting and implementing these tools as they are shown to be effective.

PMI's goal of reducing malaria mortality and morbidity, with a long term goal of elimination and ultimate eradication of malaria strongly aligns with the goals and targets outlined in the GTS and GMAP2.

PMI does quite a bit of work in the Mekong. How does the PMI strategy address the challenges of artemisinin resistance in the region? What role do you think malaria elimination will play in addressing this challenge?

One of our five strategic focus areas for the PMI Strategy 2015-2020 emphasizes mitigating risks to current malaria control interventions. This includes the challenges of both drug and insecticide resistance. PMI already supports countries in the Greater Mekong Subregion to monitor malaria treatment efficacy throughout the region and also supports countries efforts to identify sub-standard and counterfeit drugs and remove them from the market. PMI also has put a strong emphasis on scaling up diagnostic testing for malaria at facility and community level, to limit the overuse of ACTs and has supported countries in reviewing and revising their malaria treatment policies when current first-line treatments are failing.

In your opinion, what role do country-driven regional initiatives, like the Elimination 8 (E8) and the Asia Pacific Malaria Elimination Network (APMEN), play in driving down malaria and preventing reintroduction? How do these regional initiatives impact PMI's work?

PMI supports the efforts of countries to work together to address mutual challenges of malaria control. We have supported the development of the Asia Pacific Malaria Leaders Alliance and their focus on issues of drug quality and malaria elimination. PMI also looks to groups like APMEN and Elimination 8 to disseminate lessons learned and best practices for pre-elimination and elimination that we can then help apply in PMI supported countries that are moving towards pre-elimination and elimination.

Many in the global health community acknowledge there has been a recent paradigm shift that aims to transform the vision of a malaria-free world into a reality within a generation. Since PMI is a U.S. Government program that has garnered bipartisan Congressional support, have U.S. lawmakers acknowledged this new framing or discussed how their investments can support this goal?

PMI has been fortunate to have broad bipartisan support from Congress and the support of President Obama. That continued support is, in large part, due to PMI and its partners to demonstrate progress in reducing malaria burden. Continued support for PMI will be contingent on our ability to continue to demonstrate results from our support for malaria control.