Net gains in the fight against malaria

April 25, 2007

April 25 is Africa Malaria Day, and the first-ever Malaria Awareness Day in the U.S. Not long ago, Americans would have needed no special reminder -- malaria was not eradicated here until 1951.

Today, a $1.2 billion President's Initiative on Malaria and Congressional efforts to restore $2.2 billion to the Global Fund demonstrate America's renewed focus on fighting the disease. But recalling that the U.S. and many other countries eliminated malaria in the last century, why is it epidemic now?

300 to 500 million people contracted it last year, more than 90 percent of them live in Africa. In hotspots like Zambia, malaria incidence tripled in the last 30 years. Global infection rates are rising too -- some three billion living in malaria-affected areas worldwide. Malaria now kills between one and three million annually and is the worst killer of children. 3,000 under age five die daily in sub-Saharan Africa alone.

How in the 21st century could such a treatable, preventable, ancient disease survive and thrive? Described by Hippocrates in 600 BC and by Chinese sources in 2,700 BC, the Roman empire fought malaria by draining swamps. The British empire fought it by drinking gin and tonic. After hospitalizing 80 percent of the Panama canal workforce in 1905, concerted prevention and treatment brought malaria under control there by 1912.

Panama, Greece, Spain, Italy, and Jamaica all enjoyed surging economic growth after malaria eradication in the 20th century. Why do Angola, Burundi, DR Congo, Ghana, Kenya, Mozambique, Uganda and Zambia languish in the downward spiral of malaria and poverty?

There are several explanations. Eradication programs in the last century never reached sub-Saharan Africa, and today those most at risk -- often displaced victims of disasters or conflict, living in Africa's poorest, most remote communities -- are still the most difficult to reach. Global warming expands the range of the malaria-carrying anopheles mosquito into new areas such as the Kenyan highlands, where residents lack immunity. Amid the AIDS crisis and other disasters, donor countries temporarily lost some focus on malaria in the last decade, during which it surged.

But despite all this, perhaps for the first time in its long history, we can defeat malaria in Africa and elsewhere -- not so much because of new, high-tech advances, but because we know what works.

High-tech research into vaccines and genetically altering mosquitoes is important. So is selective treatment with new-line drug combinations. But other highly effective measures are more basic: better sanitation, health care access, and education, plus interventions like insecticide spraying or sleeping under long-lasting insecticide-treated mosquito nets (LLITNs).

"Highly effective" need not mean "highly expensive." For example LLITNs work anywhere, even among transient populations, or in places where insecticide spraying wouldn't work or could contaminate water supplies. Used properly, nets prevent infection and can cut local mosquito populations by 80 percent. One LLITN lasts up to five years, protects several people, and costs just $15 including training for recipients.

In general, controlling malaria would cost a fraction of the $12.3 billion it costs Africa in lost GDP. Today, donor countries including the U.S. and large international agencies do spend billions fighting malaria. But even given sufficient funding and effective measures, intractable delivery problems remain.

For example, it's relatively straightforward to distribute LLITNs. But getting recipients to use them properly, or at all, requires educational workshops. Without training, caregivers can't recognize signs of malaria infection, which can kill children in hours. Nor can they slow its progress until they reach medical care. Among at-risk populations, literacy is low, villages are scattered, so training requires sustained, on-the-ground, face-to-face contact -- with hundreds of millions of people over perhaps a million square miles.

What organization has the capacity to do that? In Africa, where 40 percent of health care is church-based, it's the Anglican Church. Along an integral part of local African communities, it offers a ready-made, decentralized aid distribution network and commands trust needed to help influence behavior.

Through the NetsforLifeSM program, a new partnership with global corporate and individual sponsors, the Anglican Church is delivering a million LLITNs and accompanying training in 16 sub-Saharan countries over three years. Local clergy, church volunteers and lay groups get trained to conduct the distribution and education programs themselves. Working with the Church, community members become active participants in fighting the disease. NGOs call this "local capacity building," always preferable to importing one-time relief measures from outside.

Hurricane Katrina and the Indian Ocean tsunami proved that big relief efforts can work better when channeled through the deep community roots of churches and faith-based groups. So too in the case of malaria, where much depends on community-based networks for effective delivery and training. Connecting churches, FBOs and NGOs -- such as Roll Back Malaria -- with international sponsors may be a missing link that allows us finally to defeat this deadly disease.

-- Robert W. Radtke is president of Episcopal Relief and Development, implementing partner of NetsforLifeSM.