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Low Sierra -- Dr Roger Bate, TCS Daily, 2006-02-14
  Low Sierra Roger Bate There are few things more distressing than aid intended to help the poorest actually causing them harm. For example, it is a sad irony that aid for HIV care is actually displacing far more valuable child immunization work in the wretched West African country of Sierra Leone. Rather than adding to capacity, the few competent staff are simply drawn away from these basic but vital services toward the high-profile, higher-paying HIV program. An integrated approach to aid giving must occur or more will die needlessly from good intentions. By varying estimates from the World Health Organisation (WHO), The World Bank and other multilateral agencies, Sierra Leone has one of the world's worst performing health sectors. It is at the bottom of a very long WHO list of underperforming countries. It has astonishingly high child mortality (284 out of every 1000 die under the age of five) and maternal mortality (1,800 maternal deaths per 100,000 live births). Almost half of child deaths are attributed to malnutrition. And with malaria rates increasing along with outbreaks of Lassa and yellow fever, Sierra Leone is perhaps the worst place to be a child in the entire world. HIV incidence is hard to measure but Sierra Leone's rate is somewhere between 3 percent and 8 percent, although it is apparently far higher in the military (WHO estimates a remarkably high rate of 25 percent). As the WHO says: "During the past ten years, the displacement of hundreds of thousands of people, the breakdown of social structure, a lack of government capacity to create a national policy for HIV/AIDS, and a reluctance to speak about the disease are all factors that could induce a fast propagation of the disease." The suggestion that the military has a high HIV rate, accompanied by a very high incidence of gender-based violence -- including an appallingly high rape rate -- led the international community to determine that Sierra Leone needed a considerable AIDS program. According to published documents as well as sources in a key donor/lending agency that wish to remain nameless, last year it received about $8 million for HIV (that is less than $2 per person in a country of 5.5 million people). Activists and aid workers complain that with a rising HIV threat this is a woefully small amount with which to educate prevention of HIV as well as to treat those infected. Local doctors and health specialists within western aid agencies -- a far less vocal and hence politically impotent group -- point out that HIV is not the only threat to Sierra Leone. While AIDS experts say their $8 million is not enough, only $6 million is allocated to all other healthcare put together. So in a country with a GDP of $1.1 billion, approximately 0.5 percent of the budget or $1 a person is spent on non-HIV health. This feeble allocation to health ensures that Sierra Leone stays near the bottom of the heap and a long way from the ambitious but not unreasonable United Nations target of 15 percent of total government budgets going to healthcare in poor countries set in Abuja, Nigeria in 2000. One of the many dangers of targets is that they mask all kinds of evils. After all, if one includes the HIV spending with the other health expenditure, Sierra Leone does better at 1.3 percent of budget spent on health. But the HIV spending is actually hurting the country because it is drawing the best qualified doctors and nurses from working on child immunization, respiratory infections and malaria control. While each life lost to HIV is tragic, far more lives are lost by drawing the attention of the best and brightest medical minds from more critical areas. Children can easily be prevented from contracting numerous killer diseases if effort is made when they are very young. Addressing malnutrition and malaria is much more complex than giving an injection, but effort is warranted given the massive returns. By comparison, spending hundreds of dollars a person a year on anti-retrovirals seems a dreadful misallocation in such a poor country. But child health doctors can receive three times the pay to work on HIV, and in a country of violence and funding volatility, secure outside funding, higher incomes and international exposure may mean travel opportunities tomorrow and certainly a better life today. Is it any wonder local doctors are switching to HIV work? International funders must take a broader focus on the needs of the country where they lend money -- or accept that their largesse may backfire. Roger Bate is a Resident Fellow of the American Enterprise Institute.

Fighting Malaria - the right way -- Dr Roger Bate, Washington Examiner, 2006-01-09
  Fighting malaria - the right way By Roger Bate The fight against malaria has scored a major victory. The U.S. Agency for International Development has elected to use nearly half of its budget to buy proven interventions against the disease, which affects 500 million people and kills more than a million children around the world each year. USAID has promised $15 million expressly for insecticides, recognizing their unique effectiveness in reducing the burden of malaria. The agency has opted to streamline more funding to fewer countries in order to improve accountability and focus on results. This announcement follows USAID chief Andrew Natsios' resignation and marks an ideological shift in the agency's approach to malaria control. Since it joined the World Health Organization's global effort to roll back the disease in 1998, it has devoted most of its budget to U.S. consultants whose technical advice emphasized mosquito nets and largely ignored indoor residual spraying. This has proved a losing strategy. Recent estimates of malaria rates show they have increased substantially over the past decade. Holding USAID to account has proven difficult because malaria primarily affects African children and public interest in the U.S. is limited. It has taken much pressure from malaria experts to ensure the policy shift. There is still room for improvement since its unclear how transparent the new effort will be, but hope is running high within the community. The "Kill Malarial Mosquitoes Now!" coalition, which has presented USAID with a declaration calling for two thirds of the agency's budget to be used to buy life-saving commodities (namely the historically maligned but singularly effective insecticide DDT) has played a part in the recent shift. Signatories to the declaration include Nobel Laureates Archbishop Desmond Tutu and Dr. Norman Borlaug, as well as doctors, lawyers, public health experts, business professionals and civil society group leaders from diverse backgrounds. The "Kill Malarial Mosquitoes Now!" coalition has welcomed the announcement by USAID but believes that the agency must go further in fighting the disease. There is no guarantee that the money USAID has committed toward indoor residual spraying will be used to buy DDT. This chemical is the cheapest and most effective insecticide available for IRS. It brought malaria rates down by 75 percent in both Zambia and South Africa. A spokesman said USAID has previously followed environmentalists' ideology in avoiding the chemical, pointing to exaggerated and often unfounded accounts of its harmful effect on humans. Yet the science remains on the side of using DDT. Marginal side effects do not prevent the use of pharmaceuticals in the U.S. to treat far less devastating diseases than malaria. If asked, an African mother would rather risk a few squirts of DDT on the wall to save her child's life or to prevent an average of 300 mosquito bites a night during the rainy season. USAID also needs to avoid fudging numbers, a situation most donors are guilty of at some stage. The agency must establish clear, scientifically sound baseline figures for malaria rates in the countries where it operates. This should be a high priority in their move to concentrate more money in fewer programs; it is the only way progress can be judged. How else will the president know that malaria deaths have been halved, if there is no baseline from which to judge it? In the past, the agency has borrowed inaccurate or incomplete figures from the World Health Organization. Additionally, USAID has fudged its efficacy data for insecticide-treated mosquito nets by assuming that they are used appropriately and consistently. It is hoped that this will no longer be tolerated in the new USAID. President Bush and USAID must be commended for being the first leader and aid agency to explicitly mention funding spraying programs (and although there is no guarantee, there is the mention of using DDT as well). Hopefully they will be copied around the world, especially in Europe. Millions of lives are at stake and the tools to protect them are at our fingertips. Roger Bate is a resident fellow of the American Enterprise Institute.

South Africa's Good News on AIDS -- Roger Bate,, 2005-12-20
  JOHANNESBURG, South Africa -- Bad policy contributing to rampant AIDS has become the master narrative of much western reporting on South Africa. But the tide has turned and there is progress to report. Science Breakthroughs South African researchers have developed a cheap CD4 test for HIV patients, which is particularly vital in rural areas where testing costs can be high. The team is led by Dr. Debbie Glencross from the Medical School of the University of Witwatersrand (Wits) in Johannesburg. The test reduces costs by over 75 percent and allows for greater rural access to testing -- a major advance in the treatment of the poorest in Africa. With at least 5 million HIV-positive South Africans alongside 20 million more infected Africans, it is important that as many people as possible receive sustainable treatment. But it is impossible to provide appropriate treatment for HIV-positive patients without measuring the CD4 count in white blood cells. (The CD4 count helps physicians determine how far the disease has advanced and how strong a person’s immune system is at the time.) Where counts drop below a certain level (clinical policy can change but it is currently a CD4 reading of below 200 in South Africa), treatment with anti-retroviral drugs becomes vital. Otherwise the patient may -- and eventually will -- contract opportunistic infections and develop full-blown AIDS. The availability of cheap tests is vital because CD4 counts have to be monitored continually during the life of the patient. That way, drug regimens can be altered in response to CD4 changes over time. The novelty of the Glencross/Wits test is that it utilizes the white cell count as a reference point. Traditionally, CD4 cells are referenced to total lymphocytes, a sub-population of white cells. Measuring the total lymphocytes is a less reliable indicator, but easier to use and hence formed the basis of previous tests. To ensure accuracy, other additional measures of lymphocyte concentration through flow cytometry are often undertaken, which increases costs. By simplifying the strategy and referencing the test to all white blood cells, the need for extra steps disappears. Not only is this approach cost-effective, it also has an additional benefit: unlike the traditional tests which require testing within 24 hours, samples can be tested even up to five days after blood is collected. Some African locations are very remote. Given their distance from the few existing HIV clinics, this new test brings hope. By lowering the cost of testing and providing an extra five-day window, many more South Africans will be tested and properly treated. Given that about 27 percent of the sexually active population (at least 5 million people) is probably HIV-positive, more action is required. Herpes and HIV…Together Forever? Interesting work is also being done on Herpes Simplex Virus and HIV. HSV is one of the most prevalent sexually transmitted infections in the world. According to figures from Wits University, 22% of Americans have the disease (which is apparently dormant for most of one\'s life), and an astonishing 70% of South African women have it. Although HIV and HSV act in entirely different ways, there are some unfortunate synergistic effects. Critically, a HSV-infected cell makes it easier for HIV to take hold. Due to the ulcers that HSV causes, there is an estimated three-fold increase in the risk of contracting HIV from those who are infected with both HSV and HIV than those who only have the latter. This observation is relevant because there is a cheap prophylactic anti-viral drug called “acyclovir” that can prevent Herpes. If it is given to HIV-negative people with HIV-positive partners, it can lower the chances of transmission considerably. Teams at Wits Medical School and Chris Hani Baragwanath Hospital in Soweto are currently undertaking a Gates Foundation-sponsored clinical trial. The trial focuses on discordant couples (i.e. one with both HSV and HIV and the other with neither disease) and it is designed to show whether acyclovir can lower rates of uptake of both diseases in the negative partner, but especially prevent the uptake of the more virulent HSV. The trial is ongoing, but physicians are optimistic that there will be a lowering of transmission of HSV, and hence HIV. A related group is also testing microbicides to prevent HIV infection. These compounds are a useful prophylactic that can be controlled by women, whereas condom use is nearly always determined by the man. South Africa publicly distributed over 300 million male condoms last year, but consistent use is low. 757 HIV-negative women in Soweto are participating in a trial funded by the UK Department for International Development. As with the HSV trial, the researchers expect tests to show a substantial reduction in uptake of HIV. Microbicides can be applied as a gel but also as a sponge which gradually releases the active ingredient. A few of the women have had vaginal irritation resulting from the gel use, but there have been no major side-effects. The microbicides are anticipated to be on the market as of 2008, and many are hopeful that such measures will make a big difference in empowering women to protect themselves. Roger Bate is a Resident Fellow of the American Enterprise Institute.

Africa’s economic fate in its own hands -- Jasson Urbach & Richard Tren, Business Day, 2005-12-13
  Africa’s economic fate in its own hands Jasson Urbach & Richard Tren -------------------------------------------------------------------------------- AS TRADE ministers gather in Hong Kong for the World Trade Organisation (WTO) meeting this week, many hold out hope of increased prosperity that will come from freer trade. One would hope that, in particular, trade ministers from Africa will appreciate the location of the talks. A few decades ago Hong Kong was a barren rock; now, thanks largely to open trade and a free economy, Hong Kong it is thriving and prosperous. Africa can achieve prosperity too, but it has to be more open to trade; must stop blaming others for its problems; and has to improve the institutions of a free society. Economists say free trade allows countries to specialise in what they can produce better and cheaper than others (known as comparative advantage). They can then exchange, to each other’s mutual benefit. Of course, some people are harmed as imports threaten their jobs but overall far more people reap the benefits of trade. No country in recent decades has achieved economic success, in terms of substantial increases in living standards for its people, without being open to the rest of the world. While much of the world is liberalising and increasing trade, Africa’s trade with the rest of the world has been declining. The major reason for the substantial decrease in trade is attributable to trade policies. African countries have kept their countries locked behind protectionist walls for decades. Governments claim that they need to protect producers but forget about the millions of consumers that are hurt in the process. While governments focus on increasing exports, they miss the point that it is through importing that countries develop. Low-priced inputs mean that productivity gains can be made and competition from abroad means local innovators are spurred on to become more competitive. A recent paper by Dr Marian Tupy, of the Washington DC-based Cato Institute, explains that while most of the world has made progress in reducing trade barriers, Africa has been far more reluctant to free up trade. For instance, Tupy notes, "while rich countries reduced their average applied tariffs by 84%, sub-Saharan African (SSA) countries reduced theirs by only 20%". World Bank figures show that African nations impose tariffs as high as 33,6% on agricultural commodities from their neighbours. South Asian nations reduced their average tariffs by 70% between 1983 and 2003. Although their average tariffs are now around the same level as most of sub- Saharan Africa’s, the liberalisation has benefited the region enormously. Other World Bank data suggests that welfare growth by 2015 in the region would be $1,746bn greater if only intraregional trade liberalisation were to take place. While trade liberalisation is a necessary condition for growth, it is not in itself sufficient. Columbia University economist Arvind Panagariya says: "There are complementary conditions, such as macro-economic stability, credibility of policies and enforcement of contracts, without which the benefits of openness may fail to materialise." Whatever happens in Hong Kong, African leaders have the power to reform their own economies, give their own consumers greater choice through free trade and set the stage for growth and opportunity. We should not, and must not, accept Africa’s poverty and nor should we be looking anywhere other than but at home for solutions. ‖Urbach is a researcher for the Free Market Foundation and Tren is a director of health advocacy group Africa Fighting Malaria.

Why the Top-Down Approach Has Failed -- Dr Roger Bate, TechCentralStation, 2005-12-01
  Why the Top-Down Approach Has Failed By Roger Bate Published 12/01/2005 JOHANNESBURG, South Africa -- Another World AIDS Day has arrived (Dec. 1) and with it more HIV cases than ever before -- over 40 million. The World Health Organization\'s target of treating three million people by the end of this month has failed by about two thirds. Until very recently we heard little remorse, and still haven\'t had a proper assessment of whether the original target made any sense. But in true Stalinist Plan mode, a five year target -- of access for all by 2010 -- is the new mantra. In the urgency of scaling up much needed treatment for people living with HIV/AIDS, setting targets is a natural and central prescription; however targets are political tools and should be used with extreme caution by international technical bureaucracies. Although targets can be successful in attracting attention and funding, unless a robust plan underpins a target there is a real risk that political and financial capital will be squandered. There is great sympathy and desire among the general public to care for those affected by AIDS, but few have a realistic notion of the difficulty of rolling out AIDS treatment. A key problem is that many of the countries hardest hit by HIV/AIDS barely have the infrastructure, expertise and finances to provide even the most basic healthcare, such as vaccinations. Even preventable and wholly curable diseases like malaria still ravage many sub-Saharan countries, partly because doctors are so scarce that sick people often have to walk for many hours to visit a clinic, where the only drugs available may not be effective. A hospital stay is beyond the resources of many because a family member must stay with the patient to provide food, personal care and laundry services. Although the antiretroviral drug regimens for HIV have been greatly simplified in recent years, doctors and nurses need specific training in order to dispense them properly. Ensuring that patients are treated regularly and can rely on good stocks of medicines requires reliable drug procurement and logistics and good storage facilities, including continuous cold storage during transport and at the treatment centers. In addition, patients need to see physicians and other trained medical personnel several times before they begin treatment, several times during the first 3 months of treatment and then at regular 3 month intervals. Patients should still have a good support network at home so as to ensure that they take the right drugs at the right time and stick rigorously to the treatment requirements. In addition, patients should have support at home to assist with the side effects of treatment. In reality, not a single one of these requirements for best practice can be relied upon in southern Africa, where the burden of disease is greatest. What, Then, To Do? There are many groups attempting to address these difficult issues and some do better than others. This brief overview of two current approaches shows that those that are able to adapt best to local conditions and give more power and respect to local health workers stand the best chance of actually working. Approach 1: A two-year, extremely bold, broad-ranging plan was quickly put together to massively increase distribution of low-cost drugs to existing primary health care facilities. The goal of treating three million people by 2005 called for a sharp increase in drug production, which would result from allowing certain multi-drug therapies to be \'fast-tracked\' through the drug evaluation procedures. It was expected that prices would be reduced based on bulk production and that medical facilities could then ramp up patient numbers. What this campaign, in its enthusiasm, failed to take into account was that drug companies expected to capitalize the expansion of production without guaranteed orders, were reluctant to take the risk. The distribution logistics of the drugs were haphazard -- with shipments being held up at customs and stock-outs lasting for several months. The campaign also ignored the evident and long-standing lack of medical and infrastructural capacity in target populations, where clinicians and all other health workers were already overstretched, understaffed and under-resourced in terms of facilities. They risked compromising care if they took on any more patients. Lastly, the equally-evident risk that was taken in pre-approving drugs for the campaign backfired catastrophically as, failing tests of quality or efficacy, 18 drug products were suddenly withdrawn. It will dismay many who have faith in international organizations and their ability to mount large-scale campaigns to learn that this approach was designed and coordinated by the World Health Organization. The campaign is fading to a close, having reached maybe a third of the target set, but with little guarantee that treatment is of high quality or is sustainable. Instead of setting grand targets, the WHO would have been wise to see what other programs were achieving in some of the most resource-poor environments, such as that described in Approach 2 below. Approach 2: Bristol-Myers Squibb initiated Secure the Future in 1999. This 5-year project set out to provide a platform from which local initiatives could be developed, sustained and replicated through training and networking among many groups -- drug companies, governments, medical schools, auditors and non-governmental and community-based organizations. Planning, integration, training and evaluation were established before treatment began. The project has produced several outcomes. A new, fast, low-cost CD-4 count test for HIV was developed A study establishing an effectual treatment for mother-to-child transmission of HIV received the Nelson Mandela Award for Health and Human Rights And another study on AIDS mortality data is attracting a high level of interest. In addition, two \"legacy programs\" will remain up and running long after the sponsor has gone have been established. A Community-Based Treatment Support Program has opened six model collaborative centers in South Africa, Swaziland, Lesotho, Botswana, Namibia and Mali, to provide medical treatment combined with care and support beyond the clinics, including home-based care, psychosocial counseling, food security, orphan care, and income-generating projects. Another legacy program is a training institute designed to develop management, good governance and leadership capacity among NGOs to enable them to develop, execute and scale-up programs. In 2004, there were more than 1700 participants in pilot training courses in five southern African countries. Approach 1 or 2? WHO\'s 3 by 5 Campaign has attracted $27 billion in funding pledges, but with the major constraint to treating patients being the lack of medical personnel and infrastructure, which take time to build up, it is difficult to see how such a sum could be usefully absorbed in such short timeframe. The legacy of WHO\'s 3 by 5 campaign will be disappointment for the patients who received the drugs that had to be withdrawn. HIV is highly adaptable and goes through several stages of development. Each stage must be attacked in strict sequence with specialized drugs in particular quantities. If any phase is attacked with a sub-lethal dose the virus can mutate and become resistant. This is why special training must be given to those dispensing treatment. Patients who started a course of the generic drugs that were discontinued are at great risk. Furthermore, the drugs in question were not fully tested, and in some cases were not bio-equivalent to the branded versions. Some actually had new ingredients altogether which means that nobody knows exactly what effect they had. This leaves doctors having to guess what to prescribe next. Pre-qualifying copycat drugs was a known and foreseeable risk taken by the WHO for the sake of achieving a target that was too short-term and ambitious. On a recent visit to various AIDS facilities in Lesotho, including the Secure the Future clinical center mentioned above, I was shown evidence that sub-optimal single, dual and poorly monitored triple ARV therapy all occur throughout government programs. In one report, of 24 patients seen by a doctor, six were on inappropriate mono or dual therapy and a different patient had been prescribed just 10 doses of Nevirapine, which is meant to be taken indefinitely in conjunction with other drugs. Local doctors estimated that of a total of 2000 patients perhaps 800 were on suitable, sustainable treatment. One doctor said that if the government pressured them to cut corners, they could manage perhaps 5,000 patients by end 2005. But it would be under protest. The point here is that the target set by WHO under 3 by 5 was to treat 28,000 by the end of the year. This may mean either that the organization did not have a realistic idea of what could be achieved or that it thought the clinical staff could do better if they really tried. Neither option is acceptable. Meanwhile Stephen Lewis, the UN Special Envoy on AIDS said after WHO\'s admission that it would miss the 3 by 5 global target that the present time constituted \"one of the UN\'s finest hours\" claiming it \"has unleashed an irreversible momentum for treatment\". Having met doctors in the field who have been utterly demoralized by the 3 by 5 experience, it is hard to agree with this rosy interpretation. Certainly, the patients deserved better. And 3 by 5\'s failure has simply been replaced with a new target of universal access by 2010 - is this also meaningless? Meanwhile Secure the Future has spent $115 million, coordinated a broad-reaching and effective partnership with researchers, universities, doctors, faith based groups, nutritionists and local NGOs. This partnership has achieved its aim of leaving in place sustainable, dynamic and replicable systems, such as the Baylor International Pediatric AIDS initiative. This effort coordinates a nurse education and physician exchange program between five African countries and the U.S. and provides a model which could be scaled up appreciably and make very good use of large sums of money. Perhaps a national program could offer to pay part of the loans of newly-graduated medics in return for service in Africa. Indeed, Dr. Bill Frist the Senate Majority Leader and a medical doctor spends an annual working holiday in African clinics and could perhaps be encouraged to lead such an effort. Building From the Bottom Up There are many such collaborations among business, academia and the Bill and Melinda Gates Foundation that are making cost-effective breakthroughs in treating diseases of the developing world. In controlling and treating a far more manageable disease, like malaria, partnerships between the private sector, academia and governments have delivered impressive results. Clearly, it is difficult for large organizations to be flexible, transparent and responsive, but it shouldn\'t be impossible. In particular USAID\'s renowned technical expertise is exactly what is needed to build local capacity and infrastructure. The key is to ensure that assistance and expertise will equip poor countries to deal with their AIDS problem better. Of course, the WHO is charged with looking at the global AIDS problem and projects like Secure the Future only treat a few thousand people. But it is the small projects, that have been adopted and adapted to local cultures and expectations, that encourage and inspire others. This is where momentum is built and health workers in the field - such as those with MSF, Anglo-American, AHF -- are all doing admirable work along these lines. A heavy-handed target imposed from outside will never be successfully accommodated in the short-term, no matter how much money is thrown at it, and leaves feelings of failure among recipients and waste among donors. At the same time, the WHO is perfectly placed, with a truly global network, vast knowledge and expertise among its staff and access to substantial funds, to take on the intricate and demanding role of steadily building capacity from the bottom up through the multi-partner groupings described in approach 2 above. Target setting is the political approach -- it gives a good impression but is likely to do more harm than good -- and the WHO has such great potential as a technical body that it is a pity to see it wasting its talents. Copyright © 2005 Tech Central Station -

WHO\'s Striking -- Dr Roger Bate, National Review Online, 2005-11-30
  November 30, 2005, 4:44 p.m. WHO’s Striking Maybe that’s good, considering its AIDS record. By Roger Bate With the worst pandemic since the Black Death reaching its 21st birthday and another World AIDS Day this week (Thursday), staff at the World Health Organization’s Geneva headquarters are preparing to strike over pay and conditions. Had the staff been striking in disgust at the woeful performance of the campaign to treat HIV around the globe then maybe they would gaine some sympathy. As it is, the WHO director-general, Lee Jong-wook, has been forced to remind key office staff that others in regional postings such as Darfur or Baghdad will be more than willing to step in and cover any “essential” work they are doing. He has said that “the threat of a work stoppage risks bringing WHO, and our achievements, into disrepute. It is unprecedented in the history of WHO. It is out of proportion to the concerns expressed by some of the staff. It undermines the credibility of WHO.” Lee should appreciate that the credibility of WHO has been undermined by his own staff’s performance. It’s ironic that they choose to strike on World AIDS Day. Toward the end of 2003 WHO established the 3 by 5 Initiative — to treat 3 million HIV-positive people with antiretroviral drugs (ARVs) by the end of 2005. It was a grandstanding, fundraising, overreaching epitome of counterproductive target-setting. To anyone monitoring the situation it was obvious that it would fail from the beginning, and that WHO had no real intention of the target being hit since they didn’t even consult the key countries (South Africa, for example) as to the target set for them. Remember WHO does not provide many of the drugs, funds, doctors, etc. to hit such targets, so consultation should have been necessary. This oversite led to an ugly, unprofessional, and damaging spat with the South African government. WHO set a target of 375,000 people and then blamed the South African government in June when it was clear that its arbitrarily set target would not be hit. The South African health minister hit the roof; she said that her “government is not withholding treatment for opportunistic infections, including ARVs, but our objective is to promote quality healthcare. We are not just chasing numbers.” Rather than help South Africa and other nations treat more HIV patients, WHO started a pointless war of words. Earlier this week WHO apologized for missing the 3 by 5 target — five months after it had attacked South Africa because its target would not be hit. The cornerstone of this target-setting was WHO’s promotion of cheaper, generic copies of ARV drugs. Generic drugs certainly can have a role in combating the HIV pandemic, but using drugs with untested efficacy or non-bioequivalence leads to clinical uncertainty, which undermines patient performance evaluation, and increases the risk of drug resistance. It also undermines future drug development by lowering profits of originator companies. Lee’s memo to his staff regarding the strike says that the threat of a work stoppage demonstrates “a betrayal of trust, and are neither in your interest, nor that of the hundreds of staff who are working in hardship posts around the world and field stations in Africa and Asia, nor those whom we serve.’ The effect of Lee’s administrative approach to combating HIV has been to betray the trust of the people of Africa and other increasingly HIV-prone locations. He should apologize to the world for that. WHO has an important role as a purveyor of information and as an urgent responder to international concerns, like SARS (where it did well) or bird flu. Were it not for that I’d endorse the strike by WHO staff, not because I like strikes, but because WHO in so many of its roles is counterproductive — and fewer WHO staff on the job is therefore good news. — Roger Bate is a director of health-advocacy group Africa Fighting Malaria and a resident fellow of the American Enterprise Institute.

How DDT can stop millions of malaria deaths -- Richard Tren & Philip Coticelli, Mail & Guardian, 2005-11-09
  How DDT can stop millions of malaria deaths Richard Tren and Philip Coticelli 09 November 2005 08:45 Every year, more than a half-a-billion people suffer agonising pains and fevers because of malaria, a disease that is entirely preventable and curable. In Africa, someone -- normally a child -- dies every 30 seconds from this disease, causing unimaginable grief, human suffering and economic stagnation. It needn't be this way, however; about 50 years ago, malaria was eradicated from Europe and the United States, and right now some countries have successful anti-malaria programmes. Yet, far from helping countries with malaria, many donor agencies and United Nations organisations actually hamper the fight against the disease and the deadly mosquitoes that transmit it. One of the best ways of controlling malaria is to use the insecticide that most environmentalists love to hate -- DDT. If mosquitoes and parasites were not enough to contend with, the politics surrounding the use of DDT and vested interests that oppose it make it nearly impossible for countries to use DDT for malaria control in spite of its incredible success. DDT was first used during World War II to halt the spread of lice-borne typhus. Typhus epidemics raged in many war-torn areas. DDT powder was dusted over civilians, soldiers and concentration-camp survivors and put in their clothes and bedding, and before long the spread of the disease was halted. Malaria-control experts soon noted the success of DDT in typhus control and began to apply the insecticide against mosquitoes. When used in malaria control, DDT is sprayed in tiny quantities on the inside walls of houses. This application repels mosquitoes so that they don't enter houses to feed on humans, and kills them if they do enter. Indoor residual spraying (IRS) with DDT eradicated malaria in the US and Europe and led to spectacular declines in the disease in Africa, Asia and Latin America. Wherever DDT was used in public health, death and disease fell and the conditions for development and wealth creation improved. But while DDT was saving lives in malaria control, it was also being used in agriculture. Sprayed in enormous quantities aerially, DDT protected crops from pests like boll worm. This use of DDT raised concerns in the early 1960s from the nascent modern environmentalist movement. In her book Silent Spring, Rachel Carson described potentially catastrophic consequences for wildlife and humans of the widespread use of DDT. US hearings Growing campaigns by environmentalist groups during the 1960s culminated in the hearings into DDT by the newly formed US Environmental Protection Agency (EPA). After eight months and extensive, in-depth hearings presented with evidence from experts both for and against DDT, the presiding Judge, Edmund Sweeney, ruled that DDT should not be banned. Despite the popular view that DDT was highly damaging to the environment and human health, there was, in fact, little scientific evidence to support these beliefs. Yet DDT was banned anyway by the head of the EPA, William Ruckelshaus, in a neat example of politics trumping good science. The EPA had just been formed and its head was keen to demonstrate that the agency could and would take decisive actions to protect the environment. The fact that banning DDT wouldn't actually help the environment was neither here nor there. Since the EPA banned DDT in agriculture, countless studies have been conducted into the potential impacts of DDT on human health, yet none of them have been able to find any concrete evidence of actual human harm. DDT is remarkably non-toxic to humans; people have tried to commit suicide by eating it and failed miserably. DDT is classified as a possible human carcinogen by the International Agency for Research on Cancer, which may sound alarming, but is the same classification given to coffee and many other foodstuffs in our daily diet. Even though the evidence of environmental harm from DDT has been exaggerated, the use of DDT in malaria control cannot result in environmental degradation. First, it is used in small quantities indoors. Second, most environmental degradation in malarial areas arises from poverty, an over-reliance on natural resources for food and fuel, and a lack of clearly defined property rights. If DDT spraying can reduce disease and catalyse development, drawing in tourists and investors, the state of the environment is likely to improve. Dwindling support The agricultural banning of DDT, in theory, did not affect the public-health use of the insecticide. DDT remained available for use in malaria control; however, the support given to the insecticide and the spraying programmes that used it began to dwindle. Many malaria-control programmes rely on financial, logistical and scientific assistance from donor agencies and the various UN agencies that are involved in malaria control, such as the World Health Organisation (WHO) and the UN Children's Fund. Without support from these organisations, maintaining malaria-control programmes became increasingly difficult, and from the 1970s onwards, malaria gradually increased worldwide, claming more and more lives and condemning hundreds of millions to repeated bouts of illness. South Africa has maintained its IRS programme for decades and used DDT very successfully until 1996, when it was withdrawn in part to comply with WHO resolutions to reduce reliance on the insecticide. The result was one of the worst epidemics in the country's history. Tragically, the Anopheles mosquitoes were resistant to the insecticides that replaced DDT. After malaria cases had risen by about 1 000%, South Africa reintroduced DDT in 2000 and in just one year achieved an 80% reduction in cases in KwaZulu-Natal, the worst-hit province. Malaria cases remain at almost all-time lows in the country thanks to DDT. In 2000, a private mine, Konkola Copper Mine on the Zambian Copperbelt, restarted its IRS programmes using DDT. Malaria control had declined along with the economic fortunes of Zambia in the early 1980s and, as a consequence, the disease had returned with a vengeance to many areas. Yet after just one season of DDT spraying, malaria incidence was halved, and was halved again the following year. So successful has the application of DDT been that the Zambian government restarted its IRS programmes in several other parts of the country. Uganda has been trying to restart its IRS programme and use DDT. Yet, recently, the European Union threatened to ban Ugandan agricultural exports should the programme go ahead. The EU's fear that some DDT could leak on to agricultural produce is largely unfounded and ignores the fact that most countries that use DDT have instituted tight controls and strict audits of their malaria-control programmes. The EU position is shameful and a double whammy to the health and development of Uganda. Importance of IRS and DDT Fortunately, the Global Fund to Fight Aids, Tuberculosis and Malaria (GFFATM) clearly recognises the importance of IRS and DDT to malaria control, and has therefore been funding several IRS programmes in Southern Africa. Other donors, such as the US Agency for International Development (USAid), do not have the foresight or good sense of the GFFATM and fail to fund IRS programmes in any significant way. In fact, in 2004, of USAid's $80-million malaria budget, only $4-million was spent buying commodities such as drugs and insecticide-treated bed nets that could actually save lives. The vast majority of its budget is spent in the US and used by consultants that fly to Africa to tell malaria-control scientists what to do -- but that doesn't actually buy the tools to do the job. Additionally, USAid promotes bed nets as a malaria-prevention strategy to the near-exclusion of IRS with DDT. So, when a country wants to improve its malaria-control programme and tries to use DDT, which has been shown time and again to be highly effective, it faces opposition from the well-paid consultants that prefer to promote policies that keep them employed and earning air miles. They also face opposition from the trade-protectionist EU that panders to alarmists and mischievously uses junk science, even though it hampers malaria control and costs lives. Role of business The obstacles to good malaria control unfortunately do not end there. Big business also plays a distasteful role in this saga. Recently, the Financial Times reported that Gerhard Hesse, business manager for vector control of Bayer Crop Sciences and a board member of the Roll Back Malaria Partnership, wrote an e-mail to various health academics claiming: "We fully support EU to ban [sic] imports of agricultural products from countries using DDT … DDT remains for us a commercial threat [but] mainly a public image threat." Bayer produces alternatives to DDT and clearly attempts to direct malaria-control programmes so that they benefit its bottom line. Recently, the Bill and Melinda Gates Foundation donated more than $50-million to the Innovative Vector Control Consortium to create new insecticides. Regretfully, the commercial-development arm of the project is none other than Bayer Crop Sciences. New insecticides are enormously important for malaria control, but the existing ones -- such as DDT -- are working extremely well right now and saving thousands of lives. Many more could be saved if donors, the UN and the private sector start to listen to African malaria scientists and put science ahead of politics and their own vested interests. A noble attempt is being made to ensure that this happens with the Kill Malarial Mosquitoes Now! declaration, which calls for widespread changes to malaria control and demands that the US government start to spend the majority of its malaria-control budget on insecticides and drugs that will actually save lives. Recently, Archbishop Desmond Tutu joined a broad array of scientists, public-health experts, human rights advocates and religious leaders in demanding change in malaria control. If the declaration is successful, millions of Africans will be freed from the vice-like grip of this ancient and devastating disease. Richard Tren is a director and Philip Coticelli is a researcher of the health advocacy group Africa Fighting Malaria. The Kill Malarial Mosquitoes Now! declaration can be downloaded from

Let DDT take care of malaria scourge -- Philip Coticelli & Richard Tren, Business Day, 2005-11-08
  Posted to the web on: 08 November 2005 Let DDT take care of malaria scourge Philip Coticelli & Richard Tren -------------------------------------------------------------------------------- THIS week, the Southern African Development Community commemorates malaria week and, coincidentally, the US congress is debating appropriations for malaria control to be spent by the US Agency for International Development (USAID). Unless congress insists on wide-ranging changes to the way malaria control is conducted, most of the money appropriated will be wasted and Africans will continue to mourn their children, mothers and fathers for years to come. USAID has become a magnate of malaria control by virtue of its deep pockets — but has little to show for the millions it spends. According to the World Health Organisation’s Roll Back Malaria Partnership (RBM), malaria in Africa has increased or remained the same since 1998. Malaria has risen sharply in several African countries despite endless technical advice from USAID, RBM and other donors. This is because these organisations single-mindedly focus on mosquito nets as a prevention strategy. USAID claimed, for example, that the distribution of insecticide-impregnated mosquito nets in Togo and Zambia effectively protected 90% of the recipient population (a few thousand children). This figure is a product of many convenient assumptions: that people stay under the nets from dusk until dawn; that nets are never torn or misused; that the nets are annually re-impregnated with insecticide by their owners, etc. However, only one net per household was given and USAID admits (in a footnote) that only 56% of those were being used. Mosquito nets alone are insufficient. DDT, a chemical insecticide which kills mosquitoes, was used to eradicate malaria from the US and western Europe by the mid-20th century, saving untold numbers of human lives. In 1971, the US banned DDT based largely on unsound science and scaremongering. Largely for this reason, DDT is absent from USAID control strategies despite its proven success. Where DDT was used in Zambia to target malarial mosquitoes, reported cases of the disease plummeted 75% in two years. In SA, DDT was removed from national malaria control strategies in 1996 to appease environmental interest groups. Cases had increased tenfold by 2000, when the government promptly reintroduced the chemical and watched the malaria burden drop nearly 80%. Yet DDT continues to be demonised. Its use in public health programmes is limited to spraying tiny amounts of the chemical inside houses — not aerial spraying of agricultural fields as opponents would have you believe. Spraying it on the inside walls once a year is sufficient not only to destroy mosquitoes coming into contact with the chemical, but also to stop mosquitoes from entering the house. Moreover, DDT has not been linked to a single case of human cancer in five decades of use. Perhaps DDT’s adversaries would relent if they, like many African children, were bitten every night by deadly insects. DDT remains the cheapest and most effective means of combating malaria. The US has the money to buy DDT and the political might to rebrand its image. This is why a coalition of public health experts and political leaders has signed a declaration to “Kill Malarial Mosquitoes NOW!”, demanding that 66% of the house foreign appropriations funding for malaria control be used to buy DDT. The declaration is being actively circulated, and has so far been signed by Archbishop Desmond Tutu, a former US Navy surgeon general, the Congress of Racial Equality chairman, a cofounder of Greenpeace and the Association of American Physicians and Surgeons president among others. If the coalition has its way and USAID reforms itself, many lives will be saved. The fact is Africa desperately needs DDT. USAID should buy it. ‖Coticelli is a researcher and Tren is a director of the health advocacy group Africa Fighting Malaria.

Finding Hope Where the Streets are Named for Lenin and Mao -- Richard Tren, TechCentralStation, 2005-11-03
  Finding Hope Where the Streets are Named for Lenin and Mao By Richard Tren Published 11/03/2005 MAPUTO, Mozambique -- Driving around Maputo, the capital city of Mozambique, is like driving through the pages of a socialist history book. Avenida Vladimir Lenin leads into Avenida Mao Tse Tung and Avenida Kim Ill Sung runs parallel to Avenida Salvador Allende. So, in fact, it is more like driving around a history book of disastrous economic policies and human catastrophes. And yet Mozambique is not the desperate failure that the capital's street names would suggest. By abandoning years of failed socialism and embracing economic freedom, life for ordinary Mozambicans is improving. After years of socialism and bitter civil war that destroyed most of the country's infrastructure, to say little of the destruction of human lives, the country has been at peace for more than fifteen years and has had several democratic elections. Successive peace time governments have steadily increased economic freedom and have been rewarded with increased economic growth. According to the Heritage Foundation's index of economic freedom, the Mozambican economy moved from a score of 4.39 in 1995 to 3.34 in 2005, where 5 measures the least free and 1 the most free. There are still many aspects of the Mozambican economy that are not free and, overall, the country is ranked as "mostly un-free". Yet the trend is towards greater freedom and given the obvious benefits that the country has reaped from freedom, it is hard to believe that it will regress. Economic growth was over 7% last year and inward investment has been impressive. According to Heritage, "Mozambique allows 100 percent repatriation of profits and retention of earned foreign exchange in domestic accounts." South Africa's wealthier neighbour, South Africa, still has foreign exchange controls which limit repatriation of profits and foreign currency accounts. I saw the evidence of Mozambique's openness to foreign investment as I drove to Maputo from the South African border. Rising out of the flat bush is BHP Billiton's Mozal aluminum smelter -- a state of the art facility in one of the poorest countries on earth. Smelters are not the most attractive constructions, but this one stands out of the featureless surroundings like a beacon of hope. Not only does Mozal represent an inward investment of more than a billions dollars, but BHP Billiton has also been funding malaria control in the country. The malaria control program run in conjunction with South Africa and Swaziland has ensured that malaria cases in the south of the country have plummeted. The program, which involves spraying tiny amounts of insecticide inside houses, has been so successful that a similar program is soon to be started further north. I first came to Maputo seven years ago and was shocked to see many dilapidated buildings and roads in a shocking state of disrepair. Yet then, as now, I was struck by the fact that so many Mozambicans were not sitting around in the street begging or waiting for a handout, but were busy selling, trading and creating something out of nothing. This attitude of self-reliance, perhaps borne out of years of adversity, seems to have paid off. There is still a great deal of poverty now, but the streets are cleaner and improved and the buildings are smarter and there are several new, gleaming hotels and office blocks. My own hotel, on Avenida Julius Nyerere, was one of the nicest I have ever stayed in and I used the wireless connection to submit the piece you are now reading. As I wandered down Julius Nyerere I considered how grateful ordinary Mozambicans must be that Nyerere's vision of African socialism and collectivization has been consigned to history. Most Mozambicans that I have encountered in the past few days are not only very friendly and welcoming, they also exude an optimism that I have only found in the US. Most reports from Africa are of death, disease and despotism. Of course there is plenty of this and more often than not I find the reports from Africa almost too depressing to read. Yet Mozambique shows that it is possible to be optimistic about some parts of Africa. Of course Mozambique's western neighbour, Zimbabwe, casts a pall over the entire continent. The Zimbabwean government has recently restarted its horrific program of destroying people's houses in what can only be seen as punishment for people who didn't vote for the monster that is Robert Mugabe. Despite the vast improvements in Mozambique, my optimism about this country is tempered by the ongoing destruction of Zimbabwe and the absence of any criticism from regional leaders. Mozambique is on the right path, but it still has a long way to go. Their journey to prosperity would, however, be boosted significantly if they were to stand up and defend democracy, human rights, property rights and basic freedoms; and they can do that by condemning Mugabe. Africa is a vast and varied continent with plenty of good news and plenty of bad. Perhaps it is a pity that one country, Zimbabwe, over shadows so many others. Yet southern African countries can improve their own prospects by taking some action against Mugabe and at the same time defend innocent men, women and children that are caught up in the horror that is Mugabe's rule. Richard Tren is a director of the health advocacy group Africa Fighting Malaria.

Deadly Mosquito Standoff -- Dr Roger Bate, Washington Times, 2005-10-21
  Deadly Mosquito Standoff By Roger Bate Published October 21, 2005 -------------------------------------------------------------------------------- Congress is about to appropriate $105 million for malaria control, and the money will be wasted -- yet again. European interests threaten poor African countries that use the best method to prevent malaria -- indoor DDT spraying. While the EU action is marginally more odious, Congress will act like the European champagne socialists by throwing money at a problem regardless how it is spent. It doesn't have to be this way. And if those signing the Kill Malaria Mosquitoes Now (KMMN) declaration have their way, it won't be for long. Ninety-three percent of Uganda's population is at risk from malaria, with millions of cases and thousands of deaths annually. Uganda does not use DDT to control the mosquitoes that carry the parasites. Southern African countries spray tiny amounts of DDT on inside dwelling walls, in carefully controlled programs that save countless thousands of lives, mainly children, every year. But chemical company Bayer sees things differently. "We fully support [the EU's decision] to ban imports of agricultural products coming from countries using DDT," Bayer's Vector Control Manager Gerhard Hesse proudly proclaimed in an e-mail exchange with malaria scientists. Admitting "DDT use is for us a commercial threat," Dr. Hesse expounded a series of half-truths and outright falsehoods, mostly denigrating use of DDT. Bayer Crop Sciences reported sales of more than $7 billion in 2004, and Bayer's Dr. Hesse is a board member of the World Health Organization's Roll Back Malaria (RBM) coalition -- as are other commercial contractors to the U.S. Agency for International Development (USAID). It has been rumored these potentially conflicting interests undermine the anti-malaria coalition, charged in 1998 with cutting malaria rates in half by 2010. Instead, RBM has overseen an increase in disease and death rates, due partly to shunning DDT. The British Medical Journal characterizes RBM as "a failing public health program." Until now, Uganda has bowed to such outside pressure. But Ugandan Health Minister Jim Muhwezi is determined to use DDT: "DDT has been proven, over and over again, to be the most effective and least expensive method of fighting malaria." Many malarial countries rely on international aid to fund their programs and therefore must adopt policies preferred by aid agencies and the European Union but that are not necessarily what the countries need. The U.S. so far has not overtly used trade protectionism to prevent DDT use. However, USAID, the recipient of malaria aid budgets, has lobbied against DDT use. Today it rarely buys any commodities, and never DDT, spending less than 10 percent of its funding that way. Most expenditures are for "technical assistance" to poor countries. In several cases, it convinced locals to sleep under bed nets or doctors to prescribe better drugs, but failed to provide either. The KMMN declaration, doing the rounds of medical schools and policy institutes, demands that two-thirds appropriated malaria control funds be spent on DDT spraying or other methods proven more effective. There is probably nothing better than DDT, but the signers appreciate flexibility is required. By demanding efficacy, they also undermine another unpleasant truth about USAID. The agency doesn't measure the performance of its malaria programs, probably because they fail so badly. In other words, KMMN throws down the gauntlet: show us something better than DDT or buy it. The White House should take note; its new malaria initiative will be run by USAID. Of course, there is resistance from USAID and its contractors to a hard earmark since they don't want to buy commodities but continue conducting business as usual. Congress must not keep giving them such a pass. U.S. taxpayers, to say nothing of Africa's children, deserve better. Roger Bate is a resident fellow of the American Enterprise Institute and a director of Health Advocacy group Africa Fighting Malaria. Dr. Bate has signed the KMMN Declaration, now posted on the AFM Web site.

Niger's Famine: Another Green Debacle -- Dr Roger Bate,, 2005-09-28
  Niger's Famine: Another Green Debacle By Roger Bate | September 28, 2005 Tragedy struck Niger, the former French colony of West Africa, over the summer. Millions were at risk of starvation. Political corruption, drought and poverty were the main causes for the lack of food, but over this past year West Africa has also been ravaged by a plague of locusts. Commentators tried to blame Western policies for contributing to Niger’s famine. David Loyn of the BBC even cited man-made climate change as a contributor: ‘Climate change has made Niger a more precarious place to live,’ he wrote. Niger was a ‘stray after-thought, carved out of the remnants of French West Africa when the region won freedom from France exactly 45 years ago,’ said Loyn. And in 1973 it suffered the peak of its worst famine. A three-year famine devastated the country causing widespread starvation and thousands of deaths. As in most famines, political mismanagement contributed more to death than the weather. With drought in 2004 and low rainfall in 2005 Loyn draws parallels with that great famine and implies that climate change is contributing. This was the only ‘evidence’ he presented that the current drought was caused by climate change. He fails to note that the famine of 1973 came at a time when global temperatures were at their lowest for most of the past century. Popular opinion notwithstanding, the link between man-made emissions and drought in Niger is largely theoretical and tenuous. But Western policies that perpetuate aid rather than trade do cause direct harm, however worthy the original intentions. And this is also true for the environmental policy that banned the only viable form of protection against the locusts which have caused such devastation. The desert locust, which changes color as it develops, can devour its own weight (about an ounce) in fresh food in 24 hours. A ton of locusts, which is a tiny part of the average swarm, eats the same amount of food in a single day as ten elephants, 25 camels or 2,500 people. Locusts first moved south last summer from their breeding grounds in North Africa towards West Africa, causing widespread problems last September. But over the summer a new wave of locusts hatched and vegetation disappeared in the semi-desert of the Sahel (Mauritania, Senegal, Mali, Niger and Chad). With the end of the rainy season, the locusts are heading back north. After years of drought, this year’s heavy rains (in some parts of the Sahel at least) have provided the perfect conditions for the locusts to breed. Before they mature and can fly locusts proceed through various stages and can be attacked most easily when they are ‘hoppers’ – the stage before flight. Once locusts mature and can swarm, only crop-duster-style spraying of massive amounts of insecticide can stop them, which is expensive – too much for these poor nations. Chad and Algeria have been hit by swarms and all their domestic politicians could fund, with the help of the UN Food and Agricultural Organisation, was occasional aeroplane spraying. But Cape Verde, Senegal, Mauritania, Libya and Niger have all had massive hopper presence and could have significantly reduced the future swarms, but they couldn’t afford to do very much. And that is because they couldn’t use Dieldrin, an insecticide banned by the UN Stockholm Convention on Persistent Organic Pollutants (POPs). Dieldrin was sprayed across the path of the approaching hoppers and its persistence meant that a single spray of a thin barrier strip was enough to wipe out vast swathes of hoppers for weeks. There are alternatives, but none are anywhere near as cost-effective (on a useful life–cost basis alternatives are at least eight times as expensive), and for debt-laden cash-strapped countries of the Sahel lack of Dieldrin meant not stopping the hoppers. Dieldrin’s high persistence means it is available to bioaccumulate up the food chain, and can cause birth defects and therefore should not be used for anything else but stopping locusts. Nevertheless because the countries that are now sending aid, and also designed the Stockholm POPs treaty, don’t have locust infestations they forgot to exempt it for such use. It is possible that the green alarmists may be correct that this recent drought and famine is exacerbated by man’s emissions of greenhouse gases. But what is certain is that these same alarmists pushed a treaty which is causing death. Roger Bate is a resident fellow at AEI. Click Here to support

The Millennium Development Goal Merry-Go-Round -- Richard Tren, TechCentralStation, 2005-09-16
  The Millennium Development Goal Merry-Go-Round By Richard Tren Published 09/16/2005 This week the world's leaders are gathering in New York to discuss the Millennium Development Goals (MDGs). These goals were set in 2000 by the United Nations and aim to improve the lot of humanity on a whole host of fronts by 2015. But instead of setting goals, the UN and poor country governments should be concentrating on how to grow their economies and lift people out of poverty. Professor Amir Attaran of the University of Ottawa pointed out in a recent paper that most of the goals are un-measurable. For instance, MDG number 6 calls for the incidence of malaria to have been halted and begun to reverse by 2015. But no one, not even the World Health Organization, knows what the incidence of malaria actually is. How is one supposed to know when malaria cases have been cut in half when the starting point is unknown and no effort has been made to measure progress along the way? There are many more examples: MDG number 6 also pledges to reverse the incidence of tuberculosis; but no country measures the incidence of TB. MDG number 5 aims to "reduce by three quarters, between 1990 and 2015, the maternal mortality ratio." The maternal mortality ratio measures the number of women dying through complications of pregnancy and delivery per 100,000 live births. Yet in the poorest countries, where maternal mortality is worst, the data on live births and deaths is scanty. Professor Attaran considers one MDG -- that relating to under-five child mortality -- is actually measurable. Household surveys can be effectively used to record whether a child has died before the age of five and progress on this target can indeed be measured. If the UN were to set up goals that mean something and can be measured therefore, they can promote policies to meet the goal. It is morally reprehensible for political leaders to sign onto goals they know they have no means of attaining. Endorsing the fight against disease and poverty may build political capital for a politician, but it means little to ordinary people in poor countries. The fact that no one can measure progress allows that politician to declare success at any point or blame others for failure, as he or she likes. Regardless of the MDGs, some countries, such as Zambia, are making good progress in tackling several serious diseases. The country's malaria control program has re-started efforts to spray tiny amounts of insecticide on the inside walls of houses in malarial areas. These indoor residual spraying programs are highly effective and malaria cases are already beginning to fall. In order to monitor progress, the malaria control program conducts regular surveys which measure the number of people that have malaria parasites in their bodies. The program is well conceived, carefully planned and the government puts a great deal of effort into monitoring whether or not it is actually working. But when the Zambian Ministry of Health set about improving malaria control, it didn't have the MDGs in mind. Rather, it was determined to implement the best possible strategies and to save as many lives as possible. Instead of signing onto targets and uttering yet more platitudes, the leaders of poor countries should be doing everything that they can to reduce poverty and that can only be done by increasing economic growth. Economic growth in turn can only come from the enterprise and energy of the private sector and they can only be successful when economic freedom increases. If African leaders really care about the MDGs they would implement economic reforms, such as securing property rights, ensuring the rule of law, removing bureaucratic barriers to business and trade and reducing tax rates. Without that, economic growth will be sluggish, if positive at all, and individuals will continue to be hungry and poor. Of course, if those much needed reforms are not made it will not be all bad news at the UN and WHO. Yes, Africans will remain poor and sick, but in ten years time academics and bureaucrats will be able to raise lots of money to think up more meaningless targets and hold more conferences and the whole merry-go-round will continue. Tren is a director of the South Africa-based health advocacy group Africa Fighting Malaria.

Africa Feels EU's Bite -- Richard Tren & Marian Tupy, Washington Times, 2005-08-18
  Africa feels EU's bite By Richard Tren and Marian L. Tupy Published August 18, 2005 -------------------------------------------------------------------------------- In recent months it has become fashionable to say that future Western aid to Africa will be a hand up, not a handout. African governments, the aid lobby claims, will be encouraged to search for innovative solutions to their problems, free of Western interference. Yet, when the Ugandan government decided to introduce DDT, an effective insecticide, to its malaria-control program, the European Union threatened to embargo Ugandan agricultural exports to the EU. The EU threats are based on junk science. If carried out, they will cause a lot of harm. Uganda used DDT very successfully during the late 1950s and early 1960s. Some African countries -- Eritrea, Madagascar, Mozambique, Namibia and Swaziland included -- still successfully use it. In part as a result of the pressure from the environmentalist lobby, the South African government briefly discontinued the use of DDT in the late 1990s. Between 1998 and 2000, KwaZulu Natal, South Africa's most malarial province, experienced a 400 percent increase in malaria cases and the government was forced to reintroduce DDT. By 2001, malaria cases fell to their pre-1998 levels. Encouraged by those results, the Ugandan Minister of Health, Jim Muhwezi, floated the idea of approving the use of DDT as one way of combating malaria in Uganda. He wants DDT to be used in addition to bednets and new drug treatments. If realized, Mr. Muhwezi's wish would come not a moment too soon. Despite the fact that malaria is both preventable and curable, the disease kills up to 110,000 Ugandan children every year. Based on its past performance, it is reasonable to expect that the introduction of DDT could dramatically reduce that death rate. Unfortunately, DDT also happens to be an insecticide that most environmentalists love to hate -- and nowhere more so than in the capitals of Western Europe. DDT has been used for more than 60 years and in all that time no scientifically replicated study has been able to link the chemical to cancer in humans. Despite the bad press from environmentalists, the insecticide has an incredibly safe record of use. In any event, when used in malaria control, DDT is sprayed on the inside walls of houses in minute quantities. The chances of any trace amounts of DDT ending up on agricultural produce are tiny, and even if they did, the effects on human health would be negligible. The EU threats are part of a broader European agenda to force African countries to comply with rules and regulations that are totally unsuitable for Africa's level of economic development. Take Pascal Lamy, who used to be the EU's chief trade negotiator and now heads the World Trade Organization. Before leaving the EU Commission, Mr. Lamy proposed to open European markets to imports from the poor countries. In exchange, those countries would have to sign on to the Kyoto Protocol on global warming, the Cartagena Protocol on genetically modified organisms, and a plethora of international labor agreements. But European countries did not have to comply with environmental and labor regulations when they were at Africa's stage of economic development. After Europe developed and its standard of living increased, many people were able to pay a premium for commercial goods that were produced in an environmentally friendly way. Increased efficiency of production and the concomitant reduction of waste also contributed to better environmental quality. Forcing poor countries to accede to unsuitable treaties will only slow down their economic development. It is encouraging that the United States does not share the EU's approach to combating poverty and disease in Africa. The Bush administration has not tried to force African countries to subscribe to growth-killing environmental and labor regulations. Moreover, the administration takes a different view on how malaria should be fought. President Bush's commitment of $1.2 billion to combat malaria on the African continent explicitly allows for "indoor residual spraying with approved insecticides," including DDT. Time will show how that money will be spent. In the past, much of the money earmarked for fighting deadly diseases in Africa was embezzled by corrupt officials. In addition, U.S. aid agencies, like the European aid agencies, actively opposed DDT use in Africa. Still, the fact that DDT is back on the agenda both in the United States and Uganda is good news for the Ugandan people. It would be a shame if misguided environmentalists in Europe were to succeed in undermining the best hope the Africans have of defeating such a deadly menace. Richard Tren is director of Africa Fighting Malaria, a think tank based in South Africa. He is the co-author of a recent Cato Institute study, titled, "South Africa's War against Malaria: Lessons for the Developing World." Marian L. Tupy is assistant director of the Project on Global Economic Liberty at the Cato Institute

Man aggravates a natural disaster -- Roger Bate & Richard Tren, Business Day, 2005-08-05
  Posted to the web on: 05 August 2005 Man aggravates a natural disaster Roger Bate & Richard Tren -------------------------------------------------------------------------------- TRAGEDY is striking Niger, the former French colony in west Africa, where an estimated 3,5-million people are starving and thousands are expected to die daily. Drought and poverty are the main causes of the lack of food, but over the past year west Africa has been ravaged by a plague of locusts. Niger has one of the least free economies in Africa and, according to Transparency International, it is also one of the most corrupt. If its citizens were living in a country that protected their property better, encouraged free enterprise and trade, and was less corrupt, it is less likely that as many would be starving now. But looking at the domestic institutional failures that may have led to this famine does not seem to have much traction in the world’s media. Commentators are beginning to blame western policies for contributing to Niger’s famine. David Loyn of the BBC is even citing man-made climate change as a contributor: “Climate change has made Niger a more precarious place to live”. Loyn says it is curious that not since the great famine of 1973 has there been a cycle of three bad years in a row. He says there was a drought last year, followed by locusts that ravaged the region. This year the rain has been patchy, so people talk of a second year of drought. This is the only evidence he presents that the drought is caused by climate change. He fails to note that the famine of 1973 came at a time when global temperatures were at their lowest for most of the past century. Popular opinion notwithstanding, the link between man-made emissions and drought in Niger is tenuous. But western policies that perpetuate aid rather than trade do cause direct harm, however worthy the intention, and this is also true of the environmental policy that banned the only viable form of protection against the locusts that have caused such devastation. The desert locust can devour its own weight in food in 24 hours. A ton of locusts, which is a tiny part of the average swarm, eats the same amount of food in a single day as 10 elephants, 25 camels or 2500 people. Locusts first moved south last year from their breeding grounds in north Africa towards west Africa, causing widespread problems last September. But now a new wave is hatching and, as vegetation disappears in the semidesert of the Sahel (Mauritania, Senegal, Mali, Niger and Chad) at the end of the rainy season, the locusts are heading back north. After years of drought, this year’s heavy rains (in parts of the Sahel) have provided perfect breeding conditions. Before they mature and can fly, locusts proceed through various stages and can be attacked most easily when they are “hoppers” — the stage before flight. Once locusts mature and can swarm, only crop-duster-style spraying of massive amounts of insecticide can stop them, which is expensive. Chad and Algeria have been hit by swarms and all that their domestic politicians could fund, with the help of the United Nations (UN) Food and Agriculture Organisation, was occasional aerial spraying. Cape Verde, Senegal, Mauritania, Libya and Niger have all had massive hopper presence and could have reduced the future swarms, but they could not afford to do much. That is because they could not use dieldrin, an insecticide banned by the UN Stockholm Convention on Persistent Organic Pollutants. Dieldrin used to be sprayed across the path of approaching hoppers and its persistence meant that a single spray of a thin barrier strip was enough to wipe out vast swathes of hoppers for weeks. There are alternatives, but none as cost-effective, and for debt-laden, cash-strapped countries of the Sahel, the lack of dieldrin meant not stopping the hoppers. Dieldrin’s high persistence means it should not be used for anything else but stopping locusts, but because the countries that are now sending aid, and which designed the Stockholm treaty, do not have locust infestations, they forgot to exempt it for such use. Oh dear. It is possible that the green alarmists maybe be correct that this recent drought and famine are made worse by man’s emissions of greenhouse gases. But what is certain is that these same alarmists promoted a treaty that is causing death. ‖Bate is a resident fellow of the American Enterprise Institute and he and Tren are directors of Africa Fighting Malaria.

A Plague of Alarmists -- Dr Roger Bate, TechCentralStation, 2005-08-01
  A Plague of Alarmists By Roger Bate Published 08/01/2005 Tragedy is striking the Niger. An estimated 3.5 million people are starving in the former French Colony of West Africa, and thousands are expected to die daily. Drought and poverty are the main causes for the lack of food, but over this past year West Africa has also been ravaged by a plague of locusts. What's the cause of the problem? Some commentators, such as David Loyn of the BBC, have cited man-made climate change as a contributor. Loyn says, "Climate change has made Niger a more precarious place to live." He notes that "Niger is a stray after-thought, carved out of the remnants of French West Africa when the region won freedom from France exactly 45 years ago this weekend." And he says it's curious that not since the great famine of 1973 has there been a cycle of three bad years in a row. He argues there was a drought last year, followed by locusts which ravaged the region, and this year the rain has been patchy, with very little falling in some areas, so they talk of a second year of drought. This is his evidence that the current drought is caused by climate change. What he fails to note is that the famine of 1973 came at a time when global temperatures were at their lowest for most of the past century. Indeed, popular opinion notwithstanding, the link between man-made emissions and drought in Niger is tenuous and theoretical. What is not theoretical and tenuous is that other Western policies that perpetuate aid rather than trade do cause direct harm, as does an environmental policy that banned the only viable form of protection against the locusts. The desert locust, which changes color as it develops, can devour its own weight (about an ounce) in fresh food in 24 hours. A ton of locusts, which is a tiny part of the average swarm, eats the same amount of food in a single day as 10 elephants, 25 camels or 2,500 people. Locusts first moved south last summer from their breeding grounds in North Africa towards West Africa, causing widespread problems last September. But now a new wave of locusts is hatching, and as vegetation disappears in the semi-desert of the Sahel (Mauritania, Senegal, Mali, Niger and Chad) at the end of the rainy season, they are heading back north. After years of drought, this year's heavy rains (in some parts of the Sahel) have provided the perfect conditions for the locusts to breed. Before they mature and can fly locusts proceed through various stages and can be attacked most easily when they are "hoppers" -- the stage before flight. Once locusts mature and can swarm, only crop-duster style spraying of massive amounts of insecticide can stop them, which is too expensive for these poor nations. When Chad and Algeria were hit by swarms, all their domestic politicians could fund, even with the help of the U.N. Food and Agricultural Organization, were occasional airplane sprayings. So, it's best to stop them early. But while Cape Verde, Senegal, Mauritania, Libya and Niger all have had massive hopper presence -- and could have significantly reduced the future swarms -- they couldn't afford to do much either. Why? Because they couldn't use the insecticide Dieldrin. If Dieldrin was sprayed across the path of the approaching hoppers, its persistence would allow a single spray of a thin barrier strip to wipe out vast swathes of hoppers for weeks. But the insecticide is banned by the U.N. Stockholm Convention on Persistent Organic Pollutants (POPs) for the very persistence that makes it effective to fight locusts. And while there are alternatives, none are anywhere near as cost-effective - costing at least three times more. For the debt-laden cash-strapped countries of the Sahel, lack of Dieldrin has meant not stopping the hoppers. It makes sense that Dieldrin's high persistence would make it unsuitable for other purposes. But because the countries that are now sending aid -- and designed the POPs treaty -- don't have locust infestations they forgot to exempt it for locust use. Oh dear. It is possible that the green alarmists may be correct that this recent drought and famine is exacerbated by man's emissions of greenhouse gases. But in the immediate circumstance what is certain is that these same alarmists pushed a treaty banning insecticides that is now causing death. Roger Bate is a resident fellow of the American Enterprise Institute and a director of Africa Fighting Malaria.

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