Seduced by 'winnable war' donors throw money at malaria

Staff Writers | 01 Jan 2008
In Belalanda, a small village of reed huts in southwest Madagascar, women with faces smeared with a skin-lightening face pack file away from the local health clinic with packages on their heads.

Each contains a free insecticide-treated anti-mosquito bed net, 1.5 million of which were distributed to pregnant women and children during the biannual Mother and Child Health Week in October.

Malaria kills upwards of 1 million people annually, mostly young children in Africa. On this Indian Ocean island, the disease known simply as 'tazo' (fever) is the number one cause of death, claiming two children every hour. The district of around 12,000 people in which Belalanda is located, near the coastal city of Tulear, gets about 20 cases a month, two or three them fatal.

Waving away mosquitos from the baby clamped onto her breast, Charline Herla says she was treated for malaria three years with an old, cheap drug called chloroquine to which some forms of malaria have become resistant.

Help is now at hand as donors, seduced by talk of a "winnable war," dig deeper into their pockets to try to swat a disease that was banished from Western shores after a last push in the US in the 1950s.

"This is the most money malaria ever got," anti-malaria campaigner Louis da Gama said triumphantly after the Global Fund for HIV/AIDS, tuberculosis (TB) and malaria announced in November it was more than doubling its spending on malaria to $469 million.

In explaining its decision to allocate 42 percent of its total spending to malaria - compared with only 10 percent for TB, which kills 1.6 million people each year - the Fund cited "spectacular" progress in 2007 in malaria prevention and treatment.

With treated bed nets that protect at least two people from night-feeding malaria-carrying mosquitoes costing only a few dollars, malaria prevention offers considerable bang for donors' bucks. Last year the Fund financed bed nets for 46 million families.

Promising results from clinical trials in Mozambique of a long-sought-after malaria vaccine have also led some NGOs to start talking about shifting the goalposts, from "rolling back" malaria to outright eradication.

The trial showed infants who received the vaccine were 65 percent less likely to contract malaria.

"If the US wants to win a war it ought to be the war on malaria." Senegalese singer Youssou N'dour, a Global Fund ambassador, said during a visit this year to the United States, whose President George W. Bush has made malaria a cornerstone of his Africa policy.

British Prime Minister Gordon Brown, recently announcing increased funding for malaria, also declared it was time to "kill the disease for good".

But experts are wary about oversimplifying the struggle against a disease with a history of resistance to drugs, pesticides and good intentions.

"Having a grand goal such as eradication in mind is good, but we can and should learn from history and previous efforts at eradication before we get our hopes too high," Africa Fighting Malaria director, Jasson Urbach, wrote in a South African newspaper recently.

Malaria was essentially a development issue, he argued. As countries became wealthier they were more likely they were to drain soggy land and build houses with better protection from mosquitoes.

If development is the key Madagascar is set to be plagued by malaria for years to come. Some 69 percent of Malagasy live below the poverty line and only 40 percent have access to health facilities.

Undeterred, the government of President Marc Ravalomanana has announced plans to eradicate malaria by 2012 - by giving every home two bed nets, rolling out new, more effective combination drugs (ACTs) and, in lesser-affected regions, spraying homes with insecticide.

"All of these strategic plans are only plans as long as donor funding is maintained," warns Da Gama, estimating at three years the amount of time before "malaria fatigue" sets in.

Much depends on the outcome of the 2008 US presidential election. A quarter of the cost of Madagascar's $162-million programme is met by the US President's Malaria Initiative.

During a visit to Madagascar PMI coordinator Admiral Tim Zeimer discounted fears the next US president might be tempted to put his stamp on, say, diarrhoea.

"There is no doubt in my mind that the next president - he or she - will continue to invest in malaria in Africa," he said. "As we see impact we will see continued funding."

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