[afro-nets] Urgent Need to Fund Efforts to Fight Malaria

[Claudio Schuftan <claudio@hcmc.netnam.vn>]

Urgent Need to Fund Efforts to Fight Malaria
--------------------------------------------

["In 2002, during a U.N. summit in Monterrey, Mexico, leaders of
wealthy nations committed to devote 0.7% of their national in-
come to foreign aid by 2015. A handful of European countries
have already reached this goal, and the rest of the European Un-
ion has strongly committed to getting there. The United States,
meanwhile, has been reluctant even to admit it made the promise.
Currently, the U.S. spends only 0.16% of national income on for-
eign aid, making it one of the biggest laggards among industri-
alized nations."]

http://www.latimes.com/news/opinion/editorials/la-ed-malfunds13nov13,0,7689895.story?coll=la-news-comment-editorials

Los Angeles Times: November 13, 2005

MALARIA: THE STING OF DEATH

A historic opportunity

OVER THE SHORT TERM, diseases such as the black plague and AIDS
have killed more people than malaria. But medieval generations
gradually built up resistance to the bubonic plague, and the
discovery of antibiotics ended its deadly rampage. AIDS is a
relatively young disease, a couple of decades old, and medical
advancements are coming fast.

Malaria, by contrast, has stalked humanity since the beginning
of history, reaping corpses beyond counting. It is a killer
unlike any the world has known, a parasite that may have snuffed
out more people since its origin than any other. And it's get-
ting worse.

Malaria kills anywhere from 1 million to 3 million people a
year, 90% of them in sub-Saharan Africa, most of them children
under age 5. A study last year found that the child- mortality
rate from malaria roughly doubled between 1990 and 2002, thanks
largely to the parasite's growing resistance to older drugs and
a breakdown in Africa's healthcare infrastructure. Every 30 sec-
onds, or about the time it took to read this far, a child's
heart is stilled by malaria.

Over the last six years, Africa's misery has become an interna-
tional issue. Groups such as the United Nations and the World
Health Organization have set concrete targets on reducing ma-
laria by 2010 or 2015. Funding of anti-malaria initiatives has
risen sharply. The good news culminated in President Bush's com-
mitment in June to spend $1.2 billion over the next five years
to fight the disease.

Yet nobody on the front lines is declaring victory. Future fund-
ing for Bush's malaria project is uncertain. The Global Fund to
Fight AIDS, Tuberculosis and Malaria, the largest source of
funding for anti-malaria efforts, raised less money in 2005 than
2004, and the outlook for the next two years isn't promising.
The world is spending only about a tenth of what it would take
to effectively fight the disease.

At this rate, none of these international goals for reducing ma-
laria will be met. Millions more children will die, and a his-
toric opportunity to crush one of mankind's most potent enemies
will have been lost.

America gets serious

Last year, something surprising happened in the Senate: Key law-
makers began demanding answers from the U.S. Agency for Interna-
tional Development about its malaria programs, a topic that had
been widely ignored for years. Congressional hearings on the
subject proved highly embarrassing for USAID; at one hearing, a
former administrator had to admit that she couldn't account for
how the agency had spent its $80-million malaria budget in 2004.

Finally, in December, USAID released a report breaking down its
malaria allocations. The results pleased no one. Only $4 mil-
lion, or 5% of the malaria budget, was being spent on proven in-
terventions such as bed nets and anti-malarial drugs in other
countries. The rest was going to U.S. consultants. Mostly, these
consultants help African countries apply for grants from the
Global Fund, though some also work on more concrete projects
such as building a sustainable marketplace for bed nets in Af-
rica.

During the 1990s, development assistance fell sharply, and
USAID's existence was threatened. Instead of phasing it out,
though, Congress transformed it into a contracting organization.
Rather than giving money to foreign governments, it began giving
money to American contractors. It formed a symbiotic relation-
ship with these organizations: They would lobby Congress for
more money on behalf of USAID, and USAID would distribute it to
them. How they do it is anybody's guess. It is nearly impossible
for outsiders to track whether USAID programs are effective, or
even to tell how the money is spent.

USAID's report on its malaria funding didn't placate its Senate
opponents, particularly because it was an extremely sloppy docu-
ment, using only vague descriptions of project activities and
numbers that didn't add up. Sen. Sam Brownback (R-Kan.) re-
sponded with a bill requiring USAID to spend a majority of its
malaria money on concrete interventions such as pesticide spray-
ing, bed nets and drugs, and to improve its transparency.

The bill never came to a vote, and it is languishing in the Sen-
ate. But it had an effect. Brownback, a powerful force in the
social conservative movement, discussed malaria and USAID's
shoddy record with Bush. A week before a Group of 8 meeting in
July at which aid to Africa would be at the top of the agenda
for the club of industrialized nations, Bush announced his $1.2-
billion malaria initiative.

The plan seems designed to address the key criticisms of USAID.
Dr. Ali Khan, acting chief of the malaria branch at the U.S.
Centers for Disease Control, insists the majority of the money
will pay for proven techniques rather than contractors, and that
every dollar spent will be accounted for on a publicly accessi-
ble website. The $30 million needed for the first year of the
project has already been approved by Congress, but the proposed
funding will ratchet up later, and the initiative's future is
unclear in the face of widening budget deficits.

Although the anti-malaria initiative sounds good on paper, it is
still being administered by USAID; given the agency's lack of
transparency and cozy relationships with contractors, that does-
n't inspire much confidence. Malaria could be fought more effec-
tively by giving the extra money to the Global Fund.

And the Global Fund could really use it.

A visionary program in danger

The Global Fund to Fight AIDS, Tuberculosis and Malaria spends
more to fight malaria than any other entity. Created by the G-8
and the United Nations in 2001, it has very low overhead and,
unlike USAID, its spending records are thorough and easy to ac-
cess. Global Fund money goes to pay for the treatments and pro-
grams that recipients most need, not what outside governments
think they need. So far, about 31% of the money awarded by the
Global Fund has gone to fight malaria, with the rest spent on
programs to fight AIDS and tuberculosis.

One-third of the Global Fund's budget comes from the United
States. In 2004, total world contributions to the fund came to
$1.53 billion. This year, they dropped to $1.28 billion. The
U.S. contribution dropped during that time to $352 million from
$459 million. For 2006, Congress has already approved a $450-
million donation, and a pending budget bill could add another
$100 million. That still won't be nearly enough.

The Global Fund estimates it needs a combined $7.1 billion for
2006 and 2007 to keep existing projects alive and fund new ones.
So far, not counting contributions from the U.S., it has only
$3.7 billion in firm pledges from the rest of the world for
those years.

Even if the Global Fund hits its goal for the next two years,
the money spent fighting malaria worldwide won't come close to
the amount needed. The World Health Organization estimates it
would cost $3.2 billion per year to pay for all the bed nets,
drugs and other interventions needed to meet international goals
on reducing malaria. According to the Global Fund, last year the
actual amount spent worldwide was $295 million. Amir Attaran, a
professor of law and world health at the University of Ottawa
who has written extensively on malaria funding, estimates that
2005 spending is less than $500 million. The numbers are equally
bad for research on new products that could help eradicate the
disease, such as a vaccine or cheaper, more effective drugs. A
study released last month by the Malaria R&D Alliance found that
the amount spent on malaria research in 2004 represented just
0.3% of total health-related R&D investment that year - yet ma-
laria accounts for about 3.1% of the global disease.

Previous editorials in this series have described other measures
that could potentially eradicate malaria but would boost the
costs still more. An advance purchase commitment for a vaccine -
a pool of money held out as an incentive for private industry to
research cures for malaria, which otherwise is not a profitable
pursuit - would cost about $4 billion. A global purchasing pool
to subsidize the cost of malaria drugs for low-income Africans
would cost $300 million to $500 million a year.

Not cheap, by any means. Yet far from impossible for a world mo-
tivated to stem the problem. In early November, for example,
Bush proposed spending $7.1 billion on a program to protect
Americans from a flu pandemic. Although there is a real threat
of such a pandemic, it doesn't currently exist, and one might
not ever strike the United States again. There's nothing theo-
retical about malaria or its victims.

The cost of doing nothing

In 2002, during a U.N. summit in Monterrey, Mexico, leaders of
wealthy nations committed to devote 0.7% of their national in-
come to foreign aid by 2015. A handful of European countries
have already reached this goal, and the rest of the European Un-
ion has strongly committed to getting there. The United States,
meanwhile, has been reluctant even to admit it made the promise.
Currently, the U.S. spends only 0.16% of national income on for-
eign aid, making it one of the biggest laggards among industri-
alized nations.

Given the economic and human devastation wrought by malaria, ef-
fectively fighting it would be well worth the multibillion-
dollar price tag, which would only be a small portion of total
foreign aid spending if the 0.7% commitment were met. Conquering
malaria also would rank with walking on the moon and stemming
polio as among the greatest achievements of the modern age.