Malaria Vector Control
Malaria Treatment

Still Taxed to Death: An Analysis of Taxes and Tariffs on Medicines, Vaccines and Medical Devices  - Roger Bate, Richard Tren & Jasson Urbach
Bate, Tren & Urbach update their working paper on taxes and tariffs on medicines and medical devices - published by the AEI-Brookings Joint Centre.

The WTO and Access to Essential Medicines: Recent Agreements , New Assignments  - Dr Roger Bate & Richard Tren
Roger Bate and Richard Tren discuss the recent WTO agreement on TRIPS and public health and recommend that the WTO now turn its attention towards removing import tariffs on medicines and medical devices, which have been shown to reduce access to medicines and medical care.

Brazil's AIDS Program - A Costly Success  - Richard Tren & Roger Bate
Richard Tren & Roger Bate comment on Brazil's AIDS Treatment program which has achieved some notable successes, but potentially reduces research into new AIDS medicines and could result in large long term costs down the line.

AFM testimony to the US Senate Committee on Environment & Public Works  - Roger Bate & Richard Tren
Download the testimony given by AFM's Roger Bate and Richard Tren to the US Senate's Committee on Environment and Public Works. The hearing, chaired by Sen. Inhofe (R, OK) was set up to look at the role of science and environmental policy - what better case study than DDT?

An Immesurable Crisis? A Criticism of the Millennium Development Goals and Why They Cannot Be Measured  - Prof. Amir Attaran
Prof. Amir Attaran evaluates the Millennium Development Goals and criticises them for being unmeasurable and therefore largely meaningless. He also criticises the UN for failing to discuss the measurement of these goals at the September 2005 UN meeting on the MDGs.

State in Fear - Zimbabwe's Tragedy is Africa's Shame  - Archbishop Pius Ncube, Dr Roger Bate & Richard Tren
Catholic Archbishop of Bulawayo Pius Ncube, Dr Roger Bate and Richard Tren report on the horrific abuses of human rights by Mugabe's police and military. The authors call on the G8 leaders to exert pressure on African leaders, such as President Mbeki, to condemn Mugabe's regime and support the return of peace and democracy in Zimbabwe.

AFM's Comment on the WHA Malaria Resolution  - AFM
The World Health Assembly recently passed a resolution on malaria control. The WHO and UNICEF also recently published their World Malaria Report. AFM comments here on some aspects of the resolution and report.

Senate Hearings on USAID  -
The Senate Hearings on USAID's involvement in malaria control led to significant challenges to the agency's activities. Download the testimonies from USAID, Senator Sam Brownback, Professor Amir Attaran and AFM's Dr Roger Bate here.

Eliminate Neglected Diseases Act of 2005  -
Senator Sam Brownback's Eliminate Neglected Diseases Act of 2005 has been dropped in the US Senate. Read the Act and supporting documents here.

Taxed to Death  - Roger Bate, Richard Tren and Jasson Urbach
AFM publishes a working paper on the degree to which import tariffs, taxes and bureaucratic procedures block access to essential medicines in poor countries. See the latest version of this ongoing study here.

Despotism & Disease  - Richard Tren & Roger Bate
Africa Fighting Malaria report on the destruction of the Zimbabwean healthcare sector and the probable impacts on the entire region. Download the pdf version of this report here.

Ugandan Study Highlights Best Drug Combinations for Treating Malaria in Africa  - The Lancet
Results of a randomised trial from Uganda in this week’s issue of THE LANCET suggest that the drug combination of amodiaquine and sulfadoxine-pyrimethamine might offer the optimal treatment for malaria in terms of efficacy and cost-effectiveness in this region. The study also shows that the drug combination of chloroquine and sulfadoxine-pyrimethamine—the recommended first-line treatment in Uganda—is far less effective than other drug combinations.

Climate Change and Malaria  - Indur Goklany - with response from Sir David King
Indur Goklany offers some fascinating insights into climate change, malaria, poverty and development. Sir David King, the UK Government's chief scientific adviser gives a predicable response.

The Real Obstacles to Sound Treatment of AIDS in Poor Countries  - Roger Bate & Richard Tren
Writing for the American Enterprise Institute's Health Policy Outlook, Bate and Tren explore some of the reasons for low drug access in poor countries. Despite promises of cheap or free antiretroviral drugs, Bate and Tren argue that access to treatment in poor countries is abysmally low because of a lack of infrastructure, political indifference, excessive bureaucracy and taxes and tariffs.

South Africa's War Against Malaria - Lessons for the Developing World  - Richard Tren & Roger Bate
The Cato Institute published Richard Tren and Roger Bate's analysis of South Africa's recent history with malaria control. They argue that its policy on DDT use and Artemesinin based combination therapy provide excellent examples for other malarial countries.

SA's Leading Malaria Researchers Support DDT Use  -
South Africa’s leading malaria control experts, researchers and doctors support and endorse the use of the insecticide DDT to control malaria. Their statement is released in light of recent claims that DDT is harmful to human health and should be removed from South Africa’s malaria control programme.

South African Malaria Data  - SA Dept of Health
November 2003 - the malaria statistics show that malaria is still well under control in South Africa. A recent epidemic in the Limpopo Province was primarily caused by late spraying and poor case management.

South Africa Malaria Data  - SA Dept of Health
The latest data on malaria cases and deaths from South Africa show that the country's policy of indoor residual spraying with DDT (among other insecticides) and the use of artemesinin based combination therapy is working. KwaZulu Natal, traditionally the province with the worst malaria and the centre of the recent epidemic has only recorded 1 malaria death this year!

South Africa Malaria Statistics  - Dept of Health
The 11th Dept of Health Malaria Update shows the latest number of confirmed cases and deaths from malaria in the three malarial provinces of South Africa.

Saving Lives Today and Tomorrow  - Dr. Roger Bate
This paper analyses trends in drug development using data from the drug industry association, the Pharmaceutical Research and Manufacturers of America (PhRMA). Worryingly, the findings suggest that far fewer AIDS drugs are in development compared to several years ago, and at a time when drug development for other communicable diseases is increasing. There are several probable explanations for this phenomenon, but the least benign is the likelihood that continual pressure group and media attacks on the industry over pricing of drugs in Africa has reduced incentives for development of new AIDS medicines

South African Malaria Update  - SA Dept of Health
The latest malaria update from the Directorate of Communicable Diseases.

The 58th World Health Assembly’s Malaria Control Resolution – A Comment.


Africa Fighting Malaria supports the prominence given to malaria and malaria control at the recent World Health Assembly (WHA).  While the resolution marks a small improvement in the rhetoric on malaria control, there are still a number of worrying factors in the resolution and a number of structural problems in the way in which the WHO approaches malaria control.


AFM welcomes the resolution’s specific mention of indoor residual spraying as a malaria control intervention.  Two items of the WHA are steps in the right direction.  The first urges the Member States:


to support indoor residual insecticide spraying, where this intervention is indicated by local conditions;


The second requests the Director-General:


to provide evidence-based advice to Member States on the appropriate use of indoor residual insecticide spraying, taking into account recent experiences around the world.


These two paragraphs could mark the beginning of the end of many years of WHO advocacy against IRS and the use of insecticides in general.  Specifically, we were heartened during the debate on malaria to hear several countries from southern Africa forcefully reminding the various UN representatives and Member States that they were using DDT in IRS programs.  In most Southern African states, IRS remains the most effective means of controlling malaria.


AFM is also heartened that the resolution calls for greater inter-country cooperation in malaria control.  Arguably the most successful malaria control program at the moment is the inter-country effort of South Africa, Swaziland and Mozambique.  Mosquitoes do not recognise political boundaries and increased trade and movements of people between malarial countries requires better coordination or control programs. 


Notwithstanding these positive developments, we are concerned about several aspects of the WHA.


First in March of this year, a paper by Dr. Robert Snow and several other malariaologists published in the leading scientific publication, Nature, claims that the WHO has underestimated the extent of malaria cases and deaths around the world.  The paper suggests that not only are the RBM goals on the reduction of death and disease from malaria not going to be met, but that the burden of malaria is actually increasing.


Second, shortly before the 58th WHA, the World Health Organisation released the World Malaria Report.  The report calls for increased funding for malaria control because, according to the media release that accompanied the report, one of the reasons that the RBM goals have not been met is a lack of funding.


Third, the resolution seems to have changed the Roll Back Malaria targets and goal.  When RBM was set up in 1998,  the ultimate goal was halving the burden of malaria (which we take to mean disease and deaths) by 2010.  As a means of achieving this reduction in disease, RBM’s Abuja declaration set a target of ensuring that 60% of pregnant women and children under the age of 5 have access to preventive and curative measures for malaria.  The WHA resolution now states that the target is that “80% of those at risk of, or suffering from, malaria benefit from major preventive and curative interventions by 2010…”


These three instances reveal deep and disturbing flaws within Roll Back Malaria.  As the Snow paper indicates RBM has put little effort into actually tracking the progress of program.  The World Malaria Report itself admits that no attempt was made to collate data on malaria cases and deaths until 2002, four years after the program began.  The report also asserts that data on malaria in Africa, where more than 80% of cases and deaths occur, should not be relied upon. This all begs the question as to how the WHO could set a target of reducing the burden of malaria by 50% in the first place, when they didn’t know what the baseline incidence was and have not made any effort to track their progress.  Nonetheless RBM complains that the reason it is not meeting its targets is because it does not have enough money, and then WHO changes its targets from the original ones.  There is a very high probability based on this behaviour that RBM will keep shifting targets so that it can announce in 2010 that RBM has been a success.  


This practice is like journeying to a city, say Shanghai, without knowing from where you are starting and where Shanghai is, and then travelling without map or compass. Five years into the journey you complain that the reason you are not yet in Shanghai is not because you don’t where you are going or where you are but because you don’t have enough money to get there.  And then you decide that really Shanghai isn’t your goal after all, Bucharest is.  So then you set out for Bucharest.  At this rate at the end of ten years when you find yourself in Boston, you’ll declare that ultimately Boston was your goal, and you have made a successful journey.


This trend of setting targets without any real idea of how to achieve them or how to track needs to stop.


WHO also fails to address other fundamental flaws.  Malaria control is beset structural problems that began during the 1970s when both the WHO and UNICEF called for the decentralisation of malaria control.  Dismantling the vertical malaria control programs that had dedicated funding and personnel and conducted good operational research on their programs in favour of malaria control through primary health care sparked the rise in malaria cases around the world.  Malaria is a highly complex disease and requires dedicated structures to combat it.  Strengthening primary healthcare should not come at the expense of vertical healthcare programs that are successful.


We are concerned that the section of the resolution calling for greater ‘community participation’ and ‘multisectoral collaboration’ could be used to further entrench the idea that malaria control should be conducted at a primary healthcare level and not by dedicated public health teams.


Despite the limited progress in including IRS in the WHA, we remain sceptical about the real progress that this resolution will bring to malaria control on the ground, especially  given the reluctance of the donor community (with the possible exception of the Global Fund for AIDS, TB and Malaria) to fund effective malaria control.


The fight goes on.


Downloads: (require Adobe Acrobat)

WHA Resolution WHA58.2

World Malaria Report