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PC malaria programs at the World Bank

By Cyril Boynes, Jr. and Paul Driessen
web posted March 6, 2006

No nation anywhere has more childhood deaths than the Democratic Republic of Congo, notes a World Bank news release. The toll stands at an incredible 565,000 children per year. "At least one in five DRC children dies before age five, and one in ten infants dies before their first birthday."

The Congo's "number one killer" of children is malaria, which snuffs out the lives of 225,000 children every year in this war-torn nation of 58 million. Worldwide, malaria infects over 500 million people annually, and kills at least 1 million.

This crisis should generate a response of equal magnitude. Indeed, the bank has asserted a "new sense of urgency" and called for "decisive action" to control this "ancient killer." Its actual response, however, falls well short of its rhetoric.

The bank is providing US$150-million to "rehabilitate the health sector and control malaria" in the DRC. It also emphasizes "integrated vector management" and "public-private partnerships." These actions are certainly important. The Congo's healthcare, education and transportation systems are in a shambles, and 100% of its population is at risk of getting malaria.

However, only US$30 million of the US$150 million DRC grant is for near-term life-saving actions - and it is devoted to long-lasting insecticide-treated bed nets and new anti-malarial drug treatments. Increased use of these nets, one news release claims, "could slash child deaths by as much as one-fifth."

Africans would welcome a 20% reduction. But it's hardly impressive, and the word "slash" is hardly appropriate.

"Slash" would describe how South Africa, Mozambique, Swaziland and Zambia reduced malaria rates by over 75% in two years - primarily with DDT. By providing scarce artemisinin-based combination therapies (ACTs) to people who still got sick, they reduced malaria even further.
Simple math says the bank's nets program might reduce malaria deaths by 45,000 Congolese children. Based on the other countries' actual experience, a DDT-based program could save an additional 124,000 DRC kids. But bank news releases don't even mention insecticides, and too many bank bureaucrats still bristle at the mere mention of DDT. That's hard to understand.

Today, DDT is used in carefully controlled campaigns that spray tiny amounts of the chemical on the inside walls of canvas, mud-and-thatch or cinderblock dwellings. A single treatment lasts up to eight months (versus eight hours for bug repellants with DEET), keeps 90% of mosquitoes from even entering, irritates any that do come in so they don't bite, and kills many that land. No other insecticide, at any price, works this well.

Unfortunately, too many within the bank's corridors of power still view DDT as politically incorrect. Even the colonialist era had more enlightened policies. Back then, administrators and their families actually lived in their "subject" countries and thus had a compelling interest in ensuring the best possible disease control.

Today, policy makers and administrators are often ensconced in comfortable, malaria-free offices in Washington, DC. They come from places that never had malaria. They're too young to remember that DDT played critical roles in eradicating endemic malaria from Washington, New York and Amsterdam. Or they refuse to acknowledge that the alleged risks of DDT (a "possible relationship" to slow reflexes in babies, eg) are trivial compared to the very real dangers DDT could prevent: such as brain-damaged or dead babies, who have no reflexes.

Perhaps anti-insecticide activists would have a different perspective if they and their families shared the "indigenous" lifestyles of rural Africa: Mud-and-thatch huts with no window screens. Hordes of malarial mosquitoes - with no bug spray, pesticides or anti-malaria pills. Trying to sleep under bed nets when the temperature in the hut is 90 degrees, and under the net it's a hundred. Enduring the agony of acute malaria, and resigned to walking 20 miles to the nearest clinic, carrying their sick child and hoping a nurse will have medications that actually work.

Malaria would be preventable and much easier to reduce than the Third World's other two killer diseases, TB and HIV/AIDS - if we took the proper measures. Unfortunately, total funds devoted to malaria control by all agencies worldwide are far below what experts agree are needed. Worse, they are not being allocated to interventions that have been proven most effective in reducing disease and saving lives: DDT, other insecticides and ACTs.

The Kill Malarial Mosquitoes NOW Declaration insists that two-thirds of malaria budgets be dedicated to these proven commodities (see www.FightingMalaria.org). It has been signed by three Nobel Peace Laureates and hundreds of medical, religious, human rights, business and public policy leaders from all over the world.

The President's Malaria Initiative was launched for similar reasons: to focus limited resources on the most cost-effective means to control this largely preventable disease. New U.S. Agency for International Development policies take the same approach. And African communities and countries, having seen what this strategy can accomplish, are beginning to demand DDT, other insecticides and ACTs as part of truly comprehensive anti-malaria programs.

World Bank president Paul Wolfowitz and the bank's Roll Back Malaria program should follow the KMMN-PMI-USAID lead. With an annual budget of more than US$18 billion, the bank can certainly afford to play a key role. Improving healthcare infrastructures would be a valuable endeavor.

But if it is going to spend money on malaria control, it should: spend it on prevention and treatment programs that work; stop trying to "persuade" countries like Eritrea to quit using DDT; train locals, so that they can sustain cost-effective insecticide spraying programs; and implement real performance-based standards that emphasize the only relevant criterion - slashing disease and death rates. Otherwise, it should give its malaria money to organizations that will do so.

The bank should also insist that donor nations and the European Union publicly and unequivocally support DDT for disease control via indoor spraying - and stop threatening agricultural trade bans against countries that want to implement such programs. Those threats violate fundamental human rights - and cost lives.

If a corporation performed the way the World Bank has on malaria control, its managers would be sacked. If doctors treated patients this way, they'd be sued or prosecuted for malpractice.
Worldwide, two billion people are at risk of getting malaria, over and over, every year. At least 500,000 children die from it annually. We call on Mr. Wolfowitz to apply his humanitarian, results-oriented instincts - and implement these life-saving reforms immediately.

Cyril Boynes is director of international affairs for the Congress of Racial Equality. Paul Driessen is CORE's senior policy advisor.

 

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