I invite you to help me imagine a solid and realistic approach to malaria control in Africa, rather than continuing our criticism of the current poorly focussed and unsustainable attempts by WHO, RBM and the US PMI. I think we need a permanent Institute where African malaria people can develop, implement and expand anti-malarial measures. Because the current emphasis on drugs, biocides and bednets is inherently unsustainable, let us take a more sensible and rational approach which utilizes ecological changes. There are many examples of such approaches in several parts of Africa, so what we need to do is build on those successes.
Malaria is embedded in the ecology of Africa, thus our emphasis should be on ecological approaches to permanently suppress transmission. An obvious one is to eliminate breeding sites suitable for anopheline species near human habitation. Because safe housing is a basic human need, it seems it is also a basic need in permanent suppression of malaria transmission. Also, an important component in the program of this Institute should concern the history of attempts at malaria control in Africa. If we understand the history, we can repeat the successes, but not the mistakes.
Because of political stability, as well as language and geographical importance, I envision an African Institute based in South Africa, with satellite institutes in Senegal, Sudan, Tanzania and Mozambique. We need to find solid funding so that African malaria people can establish careers in these institutes, and thus amass the institutional expertise and memory to carry out the mission. Funding for the current unsustainable approaches is dwindling, but if we develop a more rational and durable approach, we will be able to find funding. The great magnitude of the latent support for attacking malaria in Africa shows up in the world-wide interest in buying bednets, even though they have mostly symbolic value.
Although the purposes are quite different, there might be advantages in planning the satellite Institutes to be coordinated with the recently described International Centers for Excellence in Malaria Research proposed by the US National Institutes of Health this month. They are proposing to develop 4 ICEMR locations in Africa. Note that they plan to do research - not ecological suppression - but at least they plan to define the existing epidemiology of malaria transmission in the several ecologic regions of Africa.
So this is the beginning of an idea. What can you contribute to the planning? What do you see that we can do now to start a durable and ecological approach to suppressing malaria in Africa?
Bill - imagining what could be