Introductory Remarks at the Oslo Malaria Conference: Getting to Zero

Check against delivery.
The Minister based his speech on the following points: 

Your Majesty,
Excellencies, friends and guests, 

• It is a great pleasure for me to see such a gathering of engaged individuals, world leaders and old friends in the fields of global health. A highly competent, experienced and engaged group of people. For me personally it is an additional pleasure that we are gathered in my old workplace – the Norwegian Red Cross. It gives me “good vibrations”. Indeed, it is like “coming home”, to be back here in the Henri Dunant conference room, where the Red Cross has raised so many important issues, issues that are part of the Red Cross’ humanitarian mandate and agenda.
• For me, this meeting is quite nostalgic as well, remembering 10–20 years back. The fight against malaria has been a priority for me ever since I accompanied Dr Brundtland to Africa in 1997 to consult African leaders prior to her appointment as Director-General of the World Health Organization.
• Everywhere we went, Dr Brundtland asked government ministers, “What is your first health priority?” And we were told that malaria – the disease of the poor – was the biggest health problem and deserved the highest priority. As a result, malaria became the no 1 priority for the WHO in 1998. Later, we also made it a government priority in Norway.
• The Roll Back Malaria initiative was launched that year by the United Nations agencies WHO, UNICEF and UNDP, together with the World Bank. It was a bold new effort that meant a global partnership of governments, donors, NGOs and local communities – to effectively tackle the increasing global problem of malaria. Now, we had come to a “new age” of health partnerships. I took part in coining the concept “roll back”. To “stop” or “eradicate” would have been too ambitious, impossible. Therefore “roll back”: to stop the tide, to push back. That is how we wanted to describe the campaign. The leadership of the WHO. The health sector was/is in many ways an innovative sector – lessons learned, evaluated, learning to work in different ways.
• As I learned more about malaria, I also saw how health challenges have an impact far beyond the health sector. How health issues can have an impact even in the fields of security and foreign policy. I realised that global health is a foreign policy issue. That there is a link here. Just think about one aspect: failed states, health sector not working, world security risks.
• So, what are the lessons I have learned? Where are the links?
• As a foreign minister, at least three key observations that I want to share with you at the opening of this conference:
• Firstly, in an overall perspective, as I already mentioned, we need better advocacy to focus attention on the connection between health and foreign policy.
• How? One thing (among many others), experts – like you – need to produce evidence and develop language that helps me, us, decision-makers, understand this point – this connection – and see its relevance: health and foreign relations.
• We need to continually show – by argument, experience, and research – the foreign policy implications of (bad or good) global health security. That the most efficient and successful partnerships grow out of international cooperation. That disease in one region can adversely affect the health and well-being of other regions.
• This has been demonstrated in recent years through the spread of diseases such as SARS and Avian flu.
• Epidemics do not know – of course not – national or continental boundaries. Cannot be stopped. So, it goes without saying, we must tackle the threat of malaria as a trans-national, global challenge – through collaborative partnerships and effective financing.
• Therefore, it is imperative to build support for political initiatives that promote a coherent global response to health issues.
• One example: the G8 commitment to focus on child and maternal health, and on HIV/AIDS, as a security issue. Another: the UN Secretary-General’s global strategy for women’s and children’s health, which has mobilised pledges of almost USD 40 billion.
• We can all work – as individual states or in small groups of states – to promote such efforts. Norway’s Prime Minister Jens Stoltenberg’s work on the health Millennium Development Goals (4 and 5) is a good example, as is President Obama’s global health initiative. Bold initiatives matter.
• Now, secondly, we need to strengthen health systems.
• Many of the most important barriers to effective prevention and treatment of malaria, especially amongst the poorest and most vulnerable, can only be overcome by addressing weaknesses in public health care systems (vertical vs. horizontal). Often “simple” and “cheap” solutions – bed nets. Concrete, helps mobilisation.
• We must focus on how malaria interventions can be integrated into normal general practice.
• One example: Ethiopia has taken a successful step in this direction. In 2003, an innovative and ambitious programme was introduced to train two high school graduates per village to act as health advisers, and to equip them with a simple kit for diagnosing malaria.
• These health care extension workers, in addition to increased focus and attention on the disease, have halved the number of people who die from malaria in the last three years. Measures have included the distribution of nearly 20 million insecticide-treated bed nets and widespread use of anti-malaria drugs.
• And the result has been a dramatic fall in deaths from a disease that used to kill one in four people in Ethiopia. In addition, countries such as Eritrea and Rwanda have reported declines of 50% or more in the number of malaria cases and deaths following intensified efforts in recent years. Simple tools. Mobilisation.
• The human costs of malaria are evident, but so too are the economic costs of the disease. Budget implications. So, my third observation or comment is that we need to mobilise funding.
• Countries where malaria is endemic are among the poorest in the world, and typically have very low rates of growth. This is directly linked to the prevalence of the disease.
• Malaria impedes economic growth and long-term development in many ways:
• It has a negative effect on the flow of trade, foreign investment and business activities. Tourists tend to avoid regions with high malaria, as do multinational firms, which will look for alternative locations to set up business.
• The total human costs of malaria are also far-reaching. Not only is it a major cause of infant and child mortality, repeated bouts of malaria can slow a children’s physical and cognitive development, and thus – of course – have an effect on education, amongst other things.
• This all means that combating malaria not only saves lives, but also improves economic and social development.
• And this is why initiatives such as Roll Back Malaria – mobilising private, public and voluntary sectors – are so important.
• Funding is always a key factor for development and the health sector is no exception. Adequate funding is needed to address the brain drain, to build up adequate primary healthcare infrastructure, and to provide much needed information about prevention. Experience sharing.
• However, funding is not enough in itself; funding mechanisms must be efficient and effective. An excellent example (re: the debate in 2000–2001) is the Global Fund to Fight AIDS, Tuberculosis and Malaria.
• Initially, the Global Fund was designed just to address AIDS. However, WHO (and others) was convinced that a broader focus would be more effective. Established by the G8 countries in 2000, the Global Fund addresses the gap in funding for health in an innovative way.
• It focuses on three major, growing diseases, and has, to date, saved 6.5 million lives: through the provision of AIDS treatment for 3 million people, anti-tuberculosis treatment for 7.7 million people and 160 million insecticide-treated bed nets for the prevention of malaria.
• The Global Fund has, in its ten years of existence, become the world’s most important financial health institution.
• A key factor in the Global Fund’s success is its coordinated fight against several diseases. It has focused on underlying public health issues, and the need for investment in infrastructure and better governance. Its approach is based on national ownership.
• Now, in concluding, I will emphasise that the Red Cross has played a pioneering role – among other things – in the distribution of mosquito nets. By coupling the distribution of nets with vaccination campaigns, you have been able to reach out to women who take their children to be vaccinated and provide them with mosquito nets to take home.
• Two objectives are thus achieved at once: preventing childhood diseases through vaccination and protecting people against malaria by means of mosquito nets (fighting it is not “high tech”, it is “low tech”).
• It is important to realise that today, in 2011, there is no excuse for children dying of malaria. We know how to prevent the disease with insecticide-treated bed nets, we know how to diagnose malaria with the help of microscopy or by rapid diagnostic test (RDT), and we know how to treat malaria with ACTs (artemesin based combination therapies).
• We have successfully eradicated malaria in most parts of Europe. Now we need to control this vector-born disease in Asia and Africa where it is now most rampant.
• And yet, we must not underestimate the daunting challenges. Genetic mutations have already enabled mosquitoes to become resistant to a major class of insecticides. And both the malaria mosquito and the malaria parasite are expected to spread to new areas as a result of climate change. Warmer weather. New approaches are needed.
• I am sure we will hear more about these new, innovative approaches during the conference and the panel debate on existing tools, new research and innovation. Thank you.