Johannesburg, South Africa — It is certain that Paul Wolfowitz will take over the helm of the World Bank, something which has got many in Europe and here in South Africa — mostly on the left — up in arms. Yet having a "neoconservative," "go-it-alone" American run the Bank could be very good news for millions of people around the world at risk from a preventable and curable disease: malaria. If the World Bank is to achieve its stated goals of reducing the burden of malaria, it will require some bold and, some may consider, politically incorrect decisions — just the sort of thing Wolfowitz is used to.
According to the most recent estimates from leading malaria researchers, every year the disease causes illness in over half a billion people and death in over one million. Most of those cases and deaths occur in Africa, which is also the least able to fight the disease. Malaria costs Africa about $12 billion a year, most of that in lost investment opportunities. The disease blights the future of millions of young people who, if they survive the disease, suffer from learning difficulties, limiting their economic prospects.
The World Bank is rightly concerned about the disease and the way it stifles development and exacerbates poverty. That is why, along with the World Health Organization, UNICEF, and various donor agencies such as USAID, it launched Roll Back Malaria (RBM) in 1998. The goal was to halve the burden of malaria by 2010. So far that goal remains a mirage. Malaria cases are actually increasing: According to the latest WHO data, they have probably risen by at least ten percent since the inception of RBM.
The failed RBM strategy has much to do with this public-health catastrophe. Almost all of the efforts to prevent malaria cases have focused on providing people with insecticide-treated nets. People, particularly pregnant women and young children — those most at risk — are encouraged to sleep under these nets in order to protect themselves from the Anopheles mosquito. The problem isn't that these nets don't work; it is simply that as a sole strategy they haven't been shown to have any significant large-scale impact on malaria transmission.
Those countries that are making progress against the disease have ramped up their indoor insecticide-spraying programs. These programs entail spraying tiny amounts of insecticide, such as DDT, on the inside walls of houses to repel or kill (or both) the malaria-carrying mosquitoes. This method of control is safe and highly effective: Malaria rates have plummeted in the very poor northern parts of Zambia where this approach is currently employed. Yet RBM and the World Bank, always politically correct, have eschewed this method of control. The World Bank even went as far as to require that its of funding malaria control in Eritrea be conditional on non-use of DDT.
Implementing a failed strategy isn't the World Bank's only mistake, either. It has also failed to come up with the money that it promised for malaria control. In 2000 it promised $500 million for anti-malaria programs; so far it has only come up with between $100 and $150 million. Current Bank chairman James Wolfensohn misled donors, the media, and others about the amount of money being spent on malaria control when he claimed in 2001 that the Bank had given out about $450 million.
The World Bank's stinginess, lack of transparency, and overall malaria strategy need serious overhauls. The World Bank is supposedly drafting a new malaria-control strategy, but repeated attempts by malaria experts to see a draft of the strategy have been stonewalled. Given the obvious and odious failures of the Bank's policies, one would think it would want to get things right this time. In order to do so, it would want to privately solicit opinions from the malaria experts who criticized it publicly in the past. This would allow for real progress towards strategies that actually save lives, rather than the current proposals and lack of transparency that only serve the interests of U.N. and World Bank bureaucrats.
Wolfowitz is far more of a team player and more aware of developing-country issues than his critics believe. He has already professed interest in combating AIDS and other poor-country health concerns. He has also stressed the international nature of the World Bank:
I will be president of a multinational organisation with 184 member nations...I am very aware that I am accountable to a different group of people than I am in my current job...the job of the president of the Bank is to pull together the most effective possible consensus.
But in the case of malaria, much like in the war in Iraq, the consensus approach was incorrect, and Malaria is far too important and disastrous a disease to sanction yet further failure. The Bank under Wolfowitz could move in a different direction, and in a few years millions of African children would owe him their lives. But only if he takes decisive action against the immoral and divisive politics of the World Bank, an organization that has until now presided over ever-increasing death and misery among the world's poorest and most vulnerable people.
— Richard Tren is director of Africa Fighting Malaria and Roger Bate is a fellow at the American Enterprise Institute.