Revamp of malaria control essential

Richard Tren | 25 Aug 2004
Business Day (South Africa)

The science journal Nature has just published a series of papers on malaria and its control. Focusing on this preventable and curable disease is crucial and timely; malaria is the top killer of children in Africa, accounting for more than 1-million deaths worldwide each year. Also, we are now at the halfway point of the Roll Back Malaria programme of the World Health Organisation (WHO), which can only be described as an unmitigated failure. Unless urgent and far-reaching reforms are made, malaria's death toll will continue unabated.

The WHO, World Bank, the US aid agency USAid, and Unicef launched Roll Back Malaria in 1998. Their aim was to halve malaria deaths by 2010. So far malaria deaths have risen 12%. Yet some countries are getting malaria control right. Mozambique, Swaziland and SA have successfully driven the incidence of the disease to almost record lows. Zambia, one of the world's poorest states, is also witnessing more success against the disease. The common thread among these countries is they are rolling out highly successful new combination drug therapies and are running insecticide spraying programmes.

Crucially, these malaria control programmes are funded not by United Nations bodies or established donor agencies but by the relatively new Global Fund to Fight AIDS, TB and Malaria and the private sector. One article in Nature points out that the funding the Roll Back Malaria partners promised to control the disease has not been delivered. In April 2000 the World Bank promised to pledge between $300m-$500m to combat malaria. So far, the Bank claims to have authorised loans of between $100m-$150m. Yet if malaria is to be successfully controlled, at least $5bn needs to be devoted to prevention and treatment programmes every year.

Like the World Bank, USAid's funding is inadequate but as importantly it ignores what malarial states really need. As malaria kills so many children, Unicef, the UN's agency devoted to the welfare of children, is quite rightly involved in malaria control. Yet this agency too appears to be failing miserably. Last year, it spent $3,7m buying malaria drugs, but most of that was spent on ineffective medicines.

But Unicef is not doing nothing. This month it has been excitedly reporting the tour of their youngest goodwill ambassador, the brilliant Chinese pianist Lang Lang, to Tanzania. Lang Lang is touring that country to promote use of insecticide-treated nets. Unicef has avoided repeated requests from our organisation for information on the cost of the tour. We do know, however, that last year it spent the princely sum of $42672 on new bed nets. It is likely Unicef spent more on this stunt than actual malaria control.

World-renowned tropical disease expert Bob Desowitz's response to the Lang Lang malaria control operation was: "Sending a Chinese pianist to combat (malaria) is ridiculous. Nothing less than the entire Beijing Opera company is required." It is high time that governments around the world and the taxpayers that fund them demand that malaria control is changed. First, those in charge of Roll Back Malaria should be held to account and, given their failures, replaced with more competent staff. Second, governments should seriously consider diverting the malaria control budgets from UN bodies and aid agencies to the Global Fund to Fight AIDS, TB and Malaria, which in the few short years of its existence has a far better track record on malaria control.

Developed world taxpayers need to grasp their money is being used badly and is, in fact, making matters worse. For the sake of the many millions at risk from malaria they must demand change now.

Tren is director of health advocacy group Africa Fighting Malaria.