World Malaria Day Interview: Sherwin Charles

Ian MatthewsNews

GBCHealth spoke with Sherwin Charles, Global Fund Board Member for the Private Sector Constituency at The Global Fund, CEO and co-founder of Goodbye Malaria, a South Africa-based initiative focused on fighting malaria, about how the organization is sustaining the fight against malaria during the time of COVID-19, and about how the global community can approach fighting the two diseases simultaneously.

Goodbye Malaria believes our generation can create innovative solutions that ultimately change the way the world sees Africa. The initiative facilitates public-private partnerships, bringing together the private sector, the governments of Mozambique, Swaziland and South Africa as well as The Global Fund while supporting and catalyzing on-the-ground malaria elimination programs.

Goodbye Malaria’s flagship program is LSDI2 (known in country as Tchau Tchau Malaria), a cross-border, regional program working in South Africa, Eswatini (formerly Swaziland) and Mozambique. The program works directly with the Mozambican Health Department’s National Malaria Control Program in a unique public-private partnership.

Mozambique, as a high malaria transmission country, shares 3% of the global malaria burden, while Swaziland and South Africa are low transmission countries. This makes it a strategic area to tackle if elimination in Southern Africa is to be achieved. Most of the work undertaken by the LSDI2 program is therefore focused on Southern Mozambique, in Maputo Province.

Read the interview below.


GBCHealth:

Can you give us some background on what’s been going on recently with Goodbye Malaria – pre COVID-19?

Sherwin Charles:

We were pretty proud of what the team had achieved over the past few months. They covered South Africa, Eswatini, and Mozambique – with different malaria programs in each of the three countries, although our emphasis is in Mozambique where the burden of disease is highest.

The IRS (Indoor Residual Spraying) program is implemented in Mozambique by Tchau Tchau Malaria. During the last spray season, we protected over 1.7 million people by spraying over 450,000 houses. If you look at the area that was covered by Goodbye Malaria… it would be bigger than some European countries. So, it was quite an impressive task. Further, when you look at the data from the southern part of Mozambique, we were getting close to pre-elimination; and our aim is elimination within the next few years.

They’ve expanded the program significantly. It’s a unique PPP that includes the private sector, The Global Fund and the three governments. This regional grant from The Global Fund is unique in that the private sector contributions account for more than 75% of the grant.

GBCH:

What are some of the ways that COVID-19 is creating challenges in the fight against malaria?

SC:

The pandemic is putting quite a heavy burden on the health systems, creating an extra challenge as we approach malaria season within high burden countries. During the height of malaria season, approximately 70% of the hospital beds are occupied with malaria cases. With the pandemic, most of the health facilities will have large areas quarantined and closed off. Secondly, there will be a vast reduction in beds that will be available to treat critical malaria cases.

So, we certainly find ourselves with a real challenge when it comes to malaria-endemic countries. I think it places a much, much higher priority on delivery of malaria prevention interventions in the coming weeks and months.

Our concern is based on past experiences, when during the Ebola outbreaks, you knew more people were dying from malaria than from Ebola.

Another challenge is the similarity in symptoms [between malaria and COVID-19]. In Africa, or in any endemic country, when someone has a fever – asking them to self-isolate or quarantine if you haven’t tested them for malaria first is a huge risk.

GBCH:

More specifically, how is COVID-19 impacting Goodbye Malaria’s work today?

SC:

The teams at Goodbye Malaria are doubling their efforts around planning, and around a redesign of how we implement critical interventions on the ground with social distancing in place. How do you do a net distribution while protecting the distribution staff? How do you implement an IRS campaign with social distancing, when this takes you to every single person’s house?

Further, most of these interventions are donor-funded, with budgets that were created months or years in advance and may no longer be enough to accommodate new guidelines for implementation. So, funding becomes a double challenge for the team.

It may be clichéd, but you really have to think outside the box today to get these (malaria interventions) done. The use of technology, new innovations and a revived implementation plan are critical to continued success.  

In the same way that we’ve all learnt how working from home can work for each of us in our different industries and business environments, we’re going to have to find the “BlueJeans.com and Zoom” of malaria control around IRS, bed nets and larvaciding pretty quickly.

GBCH:

Looking slightly ahead, how do you see COVID-19 affecting Goodbye Malaria’s activities in the fight to eliminate malaria?

SC:

Our fear right now is that the program can be severely impacted by the pandemic. And it starts with the training of 2,500 spray operators who will begin their training in July.

The biggest problem we are facing is that circumstances change on a daily and weekly basis; so any of the long-term plans that you may have put in place can change overnight. This is truly a situation of all hands-on deck, and it’s pretty tough right now.

Agility with a rapid response mechanism is needed.

There was a calculation done recently with regards to the cost of net distribution within a country under lockdown; in this scenario it’s estimated that the distribution of LLINs alone (long-lasting insecticide-treated nets) may cost at least 30% more.

We’re working in close collaboration with The Global Fund, the WHO, many of the big NGOs, and a lot of the research partners, to figure out how we achieve malaria prevention within the current environment – while safeguarding our employees when they’re going house-to-house spraying people’s homes. Technical partners, like WHO and RBM Partnership to End Malaria, become critically important as we lean on them for the technical guidance and insights to help us get this right.

And when we talk about solidarity, and about advocacy playing such an important role in what we are going to achieve, the advocacy piece is key to inform and educate these communities about what we will be doing and what action they need to take.

GBCH:

Is there anything that you learned from setting up Goodbye Malaria, in terms of aligning diverse stakeholders to fight malaria, or any challenges that were overcome in that process that can be applied to new PPPs, and other efforts against malaria, COVID and other diseases?

SC:

Most important is the alignment of all the parties to the goals and objectives that have been set, and the building of trusted relationships. During these times, you can plan all you want but you need the trusted relationships between the parties to succeed. There’s no second-guessing; there’s no doubting what the partnership is looking to achieve and how that’s going to be done. So it’s absolutely crucial to get that right.

Secondly, nothing beats in-depth planning and securing cash-flow. We’re well aware that PPE (personal protective equipment) is in short supply with high demand. So, how do we get PPE for our spray operators to protect them throughout the spray season?

Applying business principles to our public health efforts implies an understanding of our supply chain.  We always prioritize logistics and have risk mitigation measures in place, ensuring all elements are in place at the start of the program.

Our public-private partnerships are evidence of how collaboration can lead to meaningful impact, and whilst we’re proud to have saved over a million lives this past spray season, the reality is that there are many more lives to save.

The learnings from this can now be applied across other IRS programs in Africa.

The main challenge for Goodbye Malaria is to ensure sustainability of the program through to the elimination of malaria by 2030. We allow other partners to have a platform to invest in a project that they know will be grounded in good business practices and processes. We will ensure that the right measures and indicators are in place to show objectively the impact of the program.

I am reminded that we are a values-based organization. All initiatives and activities from day one have been based on our core set of values that drive everything we do. Goodbye Malaria exists to help humans. We are constantly humbled by the opportunity to impact the lives of others, and these same principles apply to dealing with the pandemic, believing that human ingenuity and responsibility is the greatest catalyst for impacting global society. One of our values is true grit. We knew that eradicating malaria was never going to be easy; it is going to take belief and endurance, backbone and sweat. It takes overcoming every challenge with conviction and grit, but we are in it together, so we are stronger. When we are determined to seize every opportunity we can do anything imaginable.

GBCH:

Any final thoughts on the fight against malaria and COVID as we approach World Malaria Day?

SC:

COVID gives us an advocacy moment around WMD to really highlight the challenges faced by the malaria-vulnerable communities, and really emphasize in the eye of the pandemic, please don’t forget about our fight against malaria.  There’s still a lot of effort needed on the malaria front.

The economic downturn and impact is going to be disastrous, and it’s going to take strong-willed individuals and true leadership to pull us out of this. And I must say that we’re blessed right now in South Africa to have the political leadership that we do; they’ve really been forward thinking and proactive in dealing with the challenge, which has really been a blessing to the country right now.

But tough days are ahead. It’s going to call for partnerships like never before. Egos, logos and pride must all be left at the door. This is us standing together and fighting against a greater evil.

We need to ensure that our malaria voice is heard amongst all this noise, and that we from the malaria community go the extra mile to make it work. We are going to have to be forceful; we are going to have to be innovative, and we are not going to give up. Because the minute we relax what we are doing for malaria, we are going to see the disease come back with a vengeance, as we have seen this in the past. Let’s rather be proactive and find ways to make it happen.  Because every life counts.

Ian MatthewsWorld Malaria Day Interview: Sherwin Charles