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Campbell & Steketee (2011): Malaria can be eliminated from Africa

Yes, given sufficient funding and scale-up it can be done
46% (12 votes)
No, we should aim for good and sustained control
54% (14 votes)
Total votes: 26

Comments

Bart G.J. Knols's picture
Submitted by Bart G.J. Knols on
This poll refers to the editorial 'Malaria can be eliminated from Africa'. What are your views? Is this the creation of false hopes, or can we really do it? The malaria world is reaching the cross-roads: Do we follow the statements made by Bill & Melinda Gates in October 2007, or should we abandon this. Perhaps continue elimination efforts at the fringes of the malaria distribution and forget about the heartland of malaria in Central Africa? Let us have your vote on this...

Submitted by Guest (not verified) on
we have scientifically and practically proven high impact interventions capable of eliminating malaria. Provided that this interventions are scaled up, there is sufficient funding and effective management system we can eliminate malaria in Africa.

William Jobin's picture
Submitted by William Jobin on
The concept that malaria can be eliminated from Africa is a fantasy, unsupported by any experience on the continent. Africa is a beautiful and culturally rich continent, with a variety that is both attractive but also daunting when one tries to devise a continental approach to any issue. The challenges to any attempt at elimination of malaria in Africa include: 1. The unstable and varied nature of many of the 54 countries on the continent. 2. The existence of other serious problems such as war, poverty and hunger, which a push on malaria elimination would have to compete with for funding and personnel. 3. The immense variety in ecologies, from desert to rainforest, all demanding different approaches. 4. Organizational programs due to the variety of languages. 5. The inherent abilities of the parasites and the vectors to adapt to drug and biocide attacks. 6. The fragile status of non-immune populations which develop after several years of successful supression of transmission, exposing them to explosive epidemics at the first instance of suspended control efforts. 7. The high cost of current control methods, which require outside funding, an inherently unreliable source. When African economies prosper to the point that countries can fund their own programs, then sustainable progress against malaria can be made. 8. The porous and enormous extent of borders between countries where malaria might first be controlled, and countries where control is in early stages. What we can do is gradually suppress transmission in the most stable and democratic countries, and expand the effort as experience is gained. This is the reality of public health programs, as opposed to the fantasy of elimination or eradication.

William Jobin Director of Blue Nile Associates

Submitted by Ricardo Ataide on
I agree with William. The elimination of Plasmodium from Africa will take more than just the will of the researchers and the open wallets of the well-intentioned (as the Bill Gates Foundation is finding). This will have to be a job that tackles several other issues that are of great concern before the elimination of malaria is actuallly achieved. It will also have to be a workload that is carried by international agencies, local governments and authorities, NGOs, funding agencies, researchers, pharmaceuticals, biotecs... you name it! So you see that the right planet alignment will have to come into place for that to happen... So, if the question had been: Do you believe that eliminating malaria from Africa is possible?" my answer would have been: "Yes (with all the reservations that I mentioned above)". But when asked if it is a question of will power by researchers and money-spending by funding agencies i have to say: "No".

Ricardo Ataíde

William Jobin's picture
Submitted by William Jobin on
Muito obrigado Ricardo, Thanks for your supporting ideas. And you are right to point out that we should not rely on open wallets. At the recent conference on malaria by Johns Hopkins University, we heard Jeffrey Sachs' account of the formation of the Global Fund in 2002 and its tremendous boost for financing the fight against malaria. However yesterday, the Global Fund canceled its next donors meeting for lack of their interest, and announced that they would not start any new malaria programs, due to lack of funds. Likewise I see the US cutting back soon on the malaria program of USAID-PMI because of the Great Recession. I pointed out this donor fatigue problem to Sachs, and reminded him that we need an Exit Strategy, based on adding permanent methods to the current batch of unsustainable drugs, biocides and bednets. And you are right Ricardo to point out that the issue is not the will power of scientists and funding agencies, but of local governments and authorities in African countries with both malaria and resources. Thus to deal with today's problem of funding cuts, I think it is clear what we need to do: 1. In countries rich in oil and minerals such as Angola, Chad and Nigeria, any contributions from WHO or PMI or Global Fund should be given only if matched by contributions from the national governments. Angola has received billions of new oil and diamond revenues in the last 10 years and are contributing almost nothing to fighting their own malaria. Why should the US PMI pay for their malaria control if they are not willing to pay for it themselves? 2. Concentrate shrinking funds in places which will have the most lasting effect, namely the most stable and democratic countries. The hope of PMI to expand to Congo must be put aside in favor of assisting stable countries like Senegal, Tanzania, Mozambique, Zambia and South Africa. It is really a matter of being rational in allocating increasingly scarce resources. Bill

William Jobin Director of Blue Nile Associates

Submitted by Guest (not verified) on
Your portuguese is excelent Bill! Having worked in Angola for a portuguese NGO in the area of HIV and STDs i had the opportunnity to witness first-hand how that country runs its health business. There are lots of people that want to do the right thing but eventually the Machine (a government based on a Cleptocracy System) is just to overwhelming. I'm guessing that other rich African countries would be presented with much the same problems. Although I agree with the two points that you have raised concerning the funding issues, I would like to pose a couple of questions to which I really have no answer myself: 1- Do you believe that we should be limiting the help that the poor populations get, in places like Angola, in order to punish the rich people in power? (i.e. is it fair to only help those populations if their governments do this or that?) 2- Some of the countries you mentioned in your second point are enourmous (at least compared to Portugal!). Even if efforts are focused on them, again, several basic infrastructures have to be put in place so that that help can be actually relevant. Also, malaria knows no frontiers... Do you think that localized, strategically directed funding would actually prove to be helpfull? And finally, just another thing on my mind. In the last few weeks a certain number of my non-science related friends have been asking me why I continue to work on malaria if a vaccine has already been found! The media has certainly been able to push a story through... if not the correct one. How are the funding bodies reacting to that? Is the funding being affected by this prevalent idea that "the problem is solved"? Cheers, Ricardo

William Jobin's picture
Submitted by William Jobin on
Thank you Ricardo. I wish my Portuguese were as good as your English. I would probably retire to Brazil. In response to your perceptive comments of 25 November: 1. When we limit our assistance to the most stable and democratic societies, it is not to punish the dictators and patriarchs, they couldn't care less about the persistence of malaria among their people. We would limit our help because our resources are scarce, and are best employed in places where their effects will endure, and can form the basis for future progress. In fighting malaria in Africa, the dictators are as much of a problem as the mosquitoes. 2. Yes, it will be a long time before we can expand successful efforts from South Africa into the Congo, or from Kenya into Somalia. Thus we should expand only as we have the success and funding to do so. The funding should gradually come from the country itself as the benefits of malaria control bring some additional prosperity and the local government is convinced of the wisdom of control. Only in this way can we be free of the outside forces of donors, such as donor fatigue. 3. Finally, I guess and hope that the people in funding agencies are not fooled by the excessive publicity for the new vaccine. Yes, funding is dropping fast. But this is because of the economic recession, and also because of donor fatigue with the WHO and PMI strategies which require continuous and repeated use of drugs, biocides and bednets. This donor fatigue would be reduced by addition of permanent improvements to the unsustainable methods. Permanent methods such as habitat reduction and housing improvements are the only Exit Strategies for malaria programs. I am aware of the Cleptocracy problem, especially in countries run by dictators. But in the case of Angola, I found a wonderful absence of this problem as we got further and further from the capitol. The folks in southern Angola were a joy to work with, and went the extra mile, with no compensation. You are clearly getting valuable experience Ricardo, and your questions show that you are giving profound thought to the complexity of the fight against malaria. You will be able to bring reality to the dreamers who long for vaccines and eradication. Bill

William Jobin Director of Blue Nile Associates

Submitted by Ricardo Ataide on
Hi Bill, I had a couple of questions for you and have sent them without having signed in... see the "I agree, but" comment... Cheers, Ric

Ricardo Ataíde

Submitted by Guest (not verified) on
Malaria cannot be eliminated in Africa with the current plan. Strengthening control should be the focus. Most malaria endemic countries in Africa don't have sustainable malaria control programmes. They rely mostly on donor funds which are affected by global markets. The countries that are currently in pre-elimation or are already eliminating are those with decades of uninterrupted control programmes and mostly used insecticides in particular DDT for decades. The control programmes are run by country governments with complete political support for malaria control programmes. The countries are relatively stable politically with generally no civil wars e.g Botswana, Swaziland, Namibia, South Africa etc. Firstly Africa is not a country but a continent with high numbers of refugees and economic migrants and this reality is currently a major challenge for some of the above mentioned countries who on any given time have a huge influx of illegal immigrants who are parasite carriers and asymptomatic.