Fighting Malaria

Roger Bate | 09 Jan 2006

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 at AEI.,pubID.23653/pub_detail.asp