The USPMI is the Malaria Initiative for Africa which I helped start in 2005 and which has since expanded to cover 21 countries in Africa and some in Asia and the Americas. So far they are doing a fairly good job, but they blindly follow the simple WHO strategy of bednets, drugs and biocides. I think this narrow approach, using ephemeral methods which require annual infusions of millions of US dollars, could be improved by broadening their approach to include permanent physical improvements. Improvements that don't have to be purchased anew every year from Big Pharma and industrial chemical companies.
In my half century of public health work in the Tropics, I have come to the realization that we should use a broader approach to disease prevention than the usual medical and chemical approaches. For instance, in my 10 years in Puerto Rico I learned that hookworm was controlled there when people finally insisted that their kids wear shoes (or just flip-flop sandals). Previous to that the public health establishment was trying to use repeated de-worming of kids with drugs. Year after year, drugs and more drugs. The minute they stopped the drugs, the hookworms came back.
In controlling Snail Fever (schistosomiasis) I found after 5 years in Sudan that safe water supplies inside the home were very cost-effective, better than repeated doses of praziquantel and continuous application of biocides to the irrigation canals and drains. However in Brazil they have been repeating drug treatment for 30 years, and the disease is still there. Year after year, drugs and more drugs. The minute you stop, the parasites come back.
It appears to me that careful use of condoms is a smarter approach to AIDS prevention than repeated doses of retro-viral drugs.
So for suppressing malaria, when are we going to take advantage of the permanent protection one gets from improved housing with good screens (and maybe even small electric fans), instead of the billions that PMI and RBM are spending on drugs and biocides?
And by the way, how many other insect vectors of disease would we be keeping out of the houses? Like house flies which transmit all manner of diarhheal diseases.
Or might we permanently eliminate breeding sites by installing tide gates along the coast, or with a few drainage ditches, or by filling depressions and swamplands, and maybe converting them into productive agricultural fields? It has been done in every country that has permanently suppressed malaria.
As of this year, the US Presidential Malaria Initiative for Africa has spent over $2.5 billion on their ephemeral chemical approaches. The minute they stop, malaria will come back with a vengeance. Do you remember the Immunity Dilemma?
Could we do some real and permanent improvements in housing with $2.5 billion? Could we eliminate a lot of breeding sites permanently, with a few billions?
Perhaps people with a broader outlook on public health should get into the fight. Any suggestions ? Any volunteers?
Bill, just an engineer