Africa must unite against malaria

Richard Tren | 25 Apr 2005
Business Day (South Africa)

THE cardinals who gathered in Rome to elect Pope Benedict no doubt had a great deal on their minds as they weighed up the different candidates. Fortunately, they did not have to worry a great deal about their health. The unfortunate cardinals who gathered in Rome after the death of Pope Gregory XV in 1623 did. In that 19-day conclave, eight cardinals died of malaria. Today, Africa Malaria Day, we should think about how and why Europe rid itself of malaria, while the disease still claims more than a million lives a year in Africa.

The World Health Organisation (WHO) and its partners such as the United Nations Children's Fund (Unicef), the World Bank and US donor USAID formed Roll Back Malaria in 1998 with the goal of halving the burden of malaria by 2010. More than halfway through that programme, malaria cases have risen more than 10%. This year's theme for Africa Malaria Day is a typically empty UN-style slogan: Unite Against Malaria — Together we can beat malaria. The WHO is only partly right in asserting that unity will beat malaria — there are successful partnerships against malaria, but most do not include any UN organisation, the World Bank or donor agencies.

There are several reasons the cardinals do not have to worry about malaria. Malaria started to decline in Italy towards the end of the 19th century as Italy became wealthier. It was only eradicated, though, after teams sprayed the insecticide DDT on the inside walls of houses. This indoor residual spraying repels or kills mosquitoes. It is probably the most effective way of controlling malaria and attracted great support from the UN and donor organisations.

Environmentalist campaigns from the 1970s onwards, with pressure from within WHO and Unicef, have meant that support for DDT has dwindled. The result — an ever-increasing number of malaria cases and deaths. However, some countries, such as SA, continue to use DDT and support dedicated malaria control programmes. SA has also introduced effective malaria treatments based on an ancient Chinese herbal remedy.

The result has been a dramatic decline in malaria cases and deaths. So successful has this strategy been that other African countries are following the model. With funding from government, the private sector and the Global Fund for AIDS, TB and Malaria, spraying programmes in Swaziland, Mozambique (which does not use DDT) and Zambia have achieved equally impressive declines in malaria.

The WHO's Afro office in Harare tries to support spraying that actually works, yet is continually frustrated by bureaucrats far removed at the WHO's headquarters in Geneva. They are also undermined by the donors that supposedly fund malaria control in Africa. USAID is particularly inept when it comes to controlling malaria. This leading donor chooses not to spend its $80m malaria budget buying insecticides or drugs that may save lives. Instead, it spends more than 70% of its budget on US consultants.

These consultants could promote effective malaria control if they wanted to — what is working is no secret. Yet funding spraying programmes would mean that the agencies would have to put money directly into health department malaria-control programmes and would have to buy insecticides and drugs. This would mean that there would be less left over for the consultants to run their workshops and to drive about in four-wheel-drive vehicles. Predictably, the agencies and their consultants prefer to promote insecticide-treated mosquito nets as the main method of control, though this strategy has led to the 10% increase in cases.

Many African governments know what has to be done. Uganda wants to restart its malaria control programme using DDT, which worked spectacularly well in the 1960s. Yet the European Union threatened to ban all Ugandan agricultural exports if it did.

Malaria is entirely preventable and curable. It is scandalous that so many people die from it each year and that the leading organisations charged with controlling it continue to fail. There is hope, though. The US senate is debating a neglected diseases bill which will force USAID to support indoor residual spraying, and to support insecticide-treated nets only if it can prove they work. African governments and the private sector owe it to the millions of malaria sufferers to unite against UN and donor politics and to promote effective malaria control.

Tren is a director of the health advocacy group Africa Fighting Malaria.