By David Brown
Washington Post Staff Writer
Sunday, December 17, 2006
For an administration trying to solve problems such as the war in Iraq, illegal immigration and the potential meltdown of Social Security, cutting worldwide malaria deaths in half looks like low-hanging fruit -- and President Bush is intent on picking it.
Bush gathered a group of global health luminaries last week to give a second debut to one of his least-known foreign ventures, the $1.2 billion, five-year President's Malaria Initiative.
The PMI, as it is coming to be called, is a younger sibling to Bush's biggest global health project, the $15 billion, five-year President's Emergency Plan for AIDS Relief, known as PEPFAR. The malaria initiative targets many of the same countries and may help some of the same people. But the infection is virtually an "orphan disease" in the minds of Americans, who have not faced the threat of malaria, except through foreign travel, for three generations.
Bush launched the malaria program in June 2005, with the goal of reducing malaria-related deaths in 15 African countries by 50 percent. The disease kills more than 1 million people a year, most of them African children under age 5.
Both the AIDS and malaria initiatives seek to prevent infections and treat them with state-of-the-art therapy not widely available in places where the diseases take their greatest toll. Both harness grass-roots organizations -- many church-affiliated and first-timers in public health campaigns -- to do much of the work. Both involve public education and the distribution of consumer goods.
There are big differences, though. Malaria does not involve sex and drugs. It can be contracted by anyone, regardless of behavior. And the chief nonmedical means of preventing transmission is a mosquito net, not a condom or a clean needle.
Those distinctions are part of the reason that Bush's malaria initiative is inviting the private sector -- corporations, clubs, elementary schools -- to join the campaign against malaria in a way that he has not done in his fight against AIDS.
As with AIDS, but more dramatically so, the malaria initiative seeks to provide potential victims with resources that are certain to work.
"For many illnesses, there is no known relief," Bush said Thursday in a closing speech to the White House Summit on Malaria, held at the National Geographic Society headquarters. "Yet for malaria, we know exactly what it takes to prevent and treat the disease. The only question is whether we have the will to act."
Research has shown that five interventions, used together, can dramatically reduce malaria's toll.
The first is a combination of drugs that includes artemisinin, a substance first used in ancient Chinese herbal remedies that can often dramatically cure cerebral malaria, reviving children who are in a coma and close to death. The second is a hand-held blood test kit that can be used even in remote villages to diagnose falciparum malaria, by far the most dangerous subtype. The third is automatic treatment of pregnant women in infested areas.
The fourth is spraying the indoor walls of dwellings with long-lasting pesticides, including DDT, which is enjoying newfound acceptance for this one purpose. The fifth is sleeping under mosquito nets impregnated with insect repellents that remain active for years.
The impact of nets is especially dramatic. Villages that got them in randomized controlled trials experienced declines in malaria deaths in young children of 33 percent (Kenya) and 17 percent (Ghana). In Gambia, the nets cut mortality from all causes, not just malaria, by 25 percent in children ages 1 to 9.
Insecticide-impregnated nets cost about $10 each -- within the reach of small donors, including children in rich countries, though out of the reach of many African households. They are the focus of numerous charitable campaigns now underway.
One, called "Nothing but Nets," has raised $1.7 million since May. It was inspired by Sports Illustrated columnist Rick Reilly, was launched by the United Nations Foundation and is supported by the National Basketball Association and the Methodist Church, among others. Newly formed Malaria No More, which promotes public-private partnerships, has produced a 16-page book called "Nets Are Nice" (with a foreword by Laura Bush) that will be given to every American first-grader in March.
Africa's Lubombo Region, which encompasses parts of northeastern South Africa, eastern Swaziland and southern Mozambique, is the best example of what can be done when all five measures are undertaken in concert.
Before 1999, 86 percent of children in the most severely affected part of Mozambique were infected with malaria annually. That fell to 21 percent four years later. In the Swaziland district, malaria incidence fell from 130 cases per 1,000 people to 1.7 cases per 1,000. In the South African area, several game parks and tourist areas no longer have high malaria incidence, and in some places the infection is now so rare that it cannot be detected by random blood sampling.
The initial work was paid for by the companies that run a huge aluminum smelter called Mozal in the center of Lubombo. It was later supported by a grant from the Global Fund to Fight AIDS, Tuberculosis and Malaria.
The potentially important role of large corporations in coordinating anti-malaria efforts was stressed at the White House summit.
"It is a strange coincidence that where there is oil there are mosquitoes," said Steven Phillips, a physician with Exxon Mobil Corp. The oil company has given $11.5 million for malaria control in Africa since 2000 and said Thursday it would spend $10 million more this year.
The list of speakers at the summit suggested a rising profile for malaria and efforts to fight it. In addition to the president and first lady, they included Margaret Chan, the incoming head of the World Health Organization; philanthropist Melinda Gates; Secretary of State Condoleezza Rice; Eyitayo Lambo, Nigeria's health minister; World Bank President Paul Wolfowitz; mega-church pastor Rick Warren, author of "The Purpose Driven Life"; and actor Isaiah Washington, who was the emcee.