This is an urgent plea to you - the reader - to support strengthening of the strategy being used by the US Presidential Malaria Initiative of USAID in Africa. Please contact Tim Ziemer or his deputy Bernard Nahlen at USAID in Washington DC to support strengthening of their malaria strategy by broadening it to include all available control methods in the most cost-effective combination.
The strong performance and success of the US Presidential Malaria Initiative is a credit to the US Agency for International Development, and I would like to help ensure a continuation of that success. Thus I am making suggestions about strengthening the strategy which the Malaria Initiative is currently following in Africa. I am also sending these suggestions to key staff and supporters in USAID, CDC and Congress, to ensure continuing and informed support for strengthening the anti-malaria effort. Your additional support would make this more effective. Effectiveness is important (1) because the USAID Malaria Initiative is spending about half a billion dollars a year nos - the biggest kid on the malaria block and (2) to avoid further problems with resistance which could destroy all the progress made in the last 9 years,
The USAID Presidential Malaria Initiative - also known as the PMI or the Malaria Initiative - has until now, closely followed a narrow strategy prescribed by WHO Geneva. This WHO strategy is unfortunately a Specialist Approach, restricted to methods familiar to physicians and health specialists, but not much different from the approach used in their failed Global Malaria Eradication Program which collapsed in disillusionment in 1969. It has the same key weakness - the emphasis on drugs and biocides which inevitably produce resistance - followed by program collapse.
To avoid a similar collapse of the Malaria Initiative, I have urged them to develop a holistic Generalist Approach which will be more durable and cost-effective and will thus strengthen the ephemeral and narrow Specialist Approach of WHO. The warning signs that the WHO strategy is nearing collapse are clear: mosquitoes in both East and West Africa are already resistant to the pyrethroid biocides the Malaria Initiative introduced there in 2006 for spraying houses and for treating bednets. Also resistance to the preferred artemisinin drug has appeared in South East Asia, and will spread to Africa soon as it follows the same path of chloroquine resistance seen in the 1969 collapse of the WHO program.
The Generalist Approach has been followed by those countries which have documented successful elimination of malaria: Italy, Puerto Rico, the USA, Israel, Mauritius and Turkmenistan. However countries using the current WHO Specialist Approach have not been able to eliminate this complex disease.
A sensible way to develop a durable Generalist Approach which will not collapse, is to utilize the experience of field personnel from Africa and the US who have been working with the USAID Malaria Initiative for the last 9 years. But first their field experience should be broadened by exposing them to the holistic classical methods for fighting malaria, and then helping them to tailor these methods to the several ecologic zones of Africa where they are working. These classical methods were the basis of the successful elimination of malaria from Italy in 1962, as reported in Frank Snowden’s prize winning book on “The conquest of malaria,” published by Yale University Press in 2006.
Unfortunately the people working with the Malaria Initiative don’t have much experience outside the narrow WHO Specialist Approach. Thus they need familiarization with the wide variety of durable methods available for fighting malaria. But instead of turning to WHO to help, they should ask field entomologists familiar with the broad and holistic control techniques developed by the US Centers for Disease Control (CDC) for the Tennessee Valley Authority in the USA.
CDC pioneered these methods in the southern US and in Puerto Rico during the Second World War. When I started with CDC in Puerto Rico in 1961 they had just eliminated malaria there, using environmental and engineering techniques for malaria control based on their success with the Tennessee Valley Authority. These techniques are detailed in the USPHS-TVA book on malaria control from 1947, and in more recent WHO manuals on Environmental Methods from 1982 and on Larval Source Management from 2013. Fortunately the Malaria Initiative people in Tanzania are already using these techniques and could easily teach them to the others.
This Generalist Approach has also been the subject of two recent conferences on malaria. See the Yale Declaration on Malaria from 2009 and the Jerusalem Declaration on Malaria from 2013, both posted recently on this website of MalariaWorld.
Finally, I urge all of you readers who care about suppressing malaria in Africa, to contact Tim Ziemer to quickly adopt the Generalist Approach to strengthen their battle against this disease which claimed the lives of a million people in Africa last year, most of whom were children.
Bill Jobin, still hopeful