Port Moresby Outcome Statement

1. We, the Ministers of Health, Senior Officials, Directors of National Malaria and Vector Borne Disease Programmes, Civil Society and Partner Representatives from Papua New Guinea, Asia Pacific, and other international organizations, gathered in Port Moresby, Papua New Guinea, for the 8^th Asia Pacific Leaders’ Summit on Malaria Elimination on June 6-7, 2024, with the theme “Invest to Achieve Zero Malaria”.
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2. Welcomed by the Hon Dr Lino Tom, MP, Minister for Health, Papua New Guinea, the Summit united stakeholders to address the significant burden and impact of malaria among Pacific Island nations, as well as the need for health system investment, regional collaboration, and innovative solutions, as highlighted by the Hon Prime Minister James Marape, Papua New Guinea in his closing remarks.
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3. Productive discussions from the two-day Summit yielded the following key highlights and outcomes.

Strengthening Regional Collaboration for Malaria Control and Elimination

1. We reviewed the significant strides made in regional malaria elimination efforts, as well as the emerging challenges and the evolving landscape of the disease. We expressed concern over the surging malaria cases in 2022, which doubled in number for the first time in a decade and knocked Asia Pacific off-track on its 2030 elimination goal. Strengthening regional collaboration remains critical in improving the programmatic effectiveness and efficiency, technical capacity building and financial resource needs in countries.
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2. We commended the efforts and progress of the Greater Mekong Subregion (GMS), which highlighted the importance of data and regional collaboration in driving malaria elimination in Asia Pacific. The Regional Artemisinin-Resistance Initiative (RAI) in the GMS offers a great example where an accelerated and well-coordinated regional approach to managing the growing resistance to artemisinin did not merely contain it but also strengthened the malaria response in each country.
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3. We reaffirmed that a regional dashboard could serve as an accountability tool and to guide evidence-based decision-making for malaria elimination. The Asia Pacific Leaders’ Dashboard, revamped in late2023, incorporated new data visualization tools that can generate more insightful understanding of the achievements and challenges in malaria elimination in the Asia Pacific region. As an evolving tool, APLMA will continue to consult with stakeholders to ensure the Dashboard serves its purpose of tracking key progress metrics.
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4. We are committed to working together to eliminate malaria. Our regional approach will involve aligning priorities, supporting malaria programmes, and securing resources across Asia Pacific. By working together, countries can improve surveillance, outbreak response, advocacy, and resource mobilization, ultimately accelerating progress towards a malaria-free region.
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5. We highlighted the importance of inclusive community-led approaches for malaria elimination in Asia Pacific, which includes strengthening primary health care and integrated service delivery for disease elimination.
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6. We commended the adoption of the Call-to-Action Statement of the Eliminating Malaria and other Vector Borne Diseases through Enhanced Regional Partnerships (EDEN) Initiative, signed by the Ministers of Health from Indonesia, Papua New Guinea, Solomon Islands, Timor-Leste, and Vanuatu.
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   1. The establishment of the EDEN Initiative aims to utilize integrated approaches to address the control and elimination of malaria and relevant vector-borne diseases (VBDs) in Indonesia, Papua New Guinea, Solomon Islands, Timor-Leste, and Vanuatu.
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   2. As a potential regional support mechanism, the EDEN Initiative serves to strengthen regional surveillance for better data sharing and informed decision-making, facilitate cross-border collaboration for rapid case detection and treatment, enhance technical expertise through regional training programmes and operational research on new tools, as well as to mobilize resources through innovative financing mechanisms. It also offers the unique opportunity to share best practices in malaria control and elimination, particularly successful community-led interventions, develop and adopt new tools tailored to address the specific challenges of our region, as well as to explore innovative funding options to support multi-year elimination efforts.
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   3. For next steps, in-depth country consultations and needs assessment will be conducted to determine specific programmatic guidance, technical capacity building, and resource needs, to develop a proposed detailed program of work plan with timelines and budget allocations for activities.

Supporting Leadership and Targeted Efforts to End Malaria in Papua New Guinea

1. We recognized the devastating impact of malaria as the leading cause of death and a major barrier to socio-economic development, the forum underscored the critical need for collective action at the provincial level in Papua New Guinea.
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2. We acknowledged malaria's devastating impact and identified challenges hindering progress. Limited provincial budgets restrict access to essential tools and personnel, while communication gaps exist between national and provincial health authorities. Additionally, we noted the issue of recent ineffectiveness of mosquito nets.
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3. We outlined key action areas to address these challenges. Strengthening leadership and resource mobilization involves provincial leaders advocating for increased budgets and securing additional funding. Effective implementation focuses on strengthening health systems through infrastructure investment, human resource training, and improved finance management. Integrating malaria control with existing programmes like primary care can further enhance efforts.
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4. We understand collaboration and innovation are also crucial. Sharing best practices and technical expertise among provinces can lead to progress. The forum emphasized knowledge sharing and continuous improvement. This includes learning from successful community initiatives and adapting strategies based on ongoing monitoring and feedback.

Exploring Innovative Health Financing Mechanisms for Malaria Control and Elimination

1. We noted that the Global Fund allocations for malaria in the Asia Pacific saw an approximately USD 100 million reduction for the current 2023-2025 Grant Cycle compared with the previous Grant Cycle. We recognized a decline in donor financing for malaria compounds the challenges of rising cases, escalating costs, and competing domestic crises, and acknowledged that filling the widening malaria funding gap will require more than incremental investments from existing sources. Based on an analysis of the latest Global Fund Funding Requests 2023 – 2025, the malaria funding gap in Asia Pacific stands at an estimated USD 339 million post-2026. We stressed that if this gap in financing is left unfilled, it will threaten hard-won gains in elimination for the entire region.
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2. We recognized that at the same time the vital role that domestic resource mobilization and sustainability planning will playing ensuring that our elimination efforts can be sustained in the long-term. We noted that reliance on external funding remains as high as 90% of malaria programme budgets in some countries within Asia Pacific and reiterated our commitment to working across sectors to sustainably mobilize additional domestic resources for malaria.
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3. We welcomed the development of innovative financing mechanisms that can pool funding for malaria from different channels, including blended financing, defined as the use of catalytic capital from public or philanthropic sources to increase private sector investment in sustainable development. We also discussed the potential strategy of directing increased investments towards integrating malaria elimination efforts with broader public health programmes.
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4. We requested that the APLMA Secretariat explore the development of such innovative financing mechanisms to accelerate malaria control and elimination efforts in the region.

Accelerating Progress with Innovation and the Adoption of New Tools

1. We reiterated our strong commitment to adopting innovative tools and technologies that have the potential to enable malaria elimination in Asia Pacific. With plateaued funding and challenges like resistance, climate change, and conflict, innovative tools and treatment options are potential gamechangers in mitigating these challenges and accelerating progress towards the regional elimination goal. Amongst recent innovations, three may be particularly relevant for our region: first, tafenoquine as the FDA-approved radical cure for Vivax malaria that causes significant malaria burden in Asia Pacific; second, WHO-recommended dual active ingredient (Dual AI) insecticide-treated nets which are effective against pyrethroid resistant mosquitoes, which have been reported in the region; third, there is also potential utility for the WHO-recommended R21/Matrix-M and RTS,S/AS01 malaria vaccines in selected relevant populations and localities in Asia Pacific.
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2. We recognized that integrated approaches with primary care systems are needed to capitalize on these innovations, these include:
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   • Data-driven resource allocation: Optimizing resource allocation using better data collection and analysis to support decision making at all levels.
   • Multi-sectoral collaboration: Working together with maternal health, nutrition, primary care, and other sectors.
   • New partnerships: Engaging broader communities like climate change and the private sector for developing targeted product profiles and development suited for resource limited settings.
   • Surveillance & detection: Utilizing new technologies and leveraging the ASEAN Emergency Operations Center (EOC) Network for Public Health for faster malaria outbreak detection and response.
   • One Health approach: Exploring connections between animal and human malaria using innovative technology, given the increasing cases of zoonotic malaria that has been detected in the region.
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3. We requested that the APLMA Secretariat support countries to adopt innovative tools and integrated approaches to accelerate malaria control and elimination efforts in the region‍

The Way Forward

1. The Summit has allowed us to reflect on the successes of our current efforts and existing partnerships while outlining specific ways to accelerate our progress and address issues of shared concern. The adoption of the Call-to-Action Statement of the EDEN Initiative, demonstrate our commitment to working together to eliminate malaria from our region. We endeavor to intensify our efforts towards our shared 2030 goal.
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2. We express our deep appreciation and recognition to the Government and the people of Papua New Guinea for all their great hospitality and efforts in organizing and hosting the 8^th Asia Pacific Leaders’ Summit on Malaria Elimination.

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