This is an archived USAID document retained on this web site as a matter of public record.
Administrator J. Brian Atwood
Combatting Malaria
Washington, D.C., October, 30 1997
U.S. Agency for International Development
I would like to thank you all for your participation in this
conference which I know has been productive. Combatting
malaria is clearly more than just a vital public health issue, it is a
dilemma whose resolution is fundamental to development as a
whole.
We have seen growing recognition of the tremendous
problem posed by malaria this year. The Atlantic ran a cover
story on the resurgence of the disease. The New York Times
published a long feature on malaria and noted that the cumulative
statistics concerning malaria, "have so many zero's that it is
impossible to conceive of the heartbreak they represent."
Senators Leahy and McConnell -- Senator McConnell who
himself suffered polio as a youth -- have helped lead the
Congressional charge that we need to do more to fight infectious
disease in the developing world. Jeffery Sachs, in a thoughtful
piece in the Economist, detailed the devastating economic effects
of tropical diseases and their costs to developing nations.
Many of these commentators have been bluntly critical of
the international community's response to malaria. The Times
commented, "The extraordinary thing about the mosquitos is that
in the current battle against the best minds of 20th-century science
and medicine, the mosquitos may be winning." There are
bountiful statistics to buttress this criticism, most of with which
you are familiar. Malaria causes more than 2 million deaths a
year, principally among children and infants. Ninety percent of
these deaths occur in sub-Saharan Africa. Between 300 and 500
million people now get malaria each year. Someone dies from
malaria about every fifteen seconds. During the last decade,
malaria has killed about ten times as many children as all the
wars in that period combined.
The direct economic cost of malaria in Africa -- including
lost wages, the cost of treatment, and the expense of traveling to
a clinic or a hospital -- was estimated to have been 1.7 billion
dollars in 1995. That already astronomical figure, is expected to
double over the next five years to 3.5 billion dollars. A t the
household level, approximately 20 percent of disposable income
of low-income African households is spent on mostly ineffective
malaria treatment. And, in many African countries out-patient
treatment for malaria accounts for up to 40 percent of all public
health expenditures. Even as malaria already extracts a heavy toll
on Africa, over the coming years it is estimated the region can
expect a 7-20 percent annual increase in malaria related deaths
and cases of severe illness.
Despite these grim statistics, the international community has
had difficulty marshalling resources to combat malaria. While
figures vary, it is clear that spending on malaria control and
research remains very low, especially when you look at the
number of fatalities caused by the disease. In short, to all those
who would criticize the international response to malaria I would
say this: you're right. We aren't doing enough, and that has to
change. We have to do a better job combatting not only malaria,
but a range of other infectious diseases, or we will risk seeing
important economic gains in the developing world undone by a
growing public health crisis.
The growing visibility of the malaria problem is an
important part of the response. We need to educate the public
and the congress about the severity of this problem. As an
agency, USAID is operating in a time of very tight resources.
This situation is replicated at the United Nations and among most
donors. Not only in the public health field, but across all of our
activities, the international community is too often forced to rob
Peter to pay Paul.
Do we cut funding in agriculture to fight AIDS? Do we
abandon environmental programs to fund family planning? Do
we fund basic education or microenterprise? The choices are
extraordinarily difficult and it is incumbent upon all of us to help
educate the public that combatting infectious diseases is a public
investment that we cannot afford not to make. We must also do a
better job leveraging resources from the private sector to help
fight malaria if our efforts are to be successful.
The U.S. Agency for International Development -- as the
lead U.S. government agency in the fight against malaria and
other infectious diseases in the developing world -- is working at
a number of levels to address the root causes of these public
health issues. USAID's approach to infectious diseases consists of
four interrelated elements. First, we are working to change the
social and economic conditions -- such as poverty, lack of
sanitation, rapid population growth and environmental degradation
-- that allow infectious diseases to flourish. Second, we are
working to improve health systems so developing countries
themselves can better control infectious diseases. Third, we are
carrying out specific targeted programs to address priority
diseases. Lastly, we are continuing to enhance our capability to
respond to emergency disease situations.
USAID's health programs focus on the major killers of
children under the age of five -- pneumonia, diarrhea, measles,
malaria -- and HIV/AIDS. In 1996, USAID devoted an estimated
$320 million to the prevention, surveillance and treatment of
these diseases, and the development of simple and affordable
technologies to ameliorate their effects.
USAID's malaria control efforts in recent years have
focused on the development of new approaches and technologies
for its prevention and control. The emergence and spread of
strains of malaria that are increasingly resistant to available
treatments poses real problems. As an agency, we are continuing
our support for the development of a malaria vaccine. In Africa
we are field testing options for practical and sustainable control of
the disease, as well as working with World Health Organization
to strengthen the capacity of national malaria programs.
The lessons learned from these programs have significantly
increased our understanding of the impact of malaria and options
for its prevention and control. As a result we, along with many of
you, have reassessed the options for malaria control, added new
interventions and strategies for a more targeted application of
existing control measures have emerged.
USAID's approach is a package of maternal and child health
interventions for malaria control that emphasizes improved
management of the disease and its prevention. One of the major
constraints we face in trying to reduce the burden of malaria,
especially in its association with the emerging drug resistant
strains of malaria, is the lack of simple and effective tools for the
prevention of malaria infection.
The success of the recent "bednet" trials in East and West
Africa has been dramatic, as you have discussed during the last
couple days. The use of treated bednets, first used by soldiers
during the Second World War fighting in the tropics, could give
us an upper hand in fighting malaria. The bednet trials showed
that insecticide treated nets can significantly reduce deaths from a
number of causes, not just malaria, and that we can significantly
reduce malaria related mortality even in areas that have been
traditionally hardest hit by the disease.
But we all appreciate that a few successful field tests do not
necessarily mean that bednets can widely be transformed into an
effective program against malaria. In many areas, bednets are too
expensive for families struggling with profound poverty, and
issues relating to market access and retreatment of the nets with
insecticide will also have to be addressed.
Again, I cannot over emphasize that to successfully meet the
challenge of malaria will require a concerted and well coordinated
effort of not simply the donor community working with national
programs, but will also need to involve a partnership with the
private sector who manufacture critically needed nets and
insecticides.
I can assure you that USAID will be a steady partner in
these efforts. USAID's commitment to expanded efforts in
malaria are linked to our agency infectious disease initiative, led
by the Congressional support of Senators Leahy and McConnell,
which is currently working its way toward passage. In 1998 we
plan on supporting an expanded application of recently proven
interventions for the prevention and control of malaria, including
a expanded field trials in Africa, within the context of our
existing maternal and child health programs. We will also be
undertaking a initiative in Africa to promote insecticide-treated
mosquito nets.
We look forward to the opportunity of working with you to
explore how best to apply the findings and recommendations you
have made during this conference. This meeting has provided a
unique opportunity to bring together new combinations of ideas
and experiences which we hope will lead to innovative
approaches to addressing the problem of malaria. And we all
look forward to a time when people will reflect back upon these
days as the time when we turned the corner in our fight against
malaria. Thank you.
This is an archived USAID document retained on this web site as a matter of public record.
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Last Updated on: July 18, 2001
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