Monday, March 3, 2008

War on Malaria

That is, for exterminating the parasite everywhere and forever, except perhaps in laboratory storage, as has thus far happened to just one disease in history, smallpox.

Their call, delivered at a malaria conference that they had convened in Seattle, was, in Mrs. Gates’s language, “audacious.” Her husband went further, asking, “Why would anyone want to follow a long line of failures by becoming the umpteenth person to declare the goal of eradicating malaria?”

To many public health leaders, that remains a good question. While some, including the heads of the Global Fund to Fight AIDS, Tuberculosis and Malaria and the President’s Malaria Initiative, have lauded the Gateses’ call as inspirational, others call it noble but quixotic, because the tools to eradicate malaria do not yet exist. A few, including the combative chief of malaria for the World Health Organization, have even argued that it could do harm.

Dr. Margaret Chan, director general of the W.H.O., backed the call, telling the audience from the dais in Seattle, “I dare you to come along with us.”

Last month on his swing through Africa, President Bush implicitly endorsed the idea without mentioning the Gateses, saying the United States would lead the eradication effort.

The Bill & Melinda Gates Foundation has spent $1.2 billion to fight malaria, which is thought to cause as many as 500 million infections a year in 107 countries, a million of them fatal.

Virtually no experts expect it to be eradicated in the lifetimes of the Gateses or the Bushes. Dr. Regina Rabinovich, the foundation’s head of infectious disease, said the Gateses knew it was a long-term undertaking, not possible without more money, better health systems and probably a vaccine, which is still far off.

Dr. Arata Kochi, the W.H.O. malaria chief, went further than other skeptics, arguing that the specter of eradication is counterproductive. With enough money, he said, current tools like nets, medicines and DDT could drive down malaria cases 90 percent.

“But eliminating the last 10 percent is a tremendous task and very expensive,” Dr. Kochi said. “Even places like South Africa should think twice before taking this path.”

False hopes, he said, lead governments to hope for miracles instead of accepting the mundane budget-draining control policies that he endorses. For example, health officials from Rwanda and Zanzibar, having drastically cut malaria within their borders, have asked him about seeking money for elimination.

Even relatively wealthy countries rarely succeed at that. South Africa, Saudi Arabia and Mexico all control cases but see new ones imported — from Mozambique, Yemen and Guatemala, respectively, he said.

Dr. Awash Teklehaimanot, director of the malaria program at the Earth Institute of Columbia University, said he worried that calls for eradication raised expectations too high, inviting frustration and a loss of political will.

“Maybe 10, 15 years from now, we should consider this,” he said.

This debate occurs more in the hallways of malaria conferences than in public, because some scientists fear that a zeal for eradication is now compulsory.

Dr. Rabinovich denied that, saying foundation decisions were not based “on whether or not people agree with public statements made by Bill and Melinda.”

-Eradicate Malaria? Doubters Fuel Debate

1 comment:

Africa Fighting Malaria said...

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