Leadership in the fight against malaria

Roger Bate | 12 Dec 2011
Africa Fighting Malaria
In the past decade great strides have been made in the fight against malaria, and many other diseases that proliferate in the tropics. US Government annual spending on malaria has increase from just under $90m in 2004 to the desired $691m requested by the President's Malaria Initiative for next year. Not only are we spending more money, but we're spending it better too.

In September 2004 I testified before the House Foreign Affairs Africa subcommittee on malaria and the US Government's performance, and I did so again last week.

The key difference is that in 2004 with a small budget the US Government was essentially advising other Governments on how to combat the disease, whereas today it is actually combating the disease - almost eliminating it from a few places, notably the Tanzanian island of Zanzibar.

US taxpayers have supported the Global Fund to Fight AIDS, TB and Malaria to the tune of over $5 billion and the Global Fund has had a remarkable impact on malaria too. Overall malaria deaths are not precisely measured but are down roughly 20-25% in the past decade, from about one million to well under 800,000. Tomorrow the World Malaria Report of the World Health Organization will make even stronger claims that deaths are under 700,000.

But these advances are fragile and could easily be undone. There are plenty of people, from Presidents and billionaires in America, to Geneva-based health bureaucrats and field operatives, who have raised and spent a lot of money to combat malaria; they deserve credit for this type of leadership, but they have failed, and repeatedly so, in standing up to those who would undermine the success.

Key among these are militant environmentalists who oppose the use of insecticides. I cut my teeth as a policy wonk defending the use of the insecticide DDT in the mid to late 90s. DDT is still useful (essential where there is resistance to other insecticides) and is the key reason why parts of Southern Africa may be able to declare themselves malaria free in a few years. But DDT is becoming more expensive every year due to the restrictions placed on it by the United Nations Environment Program Stockholm Convention on Persistent Organic Pollutants (or POPs for short). See here for UNEP's disgraceful efforts to undermine DDT.

UNEP's POPs secretariat is staffed by blinkered greens who now want to limit malaria control officers to even fewer insecticides. The malaria community is standing by watching the demise of yet more chemicals, which not only undermine insecticide spray programs, but also bed net use. Nets are infused with insecticides to increase their efficacy, except that mosquitoes are developing resistance to these insecticides, weakening bed net impact. At the same time, with the noble exception of the Gates Foundation, there is no real support for the development of new insecticides for public health (and agrochemicals are required to have different characteristics than health ones - e.g. persistence is a bad attribute for the environment and hence agrochem, but good for a public health insecticide). Since there is little money in public health insecticides there hasn't been a new one developed in decades. So while the malaria community rhapsodizes lyrically about a possible malaria vaccine and new malaria drugs, it ignores the resistance to insecticides - and insecticides are the backbone of prevention and prevention is the key to limiting malaria.

The malaria community also falls down when one of its programs fails, because no one wants to face the truth, and everyone wants to avoid blame. The latest problem is a malaria drug subsidy, called the Affordable Medicines Facility for malaria (AMFm). While all the evidence is not in on the AMFm performance, early indications are that it is undermining the markets for high-quality malaria drugs. I criticized this program in my testimony last week, since it is worsening diagnosis, increasing drug theft, leading to public sector stockouts, and probably increasing mortality. But the subcommittee simply ignored the problem. At the moment the US Government is not backing this subsidy and privately detests it since its own treatment programs are being undermined by it, but publicly the USG stays quiet too.

Leadership is a wonderful thing, but it is truly found when it is tested, and on that count malaria leadership has failed.

Dr Roger Bate is the Legatum Fellow at the American Enterprise Institute and a founder director of Africa Fighting Malaria