Development projects, migration and malaria in the

GMS

Dr. Deyer Gopinath MD MPH World Health Organization

Lao PDR

gopinathd@wpro.who.int

Biregional Meeting on Healthy Borders in the GMS 5-7 August 2013, Bangkok, Thailand

Presentation outline

• Malaria trends in the GMS countries

• Migration and economic drivers

• Roadways, railways, hydro dams and plantations

• Issues of development projects and malaria

• Possible entry points for engagement

Malaria Trends in the GMS Number of Confirmed Malaria Cases: 2002 - 2012

1

10

100

1,000

10,000

20

00

20

01

20

02

20

03

20

04

20

05

20

06

20

07

20

08

20

09

20

10

20

11

20

12

Cambodia

China

Lao PDR

Vietnam

Thailand

Myanmar

Number of Confirmed Malaria Deaths: 2002 - 2012

1

100

10,000

1,000,000

2003 2004 2005 2006 2007 2008 2009 2010 2011 2012

Cambodia

China

Lao PDR

Vietnam

Thailand

Myanmar

The Mekong malaria map is shrinking and concentrated on the borders

Malaria parasite incidence in the GMS, 2002

> 10

1-10

< 1

zero

Mekong Malaria Monograph III

Malaria parasite incidence in the GMS, 2010

Sources: 1. Asia Migrant Centre & Mekong Migration Network (2002). 2. Save the Children 3. IOM Lao (2009). 4. IOM Myanmar (2010). Power Point Presentation; 5. N.litthai.

GMS Migration patterns, economic corridors, biodiversity conservation areas and malaria

2D_BCI_GMS_BCL-EC

Migration routes

Migrant population in the GMS - Total :300mil

Internal: ?

Int’l labor migrants:

Regular: 1-2mil

Irregular: 3-4mil

Cross border: 250,000/day

1. Infrastructure and rural development • displacement or relocation of villagers • migration to and from the areas by

labor migrants, including internal and external migrants.

2. Deforestation for logging and farming • Illegal logging for timber • farming, especially for cash crops such as

coffee, cashew nut, rubber and oil palm require a constant large number of low-paid workers

• seasonal or circular migrants with a mix of internal and cross-border labor migrants

Migration and current drivers in the GMS

3. National development plans and demographics 4. Political factors affecting migration 5. Natural disasters 6. Socio-economic situation

Roadways

Railways

Hydro Dams

Agricultural

Plantations

? Impact on malaria

Outcomes of rapid development on malaria Road and railways, hydro dams, Plantations,

mining etc

Change in vector ecology

• Predominant mosquito species • Mosquito biting times

Influx of foreign workers

• Change in malaria parasite species ratio • Drug resistant parasites • Self medication • Increase in substandard antimalarials and

monotherapies

Local population displacement

• Highland to lowland, low immunity and no protection against malaria

• Loss of traditional occupation, more forest based activities, engaged in development projects

http://www.unescap.org/ttdw/common/tis/ah/Database.asp

Roadways

•Asian Highway Network •GMS Economic corridors - Southern Economic Corridor (SEC) - East-West Economic Corridor (EWEC) - North-South Economic Corridor (NSEC)

‘’East-West and North-South Economic Corridors and roadways now facilitate easier and more dynamic movements of people in the GMS ‘’

HIV/AIDS interventions in road construction projects

Route AH-3 (NR3): 251 km Houeixay (Lao-Thai border) to Boten (Lao-Chinese border)

Jul 12th 2013, 7:51 by T.J. | BANGKOK, ELEPHANT CRY HILL, DAWEI

Thailand – Myanmar: Tennisarim range – Dawei Sea Port

2011, Dr. Bouasy Hongvanthong, Lao PDR

Roadways and malaria

“ Railways

•Trans Asian Railway (TAR)

•GMS Railways

•Singapore-Kunming rail link (SKRL)

“Railways may be an effective route for the propagation of the human malaria parasite”

Connecting GMS countries: Vientiane Action Plan 2004–2010:

Priority routes in the Singapore–Kunming Rail Link (SKRL).

Estimated Greater Mekong

Subregion Rail Passenger and

Freight Demand Projections and

Cost of Construction by Route

Traffic Forecast

Route

Passengers (million) Freight

(million tons)

Cost Estimate

($ billion)

2014 2025 2014 2025 1 1.8 3.2 6.8 25.7 1.09 2 1.6 2.4 6.3 23.8 5.32 3 2.9 4.4 6.3 23.8 2.29 4 3.7 6.3 6.3 23.8 6.28

ASEAN Strategic Transport Plan 2011-2015

ASEAN Strategic Transport Plan (ASTP) 2011-2015, strategic actions to

be implemented in the period to support the realisation of the ASEAN

Economic Community (AEC) by 2015 as well as the new priority of

enhancing regional connectivity identified in the Master Plan on ASEAN

Connectivity (MPAC).

Hydro Dams

• Cross-border trade has increased the pace of hydropower development.

• Regional Indicative Master Plan for Power Interconnection driven by ADB, World Bank and donor assistance programs in the GMS energy sector

• It is estimated that the electric power demand in the whole Mekong Region

will increase by an average of about 7 percent annually to 2022. In order to

meet such sharp growth in demand, current electric generating capacity is

expected to quadruple by then.

.

The Current Status of Environmental Criteria for Hydropower Development in the Mekong Region - A Literature Compilation Peter King, Jeremy Bird, Lawrence Haas March 2007

GMS - Demand for electric power

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C M P E , 2 0 0 9

I n t e r p o l a t e d P f i n c i d e n c e r a t e ( 1 0 k m r a d i u s ) 0 > 0 < 1 1 - 1 0 1 0 - 1 0 0 1 0 0 - 5 0 0 5 0 0 - 1 0 0 0

H y d r o d a m s

# 2 0 0 9 - 2 0 1 0

# 2 0 1 1 - 2 0 1 2

# 2 0 1 3 - 2 0 1 5

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Hydro dams and malaria risk areas Lao PDR

HD Source: MRC, Vientiane, Lao PDR, September 2008 Pf incidence: CMPE 2008

0

500

1000

1500

1 2 3 4 5 6 7 8 9 10 11 12

_17_Attapeu

Malaria cases 2011

CMPE 2009 Source: CMPE

Environmental Impact

Assessments (EIAs)

- Too early or too late

- Private sector investment is usually

“fast tracked”

- Mitigation measures: Different laws and regulations in each

country

Mon workers making their way to Trad’s rubber plantations Pix by WHO/ Nat Sumon

http://malariacontainment.wordpress.com/2011/04/12/mon-rubber-tappers-receptive-to-preventive-messages/

Rubber Plantations

Led to changes in agricultural practices in SEA; rubber production has increased in Myanmar, Laos, Thailand, and Vietnam (Trends Biotechnol. 2007, FAO 2003)

In 2011, 7 provinces along Thai-Cambodian border, malaria cases among rubber plantation workers accounted for between 10-20% of total malaria cases reported.

The plants mature ≈ 7 years after planting – a need to understand the phases

of growth of rubber plantations and its relation to malaria risk.

Gold mine

Rubber plantation

Hydro dam under construction

Hydro dam planned

Extractive industries in a district Malaria outbreak villages

0

500

1000

1500

1 2 3 4 5 6 7 8 91011121 2 3 4 5 6 7 8 91011121 2 3 4 5 6 7 8 91011121 2 3 4 5 6

2010 2011 2012 2013

Confirmed malaria cases

Source: NMCP

A strong need to incorporate these events and predictions into future planning and control:

….. the potential for malaria re-emergence should receive substantially more attention from economic, agricultural, and environmental planning bodies...

…..Understanding the influence of land use change on malaria occurrence is critical for shaping future surveillance and control strategies

Trevor Petney et al

Road/Rail ways

• ASEAN sec –ASEAN Mekong Basin Development Cooperation (AMBDC)

• GMS - GMS Ministerial Meeting GMS Subregional Transport Forum, Economic Corridors, CLV ministerial meetings

• ADB -GMS Program, JIBC, WB • National - Ministry of transport/public works

• ADB, World Bank - GMS Program - Regional Master Plan for Power Interconnection

• Mekong River Comission (MRC) • National - Ministry of Energy & Mines - Ministry of Natural Resource and Environment

Hydro Dams

Agriculture/Plantations

• National - Ministry of Agriculture, Forestry • Research Institutes - National Agriculture and Forestry

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Thank You

Additional slides

Multisectoral engagement: Malaria: What has been tried, what worked and what not in GMS

1. Both ad hoc/responsive and planned engagement with major project developers to engage in malaria preventive and curative interventions among their workforce - responses from developers : Could try: • A simple economic argument (cost benefit): reduction in malaria case =

productivity cost? $$ and cents, used in public and private sector planning

• Developing/strengthening safeguards frameworks – HIAs, EIAs, SIAs as an essential part of any private sector led/funded development project, ‘contractual’/MoUs with economic, agricultural, and environmental, labour planning bodies etc.

Multisectoral engagement: Malaria: What has been tried, what worked and what not in GMS

2. High level platforms engaged – Prime Minister’s office, provincial governors, major funders/donors/bilaterals/military - responsive/interested, complicated, needs a champion Could try: * Regional entities engaged (ASEAN, ADB, GMS ministerial meetings, CLV etc) – commitments for health/malaria in the long term * Reaching out to multisectoral agencies – gov. planning bodies–forestry, planning and investment, labour, etc to include economic, social, population migration info etc for malaria planning. Requires formal agreements/ processes * Cross border stakeholder involvement - some progress now with military, Twin cities project etc