Fiddling Piano Keys While Africa Burns

On Friday the science journal Nature published a series of papers on malaria and its control. Focusing on this preventable and curable disease is crucial and timely; malaria is the biggest killer of children in Africa accounting for over 1 million deaths world wide each year. Furthermore, we are now at the halfway point through the World Health Organization's (WHO) Roll Back Malaria program which can only be described as an unmitigated failure. Unless urgent and far reaching reforms are made to Roll Back Malaria and its partner organizations, malaria's death toll will continue unabated. One partner, UNICEF, the UN children's agency, is even sending a pianist instead of urgently needed nets and drugs.

The WHO, World Bank, the US aid agency, USAID, and UNICEF launched Roll Back Malaria in 1998. Their aim was to halve malaria deaths by 2010. So far malaria deaths have risen by 12%.

Some countries are getting malaria control right though. Mozambique, Swaziland and South Africa have successfully driven the incidence of the disease to almost all time lows. Zambia, one of the world's poorest countries is also witnessing increased success against the disease.

The common thread among these countries is that they are rolling out highly successful new combination drug therapies and are running insecticide spraying programmes to kill adult mosquitoes that rest indoors. Crucially, these malaria control programs are funded not by UN bodies or established donor agencies but by the relatively new Global Fund to Fight AIDS, TB and Malaria (GFATM) and the private sector.

Unlike GFATM, the Roll Back Malaria partners are unwilling to fund interventions that work but upset environmentalists, such as indoor insecticide spraying. They are also not living up to their own funding requirements. One article in Nature points out that the funding the Roll Back Malaria partners promised to control the disease has not been delivered. In April 2000 the World Bank promised to pledge between $300 and $500 million to combat malaria. So far, the Bank claims to have authorized loans of between $100 and $150 million. Yet if malaria is to be successfully controlled, at least $5 billion needs to be devoted to prevention and treatment programmes every year.

During the 1950s and 60s, USAID funded the WHO's malaria eradication program. Although this program was prematurely terminated, US taxpayer funding was responsible for saving millions of lives; were that only true now. Like the World Bank, USAID's funding is inadequate; as importantly, it ignores what malarial countries actually need. USAID claims that it spends 34% of its $65.6 million malaria budget on disease treatment, but admits that it actually doesn't buy any drugs. With drug resistance rising, changing over to new effective therapies is essential. USAID's refusal to provide funds for those drugs is tantamount to a death sentence for anyone unfortunate enough to be infected with malaria.

Many African countries want to increase indoor spraying with insecticides, yet here, too, USAID's policy is failing since the agency prefers to focus its prevention strategies on insecticide-treated nets.

As malaria kills so many children, UNICEF--the UN's agency devoted to the welfare of children--is quite rightly involved in malaria control. But this agency, too, appears to be failing miserably. In 2003 it spent $3.7million buying malaria drugs, but most of that was spent on ineffective medicines. In Kenya and Burundi it purchased drugs that those governments do not sanction because they simply don't work.

But UNICEF is not doing nothing. This month it has been excitedly reporting the tour of their youngest goodwill ambassador, the brilliant Chinese pianist Lang Lang, to Tanzania. Lang Lang is touring that country to promote the use of insecticide-treated nets. UNICEF has avoided repeated requests from our health NGO, Africa Fighting Malaria, for information on the cost of the Lang Lang tour. We do know however that in 2003 they spent the princely sum of $42,672 on new bed nets. Given the cost of travel in Africa and the publicity surrounding the piano-playing malaria crusader's tour, it is likely that UNICEF spent more on this stunt than on actual malaria control.

The world-renowned tropical disease expert, Bob Desowitz's facetious response to the Lang Lang malaria control operation was that "sending a Chinese pianist to combat (malaria) is ridiculous. Nothing less than the entire Beijing Opera company is required."

It is high time that governments around the world and the taxpayers that fund them demand that malaria control be changed. First, those in charge of Roll Back Malaria should be held to account and, given their failures, replaced with more competent staff. Second, governments should seriously consider diverting the malaria control budgets from UN bodies and aid agencies to the GFATM which in the few short years of its existence has a far better track record on malaria control.

Malaria is far too serious a disease to be left to the unaccountable and ineffectual UN agencies and Roll Back Malaria partners, especially USAID. Taxpayers in the developed world need to understand that their money is being used badly and is in fact making matters worse. For the sake of the many millions at risk from malaria, they must demand change now.

Roger Bate is a visiting fellow at the American Enterprise Institute, and Richard Tren is the director of health advocacy group Africa Fighting Malaria.

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