Editor's Note: This is an extended version of the "Sustainable Developments" column from the July Issue of Scientific American.
In a dramatic call to action in April, U.N. Secretary-General Ban Ki-moon—backed by the African Union, the World Health Organization, UNICEF, the Gates Foundation, ExxonMobil, the World Bank, the Global Fund to Fight AIDS, Tuberculosis and Malaria, among other key international organizations and businesses—set a timetable for comprehensive malaria control in Africa by the end of 2010. Ki-moon has listened to the best science, weighed the recent evidence, and thrown down the gauntlet: there is no reason why a million or more children should die every year of a largely preventable and wholly treatable disease. Now we have a global timetable and a coalition to end the scourge.
The operational objective is to ensure that crucial interventions to control malaria are taken widely and at the appropriate scale within the next two and a half years. As I described in this space in September 2007, the package of technical control measures is now settled. There should be restriction of the mosquito vector (especially through the use of insecticide-treated bed nets and indoor spraying of insecticides); timely treatment of every clinical case with effective medicines; preventative treatment for pregnant women; and trained community health workers who will link clinics and communities in rural areas. In view of the lives to be saved and the economic benefits of reining in the disease, the total cost of around $3 billion a year is one of the world’s great bargains.
The main challenge of the next two-and-one-half years will therefore be organizational rather than conceptual or scientific. It is now up to a number of key international agencies to get the job done in Africa’s 49 countries, many of which are among the poorest in the world. Many skeptics doubt that this kind of program can work, much less on an accelerated timetable. The international system is a congeries of overlapping public and private institutions without clear mandates, ease of coordination or a single “conductor” to harmonize activities. Many of the key institutions are sporadically funded. The recipient governments are not always noted for their transparency, efficiency and accountability, to say the least.
Yet the chances for success are also strong. Many African leaders have long been committed to this fight. The U.N. secretary-general and the office of his special envoy on malaria represent a clear point of leadership. The Global Fund to Fight AIDS, Tuberculosis and Malaria serves as a dominant funding organization, and though its own budget depends in a complex way on the contributions from many governments, at least this single agency can channel most of the money that will be needed for success. Happily, the U.S. government is committed to its own sizable contribution, which will likely grow in view of robust congressional support. Finally, the Roll Back Malaria Partnership has had years of experience in bringing the multitude of “partner institutions” under one roof.
The needed technologies are relatively straightforward and much easier to use than those, for example, for controlling the HIV/AIDS pandemic. Bed nets and antimalaria medicines could be deployed rapidly to good effect. We may also take heart in the success of an immunization campaign in reducing measles deaths in Africa by more than 90 percent since the year 2000. Other recent triumphs, based on the up-scaling of powerful and easily deliverable technologies, include the control of polio, leprosy and guinea worm.
Still, the timing will be very tight and will require an unprecedented coordination of financing, training, monitoring and logistics. Each sub-Saharan country will need very quickly to adopt, vet, fund and monitor a scaled-up antimalaria plan. The major global commodity manufacturers of bed nets, antimalaria drugs and diagnostics will have to raise production to hundreds of millions of units. Tens or hundreds of thousands of community health workers will need weeks of training on malaria control, including both prevention (such as the proper use of bed nets) and treatment.
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7 Comments
Add CommentGive the United Nations anything and they'll bury it in a quagmire of corruption and payoffs. Instead of concocting these utopian plans they would be better off empowering the religious missionary organizatios to do the work. The United Nations is nothing but a cadre of third world criminals masquerading as humaitarians.
Reply | Report Abuse | Link to thisYour propensity to demonize stereotypes detracts from the issue.
Reply | Report Abuse | Link to thisBefore you again suggest converting malaria victims to your particular choice in religion, it would be wise to also inform yourself in regard to programs that have already been implemented and of successes which have been achieved.
If you cannot find any then perhaps you could elaborate on you plan. If you have examples of successful campaigns against malaria in recent times by religious missionaries, you are free to cite them on this website. I am sure there are many people who would be interested and might want to help in such efforts.
A worthy goal. It might help to apply the lessons we learned from eradicating malaria in the United States, like using DDT. It is environmentally friendly and highly effective when used properly.
Reply | Report Abuse | Link to thisA problem in malaria that has bothered me is, "What will happen to the people of the malaria belt if it were eradicated?" My best prognostication is that their lands will become valuable for northern people to buy for second homes and resorts. Within 50-100 years they would be crowded off their land.
Reply | Report Abuse | Link to thisNow, much of it is very difficult indeed. HIV, malaria and the politics of warlords has guaranteed that. And yet, the people are sheltering under the eaves of malaria, just as other peoples on the edges of war are sheltering there. Nothing keeps away the juggernaut of globalization except war and disease. Everything else is falling before it.
So it troubles me. Not that I am of the idea that malaria will be eliminated.
Consider the length of time the average tropical folk spend out in the open topless/shirtless working and cooling off in the open before heading to bed at night. They are exposed to the vector umpteen times before heading to bed under a bednet in what is called a shelter.
Reply | Report Abuse | Link to thisI am an advocate of taking the fight to the vector through environmental management and sound vector control practices as obtains in the South and Southeastern United States. Training in vector habitat management to compliment the use of indoor sprays and bednet is a key element in complimenting current efforts aimed at reducing infection rates.
A M Jallow
Right, because religious missionaries have such an altruistic motive. And such a great track record. "a cadre of third world criminals" is at least as apt a description, considering the toll they've taken on independent cultures.
Reply | Report Abuse | Link to thisBut hey, maybe a few missionaries spreading your own outdated, dysfunctional philosophy will help. It's hard not to make some improvement in a people that have nothing, and it's it's easy to think you're a godsend when you're allowed to run amok with an entire society.
It just feels so good on such a primal level, traveling to a new tribe, and conquering them by getting them to abandon their own culture and adopt yours. Perhaps if you convince them that only your god really loves them, they'll stay subordinate to your dominion after you leave.
...and won't leave their culture completely confused and utterly screwed up down the road. ...like missionaries have everywhere else.
In other news, a recent discovery was made. Famine and disease keep species populations in line. The greater the population surges, the greater the risks.
Reply | Report Abuse | Link to thisNow lets all throw self-control to the wind, breed like crazy, for heavens sakes don't use birth control or have an abortion, live in dense populations near waterways, encroach into jungles and other areas not suitable for supporting humans, and make half-cures for diseases as they arrive, allowing them to mutate, become stronger, and further propagate.
Whether humanity or an ant colony, life spreads stupidly until something starts killing it effectively. The ones on the edges die, the ones in the middle learn from it.