[afro-nets] Fighting Malaria - the right way

[Philip Coticelli <pcoticelli@gmail.com>]

Fighting Malaria - the right way
--------------------------------

An article by a colleague of mine in the Washington DC Examiner
today concerning our recent success in shifting USAID's malaria
policy.

Enjoy, Phil

Roger's article on malaria and the new USAID reforms appeared in
the "DC Examiner" today. Please find the complete text of the
article below or click on or type the URL:
http://www.dcexaminer.com/articles/2006/01/09/opinion/op-ed/18oped9bate.txt

Fighting malaria - the right way

By Roger Bate*

The fight against malaria has scored a major victory. The U.S.
Agency for International Development has elected to use nearly
half of its budget to buy proven interventions against the dis-
ease, which affects 500 million people and kills more than a
million children around the world each year. USAID has promised
$15 million expressly for insecticides, recognizing their unique
effectiveness in reducing the burden of malaria. The agency has
opted to streamline more funding to fewer countries in order to
improve accountability and focus on results.

This announcement follows USAID chief Andrew Natsios' resigna-
tion and marks an ideological shift in the agency's approach to
malaria control. Since it joined the World Health Organization's
global effort to roll back the disease in 1998, it has devoted
most of its budget to U.S. consultants whose technical advice
emphasized mosquito nets and largely ignored indoor residual
spraying. This has proved a losing strategy. Recent estimates of
malaria rates show they have increased substantially over the
past decade.

Holding USAID to account has proven difficult because malaria
primarily affects African children and public interest in the
U.S. is limited. It has taken much pressure from malaria experts
to ensure the policy shift. There is still room for improvement
since its unclear how transparent the new effort will be, but
hope is running high within the community. The "Kill Malarial
Mosquitoes Now!" coalition, which has presented USAID with a
declaration calling for two thirds of the agency's budget to be
used to buy life-saving commodities (namely the historically ma-
ligned but singularly effective insecticide DDT) has played a
part in the recent shift. Signatories to the declaration include
Nobel Laureates Archbishop Desmond Tutu and Dr. Norman Borlaug,
as well as doctors, lawyers, public health experts, business
professionals and civil society group leaders from diverse back-
grounds.

The "Kill Malarial Mosquitoes Now!" coalition has welcomed the
announcement by USAID but believes that the agency must go fur-
ther in fighting the disease. There is no guarantee that the
money USAID has committed toward indoor residual spraying will
be used to buy DDT. This chemical is the cheapest and most ef-
fective insecticide available for IRS. It brought malaria rates
down by 75 percent in both Zambia and South Africa. A spokesman
said USAID has previously followed environmentalists' ideology
in avoiding the chemical, pointing to exaggerated and often un-
founded accounts of its harmful effect on humans. Yet the sci-
ence remains on the side of using DDT. Marginal side effects do
not prevent the use of pharmaceuticals in the U.S. to treat far
less devastating diseases than malaria. If asked, an African
mother would rather risk a few squirts of DDT on the wall to
save her child's life or to prevent an average of 300 mosquito
bites a night during the rainy season.

USAID also needs to avoid fudging numbers, a situation most do-
nors are guilty of at some stage. The agency must establish
clear, scientifically sound baseline figures for malaria rates
in the countries where it operates. This should be a high prior-
ity in their move to concentrate more money in fewer programs;
it is the only way progress can be judged. How else will the
president know that malaria deaths have been halved, if there is
no baseline from which to judge it? In the past, the agency has
borrowed inaccurate or incomplete figures from the World Health
Organization. Additionally, USAID has fudged its efficacy data
for insecticide-treated mosquito nets by assuming that they are
used appropriately and consistently. It is hoped that this will
no longer be tolerated in the new USAID.

President Bush and USAID must be commended for being the first
leader and aid agency to explicitly mention funding spraying
programs (and although there is no guarantee, there is the men-
tion of using DDT as well). Hopefully they will be copied around
the world, especially in Europe. Millions of lives are at stake
and the tools to protect them are at our fingertips.

* Roger Bate is a resident fellow of the American Enterprise In-
stitute.