Good afternoon it is a pleasure and an honor to address this excellent event, seeing the launching of so many important initiatives. It is also quite daunting following Professors Desowitz and Kilama, two of the great men of modern malaria control and its advocacy. I represent Africa Fighting Malaria, which is a health advocacy group based out of South Africa. I’m British and live in Washington D.C., where I am a resident fellow of the American Enterprise Institute, a think tank, which has intimate involvement in international policy debates.

AFM was founded in 1999 to help prevent DDT from being banned for use in disease control. And here we are talking about spraying tiny amounts indoors (IRS--indoor residual spraying), not aerial bombardment. Over the past six years we have tried to promote DDT use as part of the arsenal of weapons needed to combat insect borne disease--notably malaria. It is available to be used, thanks to many of the people in this auditorium, but virtually no aid group buys it.

I’m not a fan of bed nets, not because they can’t work, but because from my experience compliance is bad. Anyone who has spent a good amount of time in a hot humid climate (such as Atlanta in August) will know why. Imagine sleeping with a sheet propped a few feet over your head in Atlanta in the summer with the AC broken – and you have a close approximation of what a bed net is like in much of Africa. Its one thing for mom and dad to understand the necessity of sleeping under the net (if they have one, but most don’t since they’re supplied usually to children), but what of the three or four year old allegedly sleeping under the net who just wants to cool down, get into bed with mom and dad, not go to bed on time, get out of bed during the night to go to the rest room, get up early and play and so on, when the anopheles malaria mosquitoes are biting. So it’s not that DDT for use in IRS is the only intervention--it is not--but it’s probably the most effective, and from the evidence I’ve seen probably the most cost effective. I say “probably” because performance is almost never measured for most malaria control programs, and rarely demanded by those providing the funding--it’s as though no one really cares to know.

Malaria control performance (reductions in morbidity and mortality from malaria) are so infrequently measured that only IRS with DDT has reliable output measurements (South Africa and Zambia are two such large scale examples). And when it comes to cost effectiveness, there are almost no studies--I undertook one, had it published as a policy paper, but could get no academic journal to publish it. In other words malaria control is largely done without much of an input from economics--this is unfortunate for all sorts of reasons.

First, without measurement eventually aid fatigue sets in. Remember what happened to the first malaria eradication initiative.

Second, it means less effectual interventions may be followed--and for malaria control every dollar counts given the poverty of most malarial countries and the devastation caused by the disease.

Third, no actual interventions may be funded at all. I coauthored a paper earlier this year for AEI which looked at the operation of USAID. The findings were disturbing. It’s worth realizing that less than 10 percent of USAID’s malaria budget in 2004 actually purchased commodities that save lives. In a couple of instances where data was available--and data is almost entirely absent--technical assistance was provided but no commodities. Let me be clear what this means--USAID contractors convinced people to sleep under nets, and doctors to prescribe newer drugs, but neither commodity was provided. In one instance nets were provided by UNICEF, because of an act of God (the terrible floods in Mozambique in 2000). Were it not for the flood no life-saving interventions would have been provided there either.

When I presented this information at a Senate hearing, USAID became angry and defensive, but times change and now they appear to actually want to provide interventions and  engage in useful dialogue--so I am more hopeful for the future. However, I am still worried: The latest concern is the probable use of arcane environmental regulations on impact assessments of DDT and other insecticides that will further delay the use of any insecticide purchased by USAID. Meanwhile a child dies every 20 seconds.

I mention all this discouraging news from USAID because how you spend the money you may raise is extremely important. More money is being allocated to malaria control today than ever before (albeit much of it may just be for talking shops rather than direct interventions, but its likely that more is being allocated to actual interventions across Africa and the rest of the malarial world). But malaria rates are probably still rising--and they are not falling--the latest survey by Bob Snow published in Nature estimated 515 million cases a year. A vast statistic--but each one an individual, each one a potential leader whose life might be cut short. And this year the list included someone very close to my heart--me. I was lucky enough to have the best treatment with money being no object, but if the authorities in the country I was in had sprayed DDT, I probably wouldn’t have had to go through a week of hell.

Personal sob stories aside--measuring the impact of your interventions on deaths and malaria incidence is very important and not just of academic interest--don’t you want to know whether what you’re doing saves lives.

I hope you will leverage your efforts by supporting our various campaigns to get major donors like USAID to spend their money, our taxpayer money, effectively. Paul Driessen (on the program today) is the secretary of the Kill Malaria Mosquitoes Now Declaration, which I urge you to sign onto today. You will join over 400 passionate signatories including Nobel Prize winners such as Archbishop Desmond Tutu and Norman Borlaug. It urges USAID to actually buy the interventions that save lives, the more pressure USAID comes under to do the right thing the better. Copies are available and it can be found on our web site--www.fightingmalaria.org. It is very important to show that those who care about controlling the disease (such as you in this room) are watching those spending vast resources. (The current USAID malaria budget of over $100 million can save lots of lives but only if more than 10 percent is spent on commodities that save lives).

USAID also indirectly sets global policy so it (badly) affects the other $300 million in malaria allocations.

If I were Bill Gates I’d be funding vaccine research too--he can see where his funds are being spent. I commend those of you here who are doing work to combat the disease today. While vaccine research is important, today’s interventions can work--if we bothered to buy the right ones.

We need to make today’s interventions more palatable and worthwhile--we must report results. If you distribute bed nets, you’d better measure whether they’re being used, because if not, try a different intervention and save lives today.

Thank you.

Roger Bate is a resident fellow at AEI.