From Washington Post
Brundtland Leading Efforts Against Malaria
DATELINE: October 15, 1999, Friday, Final Edition
SECTION: STYLE; Pg. C10
HEADLINE: Leading the Effort Against Malaria
BYLINE: Judy Mann
When former Norwegian prime minister Gro Harlem Brundtland was elected
director-general of the World Health Organization, she announced she would
her sights on malaria, a scourge of Africa. She is making good on her word.
A year and a half ago, Brundtland named David Nabarro to head the WHO's malaria
effort. Nabarro had been an expert on infectious diseases with Britain's
Department for International Development. On Wednesday, the WHO announced an
enormous drive to provide nearly 60 million African families with
insecticide-treated bed nets over the next five years. Bed nets have been used
for at least a century as protection against the anopheline mosquito,
causes malaria, but nets tear easily and mosquitoes can enter through the
"Bed nets, by themselves, are not terribly protective," says Nils
of the Global Health Council, the world's largest membership alliance dedicated
to improving global health. "Mosquitoes are voracious feeders, strongly
attracted by the smell of blood, and they will go through any tear or tiny
hole." What is so significant about this new effort is that the bed nets have
been treated with a nontoxic insecticide made from the chrysanthemum plant. The
insecticide, which has been approved by the WHO, creates a chemical
covers up small holes or tears.
A study in Gambia in West Africa found child deaths from all causes were
by a quarter because of the bed nets. "These kids were dying from pneumonia and
other diseases because they were weakened by earlier bouts of malaria,"
says. "So protecting them from malaria is a huge part of the child survival
picture in Africa."
An estimated 700,000 African children died from malaria last year. Fewer than 2
million African households have treated bed nets, and the number using them
properly by getting them retreated or replacing them when needed is even lower.
But their lifesaving potential got an even bigger boost from a recent review of
bed net studies that found that children sleeping under treated bed nets
percent less likely to get malaria than control groups.
The WHO's "Roll Back Malaria" campaign is co-sponsored by UNICEF, the U.S.
Agency for International Development, the World Bank, the U.N. Development
Program, the public and private sector of malaria-ridden countries, along with
development agencies, chemical makers and scientific institutions. It is a
global public-private partnership. The goal is to cut in half the world's
malaria burden by 2010.
Treated bed nets, until recently, cost $ 4 and were out of reach for many
families. A $ 70 million contribution to the campaign pledged by Britain's
Department for International Development, will change that. One of the first
major donations, this contribution will allow considerable economies of scale
that could bring the price of a bed net down to $ 2.
The Academy for Educational Development, a Washington-based nonprofit dedicated
to helping solve critical problems in such areas as health, has a $ 15 million
contract with AID to educate the public about bed nets and develop a commercial
market for them. "We think we can lower child mortality by 30 percent once the
market is developed," says John W. LeSar, who oversees AED's international
The idea is to develop a market that will sustain itself so that commercial
companies will keep on producing the bed nets at an affordable price and
government subsidies ultimately can be eliminated.
"We are interested in whether the right people use nets -- poor families,
exposed families -- whether they use them correctly and safely. The commercial
people are interested in sales. We're public health people, so we are
in how they are used" and whether their use becomes established behavior, LeSar
says. The initial educational and commercial campaigns will be reinforced
seasonally with reminders to people to get their bed nets ready.
Mosquitoes rapidly become resistant to insecticides, and malaria has become
resistant to drugs. "This is where interest in bed nets picks up," LeSar says.
"You don't get the disease. If we can jump start these commercial markets with
government funds, then governments will have leveraged their funds considerably
and can back out once the market is established."
Bed nets are only part of the solution to malaria, which goes through a number
of stages, Daulaire says. Most people don't die from it, but they get very sick
and vulnerable to other diseases, so early detection and treatment are
important. "The holy grail of malaria control is a vaccine that works well
against all of the different stages of the malaria parasite. A lot of work is
going on with that . . . but we aren't there yet," Daulaire says. Work also is
being done on environmental control of the anopheline mosquito, and unlike the
massive spraying of DDT and other pesticides that occurred earlier, the
now is to concentrate on breeding grounds by draining standing water and
introducing predator species to attack the mosquitoes.
Daulaire, who was the government's leading expert on international public
at AID, says the malaria campaign ranks with the Universal Childhood
Immunization campaign launched by UNICEF in the 1980s under the leadership of
the late James Grant. That campaign's goal was to immunize 80 percent of the
world's children, up from 20 percent in the early '80s. It succeeded and has
been one of the greatest public health victories of the century. If "Roll Back
Malaria" succeeds as well, Gro Brundtland will have more than earned the
enormous confidence the world's nations have placed in her.
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