Recently the Poverty Action Lab at the Massachusetts Institute of Technology carried out a detailed experiment in Western Kenya that compared mass distribution with a partial-subsidy approach. The results: even a small charge for bed nets led to a tremendous drop in their adoption. Moreover, there was no greater wastage of the nets received for free than for the nets that were purchased at the discount price. The conclusion of the M.I.T. study was clear: “Free distribution is both more effective and more cost-effective than cost-sharing.”
The Roll Back Malaria Partnership has now embarked on a coordinated effort to ensure comprehensive malaria control throughout Africa that includes not only anti-malaria bed nets but also medicines, rapid diagnostic tests and community health workers trained to deliver such vital interventions. The cost will be around $3 billion per year, or $3 annually for each of the one billion per person per year of the one billion people living in the high-income donor countries.
There are three lessons here. First, the poorest of the poor are in such dire straits that failures to help can lead to needless mass suffering and deaths. Even interventions that seem to be nearly free from the U.S. perspective, a few dollars per household per year, can be a financial barrier for the poor. Second, mass free distribution of bed nets, medicines, and vaccines can be highly effective and properly managed. Third, documented demonstration projects and careful experiments, working hand in hand, have improved the rigor and success of malaria policies, and those successes should now be taken to full scale.
For more background on these distribution programs, please see the readings posted on www.earth.columbia.edu
*Erratum (10/01/09): This sentence has been edited since posting to state the correct cost of mosquito nets.
This article was originally published with the title Good News on Malaria Control.
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13 Comments
Add CommentDear Dr. Sachs:
Reply | Report Abuse | Link to thisI read your article re malaria control with LLINs with interest. Without questioning the merits, you seem to say two children can use a LLIN for five years for $10 -for a cost of $0.50 per child year of use. Is that the gold standard for accuracy for environmental and social science? Did I miss something, or does $10 divided by 10 child years of use calculate to $1.00 per child year?
Edwin M. Osborne
Camarillo, CA
Dear Dr. Sachs:
Reply | Report Abuse | Link to thisYes, malaria is awful. Yes, malaria is part of what keeps many in poverty. So let's solve it! Great argument, but...
As is often the case with such great social causes, your article fails to look at the unintended consequences. Fewer people dying of malaria means more people. And the #1 cause of human-induced climate change is... humans! And people escaping poverty use more energy = more emissions per capita. So it's a double: more people and more emissions per person.
I will agree with you that helping people out of poverty is something we, as humans, owe each other. But doing so without regard to the consequences is not only foolish, but reckless as well. Can you propose a more holistic approach?
Maybe inflation entered the picture and $1.00 is only worth $0.50? One can change the article when it is posted online. How about it?
Reply | Report Abuse | Link to thisMaybe inflation entered the picture and $1.00 is only worth $0.50? One can change the article when it is posted online. How about it?
Reply | Report Abuse | Link to thisVery interesting articles.......african countries should be supported with regard to mass distribution of bed nets...Phillip M, Botswana, Africa
Reply | Report Abuse | Link to this@meadi*r and Larry144. You should both read the article more carefully. Sachs said each net protects TWO children which over 10 years equates to a total of 20 child years of protection which equals $0.50 per child.
Reply | Report Abuse | Link to thisMITDGreenb, do you really mean to say that we should let people die to avoid increased energy emissions?
Reply | Report Abuse | Link to thisFor one, that is heinously immoral.
And two, it's illogical. If you're actually concerned with decreasing energy emissions, then focus on the developed world, which is responsible for the majority of the problem. If you're concerned about over population, then focus on birth control: as it stands, most African countries (including Kenya, MIT's trial site) have little access to it. http://www.acpd.ca/acpd.cfm/en/section/acpdmedia/articleID/262
What a wonderful story about an inexpensive way to help a large number of people! I read a blog post recently about a number of low-cost tests for HIV and other conditions (http://iconsinmedicine.wordpress.com/). The organization that runs this blog and the associated program also sound really interesting (http://www.iconsinmed.org). They link up physicians with one another to provide teleconsultations. Really interesting!
Reply | Report Abuse | Link to thisPeople like MITDGreenb make me sick. to say that if a problem that is caused by the solution is to get rid of humans is despicable. If you are in favour of such a solution, why don't you start by eliminating yourself and your family.
Reply | Report Abuse | Link to thisI am in complete agreement with wealhtheow. Killing children after the fact is reprehensible. If that really is your concern, education and birth control would definitely be the moral thing to do.
Reply | Report Abuse | Link to thisWell, it would seem that MITDGreenb values total human carbon footprint more than human life....First off, wow! I didn't realize someone could be that cold-blooded. Second off, it is an illogical conclusion: citizens of the developing world have a very low carbon footprint per capita relative to the developed world. The world can tolerate many more such people from the developing world than it can people from the developed world.
Reply | Report Abuse | Link to thisBy your logic, the best solution to the climate problem would be for the citizens of the developing world to kill off several tens of millions of citizens of the developed world...they do outnumber us afterall.
This discussion is an excellent case study how a discussion goes wrong by logical fallacies (google logical fallacies for theoretical background).
Reply | Report Abuse | Link to thisThere are two points that @MITDGreenb in his/her statement made clear.
1. As it often occurs, the solution to one problem causes new problems.
2. Human overpopulation is a serious problem on this planet dispelled by many.
Now the counter argument of @trebmald is a typical straw man knock down. Killing children after the fact is reprehensible. But, @MITDGreenb didnt demand to kill children. It is @trebmalds invented straw man thats easier to burn down.
@trebmald also uses the tu quoque fallacy by declaring why don't you start by eliminating yourself and your family. In consequence, as you dont commit suicide your argument is invalid. The easiest way to solve an argument, really.
Next, in addition to a straw man, @wealhtheow employs a red herring redirecting the discussion towards problems with birth control.
An even more sophisticated red herring is applied by @Bill77. By Fist off.. he/she starts an emotional appeal. Then Second off.. a red herring but also a wrong conclusion as some of the carbon dioxide emission caused by production in developed countries is consumed as products in developing countries. We are one world after all. His final logic is an appeal to consequences, so please withdraw your argument, else we have to eliminate the developed world.
Finally, thats my point. The word suffers from too many too stupid people, and as education in developing countries is much worse than in developed countries, it must be expected that the additional life saved in developing countries will decrease the statistical average of human intelligence. In other words, it will not bestow new geniuses to solve the worlds problems but rather pirates to make everything worse. Well, this argument might be challenged, and I feel my doubts raising too.
Hmm, MPatch, you in your infinite logical wisdom apparently have granted yourself the right to judge some people to be "stupid" based upon a few sentences. Tossing around the names of logical fallacies (straw man, red herring, emotional appeal, etc) does not suddenly make your own claims true...would that not be a "non sequitur" (they are wrong, so I must be right)?
Reply | Report Abuse | Link to thisI stated:
"citizens of the developing world have a very low carbon footprint per capita relative to the developed world". My conclusion is not wrong simply because the developing world uses *some* high-carbon footprint products produced by the developed world. If you truly think this argument makes my claim false, it is YOU who is in danger of being considered "stupid". It is more than likely greatly offset by goods produced in the developing world (using cheap labor) for sale to the developed world.
The 2006 carbon dioxide emissions per capita listed in the Wikipedia, shows that much of Africa has a per capita emission of less than 1.0 metric tons. Libya and South Africa being notable standouts...but South Africa isn't really the developing world we're talking about either...former UK colony (I believe the Dutch colonized northern South Africa IIRC).
However, there are certainly people who drive cars in Africa, so my claim is just completely false then?
Saving lives will not bestow the world with new geniuses? So, genius is a product of education (knowledge), and not a high potential for intellectual creativity?
Do you understand that even with schooling, it is hard for the children of Africa to learn if they (many of them) are in a constant state of suffering and/or dying from Malaria? or at least watching their friends and siblings dying of it and other parasite related diseases?
You contend that saving the lives of people in the developing world is a waste because they are "stupid anyway" (to paraphrase your claim). Could you tell me what exactly the tens of millions of American Idol / reality TV watching citizens of the developed are doing to contribute to the betterment of the human race with their "vastly superior" intelligence? What do they contribute to justify the vast expenditure of resources spent to make them fat and entertained?