What Is Working

Roger Bate | 22 Jan 2007
East African Business Week

With a mixture of self-interest and moneymaking zeal, private businesses are combating one of the world's most intrac­table problems: the scourge of disease in Africa.

Some of the efforts are working, some not, and the keys to success seem to be honesty, sound science, and, of all things, the profit motive. Here's a look at three programs, all poorly understood, if known at all, by the public: attempts to combat malaria by global corporations, efforts to fight HIV/AIDS by pharmaceutical companies, and a low-cost approach to providing essential medicines.


Malaria

At least one million Africans, the vast major­ity of them children, die each year from malaria. In Liberia, for instance, malaria is the number-one cause of death, responsible for 47% of all mortality.

Malaria is transmitted to humans by the anopheles mosquito, which is repelled by the organic insecticide DDT (dichlorodiphenyltrichloroethane).

Unfortunately, DDT was the main villain of Rachel Carson's popular 1962 book, Silent Spring, which claimed that the compound caused cancer and made the eggshells of birds dangerously fragile (thus, the book's title). Partly as a result, DDT was widely banned for agricultural use. And since its public health functions were no longer important in the United States and Europe, where DDT helped eradicate malaria and other insect-borne diseases in the 1940s and early 1950s, support for its use globally evaporated quickly.

The dangers of DDT were greatly exaggerated, and it was only last September that the World Health Organization announced that "nearly 30 years after phasing out the widespread use of indoor spraying with DDT...to control malaria," its policy had changed, and DDT "will once again play a major role in efforts to fight the disease."

The best-known partnership raising awareness of malaria in Africa is Roll Back Malaria (RBM), which includes multilateral aid agencies such as the World Bank and the U.S.

Agency for International Development (USAID) plus corporate supporters such as ExxonMobil, Novartis, and Bayer. RBM has indeed raised the profile of malaria, and it provides a way to bring businesses into the act of fighting disease, but, like other international programs of this nature, it is infested with policies often more politically correct than soundly scientific.

One of those policies is a preference for bed nets and medical treatment over indoor spraying with small amounts of DDT.

Roll Back Malaria has been described by the British Medical Journal as a "failing" program, and other objective observers, such as Amir Attaran of the University of Ottawa, writing in Nature magazine, concur.

But perhaps the best evidence that RBM's approach is mistaken is that countries that do not require aid to fight malaria (such as South Africa) totally ignore its advice. In 1998, RBM announced a target to halve malaria rates but produced no baseline data, and today the available evidence is that malaria rates have increased globally, while declining in the pockets of the world-such as South Africa, Swaziland, Botswana, Namibia, Zimbabwe, and Zambia-where internal spraying with DDT has been used.

Companies that, in their own business operations, stress tough empiricism go all wobbly in their charitable efforts if there's a risk of criticism, as there appears to be with DDT use. "But," says the British Medical Journal, "dicophane (DDT) is effective, with a remarkable safety record when used in small quantities for indoor spraying in endemic regions.

Malaria cases soared in the KwaZulu Natal province of South Africa after it stopped using dico­phane in 1996.... Dicophane, a 'dirty word' in the malaria world, must surely be reintroduced into the conversation on rolling back malaria."

If I had an award to give to the business that is doing the most to fight malaria and other diseases in Africa, it would go to the mining company Anglo American plc.

The firm's operations are centered in South Africa, which has one of the few governments that champion indoor spraying.

South Africa also promotes artemisinin, the latest pharmaceuti­cal therapy proven effective for malaria treatment.

In countries where DDT is banned for malaria control, Brian Brink, Anglo American's health director, has persisted with other available methods to combat the disease.

Anglo American's efforts are not pure selflessness.

The company's miners can't work if they are sick with malaria. But what is sadly unusual about Anglo American is that it takes the same clear-eyed approach to combating disease that it does to taking gold and copper out of the ground.

The most startling example of Anglo American's success has come in the northern copper belt of Zambia, where it shared ownership of the Konkola Copper Mines (KCM) with the government.

In the towns of Chingola and Chililobombwe, in one of the poorest areas of Africa, KCM lowered malaria rates by 75% in two years.

The death rate fell to zero. Currently, indoor residual spraying, abbreviated IRS, protects 37,000 dwellings (32,000 sprayed with DDT and roughly 5,000 with alternative insecticides) housing nearly 400,000 Zambians.

Konkola was so successful that other mines reproduced the approach, and, soon after, the Zambian government, assisted by the Global Fund to Fight AIDS, Tuberculosis and Malaria, and even the World Bank, copied the effort.

The Global Fund and the World Bank, by the way, publicized their involvement in these programs without acknowledging that it was a mining company from South Africa that started them.

BHP Billiton plc, which, like Anglo American, is a global resources company with headquarters in London, also deserves high praise for its work in Mozambique and other African nations.

The clinics that visited recently at the Mozal aluminum smelter outside Maputo in Mozambique are a model of good medical practice, using IRS and newer medicines and educating workers through a kind of industrial theater on how to prevent AIDS and other diseases.

Houston-based Marathon Oil Corporation is successfully using IRS in Equatorial Guinea, which has an especially undemocratic and corrupt leadership.

Critics want Marathon to pull out of the country, but one should ask whether companies from China and India, which would undoubtedly replace Marathon, would do as good a job combating disease as Marathon does.

Based on my experience, the answer is probably no.

In contrast to Anglo American, BHP Billiton, and Marathon, there is Bayer Crop Sciences, a division of the German chemical giant Bayer AG, which has been trying to discourage the use of DDT, using its influence as an industry representative to the Roll Back Malaria partnership.

Roger Bate, is a resident fellow at the American Enterprise Institute, is an economist whose research focuses on disease in developing nations. He has spent a total of about 18 months in Africa over the past decade on more than two dozen trips. Among his books is "Malaria and the DDT Story" (Institute of Economic Affairs), co-authored with Richard Tren. (To be continued next week)

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