IPN Health Blog

UN confirms bed-nets not slept under, used for fishing

The UN continues to boast of millions of dollars of public money being spent on bed-nets, this time on a project in Tanzania costing $111 million.

However, the inefficiency of such schemes is infamous. Some factors are now confirmed by Ray Chambers, the UN's special envoy for malaria, who admits that people often use the nets "to catch fish".

He also confirms that "one out of two people will not sleep under a net". This blog has previously noted how people find nets uncomfortable, or simply not much use when their living conditions are particularly poor. Furthermore, they often need to be retreated with insecticides every few months.

It is no myth that they are often sold on to make fishing nets or wedding dresses.

Amusingly this story comes just days after the news that a team of peacekeepers avoided malaria entirely by - shock horror - killing as many mosquitoes as possible. The team used housefly killing machines to protect them from mosquitoes, and remarkably the infection rate plummeted all the way down to zero.

Presumably it's too late to reinvest that $111,000,000.

Mosquitoes to carry insecticides

The innovation of getting mosquitoes to carry insecticides to their own larvae is proving hugely effective, according to an article in magazine SciDev.

Researchers spread an insecticide among adult mosquitoes who then transported it back to their breeding sites.

The results were startling:

Placing the insecticide in just 3 - 5 per cent of resting areas resulted in 95 - 100 per cent of larvae dying in aquatic breeding sites.

The development offers great hope in the ongoing battles against vector-borne diseases such as dengue and malaria, especially given the stifled markets for new insecticides.

The Global Fund: failing to reverse AIDS, Tuberculosis and Malaria

        One of the biggest players in the development arena is the Global Fund for Aids, Tuberculosis and Malaria, which has spent around $20bn over the last five years fighting these diseases.

It is good, then, that the Fund has released an internal evaluation of progress made in these last five years. 

In our view, the success of the Fund should be judged against its progress in reducing the incidence of these diseases.  After all, that is its primary reason for existing.

But as the the FT reported last week, the Fund has made no such progress.  In some cases - notably AIDS - things have got worse.

Here, in more detail, is what the evaluators found:

1. while HIV treatment had been boosted considerably, there was little evidence of large-scale change in the behaviour of people most at risk;

 

2. the Fund had failed to think about how to assess the effectiveness of its programs from the very start and should have built impact evaluations into its activities;

 

3. the Fund's support has strengthened existing TB programs but shown little evidence of accelerated progress since 2003;

 

4. it praised progress in distributing bed nets and spraying to tackle malaria, but said there was litle progress in providing drugs and only a few countries provide evidence of reductions in parasite prevalence;

 

5. nonetheless, while judging the Fund's impact as positive, the study was based on a sample of just 18 countries in part because they had shown good grant performance. Two countries with the greatest burden of infectious disease--South Africa and India did not participate.

So there we have it: after 5 years of failure and billions spent, we have precious little to show for it. The Fund trumpets the resources it spreads around and the skill with which it manages itself, but it has not managed to reduce disease.

And still they ask for more money to continue on this failing path.  Sounds a bit like the US auto industry...

Malaria: the UN just doesn't get it

The UN annouced on Wednesday ambitious new plans to phase out the use of DDT for combatting malaria by 2012 - while still meeting eradication targets.

Over $40m will be spent experimenting with pesticide-free malaria eradication projects, including "eliminating potential mosquito breeding sites, securing homes with mesh screen to deploying mosquito-repellent trees and fish that eat mosquito larvae."

Well now.  This is all extremely fascinating, but there's another term for these so-called interventions: it's called "development". 

People at the UN often forget that malaria is not an exclusively tropical disease, and was present in all corners of the globe until very recently.  The reason why it no longer exists in the USA, Britain, Russia etc is because these countries got richer.  In the process, people started to afford windows for their houses, they moved their livestock away from their houses and drained fields.  Because richer countries generally employ far fewer people in agriculture, there are less people outside at dawn and dusk for mosquitos to feast upon.

All these things meant that in many cases the lifecycle of the parasite was disrupted, and the disease spontaneously disappeared (Britain being a prime example).

Meanwhile, DDT was also crucial in removing malaria from swampy areas such as Florida's Everglades.  We also know that when used for indoor residual spraying DDT is extremely effective in reducing malaria caseloads, with negligible impact on the environment on human health.

The kind of schemes the UN is suggesting will be extremely difficult to impose globally in a top-down way. I predict that this project will be quietly abandoned in a few years time.  So why don't they just save the $40m and focus on what we know works?

New study: larvicides better than bed-nets

A new study from Tanzania's Ifakara Health Institute has shown that larvicides can be just as effective as bed-nets, yet four times cheaper.

The study focussed on urban areas in Dar es Salaam, where larvicides are having a considerable effect in reducing malaria.

Malaria rates in children under five, the most vulnerable demographic to the disease, fell by 72 per cent following the application of larvicides.

One resident commented: "I can't tell the amount of mosquitoes we used to have here. They have helped us to do away with this nuisance."

March of Washingtons - website launched

With children in Africa particularly vulnerable to malaria, the quality of antimalarial drugs can literally be a matter of life and death.

Furthermore, as well as failing to treat patients, substandard drugs provoke drug resistant strands of disease.

Fortunately our friends at Africa Fighting Malaria are making huge strides with their March of Washingtons campaign.

For every $1 raised by the campaign, they provide safe, high quality antimalarial medicine to an African patient in need, and invest the rest in conducting quality control testing of antimalarial drugs in Africa.

The group have now launched a new website:

TO CHECK IT OUT, CLICK HERE

You can donate and / or sign up your organisation to the coalition.

Malaria: looking long term

As we’ve come to expect, World Malaria Day is preceded by a plethora of stories on how many billions of dollars are spent fighting the disease.

An accompanying chorus comes from actors, footballers and any grinning celebrity who wishes to tell the world how excited they are at the prospect of rich countries buying bed-nets for poor countries.

Thankfully one report with a more balanced outlook comes in today’s Financial Times. Author Andrew Jack notes that while malaria has attracted vast amounts of funds and attention, this will largely be pointless if the root causes are not addressed.

Malaria was until recently present throughout the world, yet now 108 countries can claim to be malaria-free, the article explains. In these countries the roots were tackled, mainly due to economic growth.

The article warns that the politicisation and sudden expansion of anti-malaria efforts can mean resources are “misspent while bringing unintended consequences.”

Bed-nets, for example, may not be a long term solution. If malaria persists, will wealthy governments simply continue to donate billions of dollars’ worth of more nets?

But most importantly, emphasis must be placed on measuring outcomes, rather than assuming inputs are automatically A Good Thing.

‘Too many groups hold themselves accountable by “process indicators” such as the number of nets delivered’, continues Jack, ‘rather than the ultimate impact they are having on mortality and morbidity.’

World Malaria Day always creates a lot of noise. Let’s make sure we see through the hype, and observe the most effective ways for people to overcome this curable disease.

What's wrong in the Mekong?

Yesterday I co-authored an article in the China Post highlighting the growth of drug resistant malaria in the Mekong delta.

This followed a WHO press release on the issue which failed to even mention the link between substandard drugs (including counterfeits) and drug resistance.

The WHO press release talks of "new evidence" it has uncovered on drug resistant malaria--yet other studies have been showing this for years.

Repeat studies in 2002 and 2004 showed the success rate of artemisinin falling from 85.7 per cent to 79.3 per cent. Many other investigations reveal shockingly high levels of substandard and counterfeit medicines in the same area.

The WHO's press release also states that the "likelihood of drug resistance is increased with the use of single-drug therapies for malaria", before boasting that its policy is to always treat with artemisinin combination therapies (ACTs).

Yet as recently as 2004 the WHO was advocating the use of chloroquine, in spite of increasing malarial resistance to that drug. Its "ACTs only" policy has only been adopted recently, following much pressure.

The WHO still seems to be lagging behind and ignoring the root causes of drug resistance.

Malaria: putting health before business

A new child-friendly malaria medicine could prevent thousands of deaths in Africa every year.

The drug comes in a variety of sweet flavours, making it far easier to convince children to swallow than existing, bitter pills.

As a child dies of malaria every thirty seconds, this is a wonderful development; and what's more, it will cost just $0.37 per treatment.

Good news all round, yes?

Well apparently not, according to an article in Uganda's New Vision website entitled:

"Launch of child malaria drug threatens local industry"

Therein the Ugandan "primary healthcare minister" is quoted as saying:

“The only fear is that we [already] have a factory manufacturing Anti-malarial drugs (Luzira-based Quality Chemicals)”.

This factory, it seems, has not been cleared for Good Manufacturing Practice by the WHO. Even under the extremely lax "Option C", donors like the Global Fund cannot purchase from the factory, as there is no guarantee that their drugs are of high quality.

So why are government ministers concerning themselves with its profits?

The quotation is a stark reminder of how politicians can be influenced by vested interests.

Instead of prioritising business interests above health, ministers should simply allow the market to provide the best drugs that people need and trust.

Is Bill Gates exaggerating anti-malaria success?

In his 2009 Annual Letter published recently, Bill Gates stated:

"I am ... confident that our maniacal focus on ... measuring results will make a difference."

On the face of it, a "maniacal focus" on measuring results is commendable, and a welcome change from donors citing costs (ie. how much is being spent) as if they were benefits.

Yet today William Easterly reveals that Bill and Melinda Gates have been citing discredited statistics on success rates against malaria in several African countries.

A 50 per cent drop in the number of children infected in Zambia was one claim, leading to Gates exclaming: “Look, aid is making a huge difference, we are literally saving people’s lives."

But this statistic came from a WHO report that was never finalised and has subsequently "disappeared", and was contradicted by the 2008 World Malaria Report.

In that report, a small footnote explains the reliability of their measures:

“...in most countries of Africa, where 86% cases occur, reliable data on malaria are scarce. In these countries estimates were developed based on local climate conditions, which correlate with malaria risk, and the average rate at which people become ill with the disease in the area.”

So, to clarify, these figures are based on "local climate conditions".

As we've commented previously, conflicts of interest commonly result in inflated statistics--which in turn seriously warp the allocation of resources.

The Gates Foundation should be more careful with its figures.