[afro-nets] Mosquito/Malaria Control (3)

[Peter Burgess <Profitinafrica@aol.com>]

Mosquito/Malaria Control (3)
----------------------------

Dear John Arube-Wani and AFRO-NETS colleagues

At long last some of the better known experts on official relief
and development assistance (ORDA) including Professor Jeffrey
Sachs, formerly at Harvard and now at Columbia, have started to
talk about the malaria health crisis. Others of course have rec-
ognised the crisis, and of course what was originally expected
to be a Global Fund for HIV-AIDS eventually was established as
the Global Fund for AIDS, Malaria and Tuberculosis.

What is the best way to reduce the impact of malaria? As an ac-
countant I would start off by asking what is the lowest cost way
of doing it, not just in the short run but over years? I would
ask what are the negative side effects of different approaches?
I would ask what are the results to be expected, and what re-
sults have been achieved in the past by different methods?

AIDS is a very tough health crisis to handle. Human behavior is
a critical vector for the disease, and changing human behavior
is very difficult.

But malaria ought to be easy to handle. The key vector, and as
far as I know, the only vector is the mosquito. No mosquitoes...
no malaria.

It is a long time since malaria was a mass killer problem in the
South of the United States. It was a serious problem early in
the last century. But the mosquito has been controlled and there
is virtually no malaria now. Malaria cases usually are from peo-
ple returning from mosquito/malaria infested locations outside
the USA.

Mosquitoes have been controlled in the USA by outdoor spraying.
The pesticides are sprayed mainly from the air in very low con-
centrations that are lethal to mosquitoes but not dangerous to
animals and humans. DDT is one of the most cost effective pesti-
cides for spraying, and perfectly suited to low concentration
external spraying against mosquitoes.

DDT as used as a pesticide for agricultural use is a very dif-
ferent issue. As I understand it, the concentrations were much
higher and eventually there was serious run-off into the ecosys-
tem. But the mosquito spraying is far less damaging to the envi-
ronment.

DDT sprayed indoors in high concentrations is going to be a more
serious potential hazard than using DDT in an outdoor spraying
mode where concentrations are very very low, yet still lethal to
mosquitoes.

To put it bluntly... mosquitoes are killing as many as 10,000
people a day in Africa... sprayed DDT plus dead mosquitoes might
create environmental endangerment that might result in a few
deaths a year, perhaps.

I don't know how much to value human life. Accountants are not
often required to put a value on this, but it is common in the
US judicial system for a medical malpractice suit or an asbestos
or smoking law suit to value human life in the $ millions. If we
do the calculation valuing life at a mere $1,000 then the lost
value from the malaria scourge is $10 million a day or about
$3.5 billion a year. If human life is worth $10,000 the number
becomes $35 billion a year.

I am not sure how much the various options for malaria control
will cost, and how effective each of the approaches will be. My
understanding is that $5 per bednet per year has been mentioned.
For say 300 million Africans in malaria affected areas that is
$1.5 billion a year. Bednets may reduce the incidence of malaria
by 30% (say) so human life saving becomes 30% of $3.5 billion or
about $10 billion. On that basis the bednet is a bargain, and
Professor Jeffrey Sachs and others are actively supporting the
idea of massive deployment of bednets.

But is that the best way? Is that the most cost effective?

Mosquito eradication can probably be done for around the same
per capita cost as bednet deployment. Mosquito eradication would
be done by a combination of ground fogging and air spraying.
Costs depend a lot on the physical environment. But instead of
getting a 30% reduction in mortality it is reasonable to expect
upwards of 80% reduction in mortality. Bednets were a good solu-
tion compared to nothing. Mosquito eradication is a good solu-
tion compared to bednets.

I am working with the Transparency and Accountability Network to
support a mosquito eradication agenda in Africa. There are
emerging plans to run a program in Monrovia, Liberia and I would
welcome steps to replicate the plan in other areas where mosqui-
toes and malaria are a crisis. Monrovia is particularly chal-
lenged by mosquitoes and malaria because of its geography, but
so was Florida in the USA.

It would seem to me that mosquito eradication should be a high
priority for the Global Fund (GFATM)... but I am not sure yet to
what extent they are embracing mosquito eradication as the pre-
ferred solution.

If anyone has project plans for mosquito eradication I would be
very pleased to review them and help to the best of my ability.

Sincerely,

Peter Burgess
Tr-Ac-Net in New York
Tel: +1-212-772-6918
mailto:peterbnyc@gmail.com
The Transparency and Accountability Network
With Kris Dev in Chennai India
and others in South Asia, Africa and Latin America
http://tr-ac-net.blogspot.com