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2004-04-17 - 5:05 a.m.

At the risk of becoming a bore/killjoy:

African Nightmares, Suffer the Children

Elcidio was born in the wake of Mozambique’s ruinous 16-year civil war. His father died shortly afterward in 1993, his mother was murdered three years later.

By Philip Coticelli Project Manager, Africa Malaria Day

Massive Effort Campaign

He loved music and dancing, pantomiming Kung Fu and going to the beach. His greatest desire was to learn to read and write, but he was ground down early in life by headaches, fatigue, muscle soreness, turbulent oscillation between severe fever and bitter chills. He died of malaria on May 1, 2002. Beyond the few who knew and loved him, Elcidio is merely another unread, unimagined statistic.

About 1.5 million Americans have lost their lives in battle, acts of war and terrorism since the Revolutionary War, 229 years ago; malaria kills as many African children in under a year. Malaria accounts for up to half of public health expenditure in some African countries, costing the continent $12 billion annually. It is driving Africans ever deeper into abysmal poverty.

Yet the disease is woefully forgotten by the public. In the past four years, the New York Times has written nearly a thousand articles on SARS, mad cow disease, anthrax and Ebola. These diseases have caused nearly a thousand deaths. That’s one article for every death. By comparison, the 40 articles the New York Times has written on malaria in Africa during the same period works out to about 1 word for every 100 deaths from malaria.

The means to control malaria exist, but are impeded by a vacuum of political will. In the developed world, voting constituencies are largely unaffected by malaria, and so there are hardly any advocates for the disease-affected – primarily young African children, but also a significant number of pregnant women.

The World Health Organization crafted Roll Back Malaria (RBM) in 1998 to mount a response to the exponentially rising mortality rates across Africa. Two years later, RBM convened 44 African leaders along with the United States Agency for International Development and the World Bank in Abuja, Nigeria, where they each committed to dramatic systems reform and a massive scale-up of funding to bring malaria under control.

On the summit’s fourth anniversary this month, RBM somberly discloses the details: many African countries are administering ineffective anti-malarial drugs; less than 2% of African children are sleeping under life-saving insecticide treated nets, which protect children from the nightly onslaught of mosquito bites; and many African countries still tax the purchase of these nets, despite pledging at the RBM summit to stop. The headline inks are faded, the dust thick on RBM’s scrapbook. Another 10 million children are dead.

Artemisinin-based combinational therapy (ACT), recommended in many African countries by the World Health Organization, has the potential to greatly reduce mortality rates in malaria endemic countries, but at around $1 per dose it is comparatively more expensive than less effective drugs. The United States Agency for International Development and other bilateral donors have procrastinated for over two years on ACT, trumpeting benevolent rhetoric while condoning funding for increasingly useless drugs and the needless deaths of millions of African children.

Though African governments are certainly not blameless, they are torn between what they are told will work and what they are told will be funded. 13 African countries have changed their drug policies to include ACT, but only four of these countries have had funding from international donors to procure and begin implementing the drug. Furthermore, the lag in donor commitment provides little incentive for the pharmaceutical industry to produce ACT in large order, nor to invest more resources in developing safe generic versions. To wit only 4 of the 1393 new drugs developed by the global pharmaceutical community in the last 25 years were anti-malarials.

The World Bank is a founding partner of RBM and pledged $500 million to roll back malaria at the summit in Abuja. It has since told its critics that the money is indeed available, sitting in a coffer, unsolicited by African governments. Instead of shrugging its shoulders, the Bank could provide more technical assistance to write quality proposals, as it does with many development projects. Or, as the Chief Trustee of The Global Fund to Fight AIDS, TB and Malaria, which has been financing ACT implementation in Africa since its first grants in 2002, the Bank could easily transfer the money to the Global Fund’s account.

$340 million is needed over two years to purchase enough ACT drugs to cover Africa against malaria infection. This is less than half the cost of sending two United States Expedition Rovers to Mars with the ironic objective of discovering whether life previously existed there. Perhaps we can also invest as much to protect the life that exists now on our planet.

Now go to http://massiveeffort.org/html/coticelli_editorial.html

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