Whither Idol's Money?

Philip Coticelli | 22 May 2007
New York Sun

American Idol's "Idol Gives Back" special on April 24 and 25 helped raise over $60 million to fight poverty in America and Africa. As season five comes to a close tomorrow, fans should be asking where their money went and what the impact on poverty will be.

Over six million dollars of the total was given to Nothing But Nets, an antimalaria bed net distribution initiative claiming that the funds raised have already "saved over 600,000 children." An undisclosed amount will also go to Malaria No More, UNICEF, and the Global Fund to Fight AIDS, TB and Malaria. These groups have good intentions, but their collective strategy of covering Africa with $10 insecticide-treated nets is simplistic and wasteful. Africa needs more than ITNs to stop malaria and overcome chronic poverty. Nothing But Nets claims "one net saves one life," hence six million dollars saves 600,000 lives.

Public health is more complex and this is a spurious calculation. Technical agencies like UNICEF and the Global Fund make more realistic assumptions about ITNs based on scientific evidence. UNICEF, for example, explains on its Web site, "There is evidence that ITNs, when consistently and correctly used, can save six child lives per year for every one thousand children sleeping under them." This estimate is based on a 2003 study in the Lancet, a British medical journal, and amounts to 0.006 lives saved per ITN properly used, not one.

Moreover, consistent and correct use means sleeping under an ITN all night every night. This is quite a caveat. Uganda has one of the most free and vibrant civil societies in Africa. It has received tremendous amounts of foreign aid, including over two millions ITNs by 2005. A 2006 National Statistics Bureau survey that year found only 14% of rural households owned an ITN, and only 8% of young children and pregnant women used one the night before the survey. Malaria No More and the Global Fund have distributed over two million more ITNs in Uganda since then. The fact remains that ITNs are a personal inconvenience for various reasons, the most obvious being nature's nightly call.

This is why the World Health Organization has called for more indoor residual spraying with insecticides that kill or repel malaria-carrying mosquitoes, including DDT. The West used DDT to eradicate malaria, and President Bush's Malaria Initiative has been helping countries to use it safely and effectively. Yet fundraisers, U.N. agencies, and most other donors have continued to focus on ITNs because they are easier to implement. ITNs can be shipped in and dropped off like disaster relief aid, while indoor residual spraying programs require tough policy reforms, development of health systems, and complex monitoring.

The opportunity cost of blinkered ITN distribution is huge. By avoiding systemic problems, donors have neglected fundamental public health needs. Africa has almost no laboratory capacity to test for and confirm diseases. Doctors and health care workers in rural Africa routinely administer anti-malarial medicine without knowing if the patient actually has malaria. This can complicate illness and foster drug resistance.

No laboratories also mean no regulatory capacity or quality control for drugs or ITNs. Donors and African governments rely on WHO's expert recommendations to verify the safety and efficacy of public health commodities; its recommendation for "long-lasting ITNs" is the gold standard. This has ramifications for market entry, competition, and price.

Our recent analysis found that the WHO recommendation process for long-lasting ITNs is fraught with delays and takes two years on average. This has enabled one company, Vestergaard Frandsen, to preserve a monopoly with 70% of global production capacity and taxpayer funded contracts for long-lasting ITNs.

Recently in Uganda, America bucked this trend and opened competition to independently verified ITNs languishing in WHO review. Vestergaard was underbid and lost the contract. U.N. agencies like UNICEF and the Global Fund, which finances two-thirds of malaria control spending globally, are again preserving the status quo. The $10 they require for ITN purchase and distribution costs could be much lower, but they lack incentives and, they argue, the ability to influence the policies governing how the money they raise is spent.

This makes waste at another level. African governments have nearly all exempted HIV/AIDS medication from import taxes, but ITNs are a trickier commodity. Nothing But Nets plans to use four of the six million dollars raised by Idol to buy 2.1 million long-lasting ITNs later this year for the a West African nation, Burkina Faso.

The government of Burkina Faso routinely charges a 5% import tax on ITNs, which will cost this initiative an additional $400,000-$500,000. This means 40,000-50,000 Americans who thought they were buying a net and saving a life were actually donating to the president of Burkina Faso, Blaise Compaore.

It is easy to sell quick wins like ITNs to a well-intentioned populace. ITNs are a valuable resource and should be part of integrated malaria control strategies. But African kids should not be expected to grow up under nets.

More money is not necessarily money more wisely spent. The idling Idol funds should be used by Malaria No More, UNICEF, and the Global Fund to build spraying programs and to provide the laboratory capacity needed in order to monitor disease and evaluate the impact of ITNs distributed.

Donors have avoided tough development issues for too long. Now we can only guess what the result of Idol's fundraising efforts will be.

Mr. Coticelli is the research and communications manager of Africa Fighting Malaria. Cosmin Florescu, a research assistant with the organization, contributed to the research for and the writing of this piece.