Africa: Taking the Fight Against Malaria to Americans

Gatonye Gathura | 15 Dec 2006
The Nation (Nairobi)

Americans rank malaria among the least serious diseases worldwide. This comes as no surprise because the disease was wiped out of the US 50 years ago.

Soon, however, this view - revealed by a Gallup poll conducted last weekend - is going to change, following an initiative launched by President George Bush at a White House summit on malaria yesterday.

The goal of the President Malaria Initiative (PMI) is to rally America for a mammoth public-health campaign that is likely to rival efforts that defeated polio in the 1960s.

If all goes as planned, schoolchildren across America will join corporations, religious organisations, charities and the government, in a mission to cut Africa's death rate from malaria by half in the next five years.

In a pre-summit briefing at the White House on Wednesday, Mr John Bridgeland of Malaria No More - one of the summit's sponsors - says the first thing is to awaken America and other non-malaria countries to care about the disease.

"And so we will be providing educational materials on malaria to nearly six million first, fifth and sixth graders, to virtually every public, private and parochial elementary and middle school in the United States to try to educate and make them aware of a disease that they don't know much about and that our survey data tells us that even adults in America don't know much about," said Mr Bridgeland.

The PIM actually started in June last year, when President Bush announced the five-year $1.2 billion initiative, with a challenge to the private sector to join his government in combating malaria in 15 of the hardest hit countries in Africa.

First to benefit were Tanzania, Angola and Uganda, where about six million people had already been reached, said Admiral R Timothy Ziemer, the project coordinator.

In June this year, US First Lady Laura Bush, who has made the fight against malaria one of her top priorities and the host of the summit, brought more countries on board - Malawi, Mozambique, Rwanda, and Senegal - which are now getting long-lasting mosquito nets, anti-malarial drugs, and assistance in mosquito-spraying programmes.

The summit is meant to raise awareness on malaria and seek more financial help, says Admiral Ziemer, but pledges had started arriving even before the meeting convened.

The Bill & Melinda Gates Foundation said it would increase its anti-malaria spending by $83.5 million (Sh5.8 billion), bringing its total commitment to nearly $766 million (53 billion).

Mrs Melinda Gates has termed malaria's persistence "a moral outrage," especially since it is preventable and treatable.

Apart from a campaign to create awareness among Americans, the project does not promise new tools, but an acceleration of existing interventions.

"On prevention, we're aggressively pursuing spraying, along with the distribution of nets - I'd like to say distribution and use of nets," he said.

The initiative is insisting on the use of the Artemisinin-based Combined Therapies (ACTs) for treatment.

And then there are sulfadoxine-pyrimethamine, or SPs, which the project will buy and distribute, as pre-emptive treatment, to pregnant women.

This is to increase chances of them having a normal pregnancy and healthy babies even if they are bitten by mosquitoes - carriers of the malaria-causing parasite.

Countries fighting malaria, including Kenya can identify with such measures.

The Health ministry, working with donors and non-governmental organisations, has distributed more than eight million nets through highly subsidised programmes.

Three million nets

But this year, Kenya started distributing free nets. Three million long-lasting nets will be made available to pregnant women and children under five years of age in all malaria-prone areas.

The highly effective ACTs are now provided at public health centres at no cost. Provision of ACTs, which are several times more expensive than the SPs, is financed by the Global Fund against malaria, tuberculosis and HIV/Aids.

The Ministry of Health also treats pregnant women who visit its prenatal clinics with SPs, to pre-empt malaria infection, while indoor spraying in malaria-prone areas is done to reduce mosquitoes.

The chemicals of choice for indoor spraying in the country are pyrethrum derivatives but several other African countries have adopted DDT.

A few months ago, the World Health Organisation (WHO) lifted a 30-year ban on the use of DDT for controlling malaria and the US government indicated its willingness to support spraying programmes that use it.

Admiral Ziemer said: "I think it's important to understand that much of malaria in the 1950s and '60s was done away with because of an aggressive spraying programme in this country.

"DDT is a safe insecticide. It's one of 12 insecticides that's been approved by the WHO ...

DDT to save lives

"We must learn from history. And today, we have to understand that DDT is one of 12 insecticides that saves lives. And it would be unconscionable if we didn't use it to save lives."

It is estimated that malaria kills about a million to three million people a year, mostly African children under five years old.

Malaria is probably killing as many people today as it was five years ago.

There are some success cases, however, that prove the disease can be beaten, even in poor countries.

In southern Mozambique, Swaziland and Eritrea, cases are down between 80 per cent and 90 per cent.

These are among the places that have seen a comprehensive eradication effort, including heavy distribution of insecticide-treated bed nets, and the widespread use of effective anti-malaria drugs.

So what is going to be so different this time round?

"There's a sense of change out there because of the Global Fund funding, because of movements like Malaria No More, because of what Exxon Mobil is doing, because of what Gates is doing, because of what the President is doing in leading this fight within the country, something has changed- that's awareness, that's leadership, and it's cash," says Admiral Ziemer.