Combating Malaria

Worldwatch Live Online Discussion

Anne Platt McGinn: Senior Researcher

February 7, 2003 - 1:00pm EDT

In Combating Malaria, Anne Platt McGinn illustrates how malaria, one of humanity's oldest scourges, is making a strong global comeback. Killing up to 7,000 people a day-primarily children in sub-Saharan Africa, the disease has become resistant to most anti-malarial drugs, making treatment vastly more complicated and expensive. McGinn argues that to bring this disease (which claims more lives every year than AIDS) under control, the world requires creative strategies and far more resources than are currently available.

Steve Conklin, Worldwatch Institute: Good afternoon, and welcome to chat #5 in our State of the World 2003 online discussion series. Today I would like to welcome Worldwatch senior researcher Anne Platt McGinn. Anne will answering your questions on malaria, and its deadly effects on our world population. Welcome Anne.

Anne Platt McGinn: Thank you, Steve. I look forward to a lively discussion

Louisville, KY: The banning of DDT has been criticized by some, minimizing DDT's ecological effects and attributing an increase in malaria incidence to the ban. Is there a geographical relation between malaria incidence and areas where DDT is banned? What is your view on the use of DDT?

Anne Platt McGinn: I'll answer your second question first: DDT is still an important tool to be used under special circumstances, such as the recent outbreak in South Africa. Often, the debate about DDT is polarized into an all-or-nothing situation--DDT or disease. But it's not that simple. DDT is just one of a vast armament of anti-malarial tools and should be seen in the context of the whole range of tools that help prevent, diagnose, treat, and reduce or suppress mosquitoes that carry the malaria parasite. It has become somewhat of a lightning rod issue because of the 2001 Stockhom Convention on POPS (persistent organic pollutants)but as that treaty stipulates, the use of DDT is reserved strictly to control vector diseases IF a country files a request for such use with the Convention Secretariat, and then closely monitors it, reports it publicly, and promotes the R and D of alternatives to DDT. In short, the international treaty helps ensure greater transparency and accountability for the justification and use of DDT where it is necessary for public health purposes. (DDT is banned for agricultural uses worldwide.) I believe that we can help minimize the NEED for DDT by investing in anti-malarial drug development, distribution of effective tools, improvement of health systems and capacity-building, etc etc.

Answer to the 1st question: this is a very complicated issue. THere is some evidence that the recent (1980s-90s) rise in malaria in parts of South America coincided with decline in use of DDT but the relationship is highly controversial as to why and if those two trends are related. There are many factors involved. In South Africa, officials brought DDT back into use after a several year hiatus and after An. funestus reappeared in form that resisted the pyrethroids that had replaced DDT. In the case of South Africa, DDT was effective in controlling the epidemic. The reasons for its success are many and complicated and therefore difficult to generalize to other areas where other mosquitoes are dominant and the infrastructure and resources to employ DDT may be more limited.

Boston, MA: Why do you think malaria is so often overlooked in relation to other diseases like AIDS? Is there political motive, financial motive through drug production?

Anne Platt McGinn: A number of factors are at play here.
1. POLITICAL: the political constituency for AIDS has been highly vocal and succssful in attracting necessary resources and attention; malaria simply hasn't had the same attention b/c it's a disease that many people thought was under control long ago. For many years, malaria was in decline thanks to global eradication efforts in the 1960s and other advances. At the time, people, gov'ts, and health authorities had good reason to dedicate resources to other health issues. In past 20 years or so, however, malaria has been coming back and we haven't adjusted our thinking to the degree warranted by the burden;
2. there is a long-standing perception that malaria is a poor person's disease: Up to 90 percent of cases and deaths occur in sub-Saharan Africa. This fact shapes our perception: the problem is over "there" so we in industrial countries don't have to worry about it;
3. Pharmaceutical companies have little incentive to invest in drugs that treat poor people: from 1976 -1999 only 4 of 1,393 new drugs developed worldwide were anti-malarial compounds. There is little money to be made in the business, so companies focus on more profitable diseases like obesity.

Fortunately, malaria IS getting more attention and funding today thanks to WHO efforts, Global Fund and many other efforts. but this is not enough. Although the malaria parasite is about 100 times more complex than AIDS virus it still receives only about one0tenth as much funding for research.

Washington, DC: What is the status of lifting tariffs on bednets in developing countries? What's behind the delay in lifting the tariffs? And what can international organizations do to pressure those countries?

Anne Platt McGinn: As of MArch 2002, (now almost a year ago) WHO reported that only 15 of 44 countris in Africa who pledged to address tariffs on bednets in an April 2000 Abuja Declaration had actually done so. And some of these countries only reduced the tariff level, instead of eliminating it. I don't have current information. At any rate, it is absurd that such tariffs and taxes exist in light of the benefits of treated bednets. INternational organizations should be highly vocal on this issue and call for redress through trade policies---restricted foreign aid until economic disincentives are dismantled. Countries also need financial assistance to pay for nets, with or without tariffs in place so NGOs and other groups should be pressing for that too.

Troy, NY: Where does the most funding for combating malaria currently come from? Do you think that victims from malaria are in a way victims of the AIDS epidemic, because now that so much funding goes to battling AIDS there is much less for fighting other vicious diseases such as malaria and TB? Are there any current developments that provide encouragment for more effective fight against this disease?

Anne Platt McGinn: While AIDS has definitely affected the distribution of health resources dedicated to malaria there simply is far too little to go around in the first place, with or without AIDS in the picture. Recent Global Fund to Fight AIDS, TB, and Malaria and Medicines for Malaria (MMV) Venture are good starts to get more money and attention and solutions, but these and other efforts are still vastly underfunded. Their budgets are in the tens of millions of dollars compared to the $3-12 BILLION malaria costs sub-Saharan Africa each year. Funding comes from a variety of sources including private (e.g. Norvartis AG and other drug companies), private foundations (e.g. Gates Foundation), UN money, USAID, individual gov't money, etc.

Finland: Do you think that it's possible that when the climate change goes further malaria will spread also in Europe? And if so, can this be avoided someway other than just by stopping global warming?

Anne Platt McGinn: It is difficult to anticipate and accurately predict where malaria-carrying mosquitoes and the malaria parasite might survive in the future, but some climate models show a possible return of malaria to areas where it has been under control for many years, such as southern Europe and western China. There is no silver bullet to prevent malaria, but discouraging the spread of malaria in these areas means keeping a close eye on outbreaks, treating cases immediately and effectively, monitoring the envrionment for Anopheles, reducing human-vector contact, and limiting the frequency that infected people are bitten, etc..all steps that are needed and necessary in malaria-ridden areas today. The key is continued vigilance, b/c history has shown that once we become complacent about malaria it finds a way to evolve and reemerge.

NY, NY: Ms. McGinn, at what point do you forsee malaria moving from what people now think is a 'far away' epidemic, to one that will hit close to home here in the United States, and other 1st World nations?

Anne Platt McGinn: I think we're gradually getting to the point that we truly see malaria as a GLOBAL threat that we have to live with and deal with on an on-going basis rather than a "far away" epidemic that comes in vicious spurts but we're definitely not at this point yet. Recent outbreaks of West Nile virus in the U.S., malaria in suburban Virginia, and other mosquito-borne diseases in Europe and Latin America have helped put tropical diseases in the headlines and advance the public perception that they are a threat everywhere. For malaria specifically, the efforts of many committed scientists, public health authorities, and others (e.g. Kofi Annan, Bill Gates, Jeff Sachs, and Gro Brundtland, Boston Globe) are helping bring attention to this issue. WHat else will it take? tourists going to malaria-prone areas have to speak up; thinking about health as an economic and human security issue is key; making the war against malaria and other diseases of poverty as much a global priority as the war on terrorism would help immensely. UNtil we see the connection between global health and global stability and well-being we won't bridge this psychological gap. Private companies that operate in malaria-prone areas have long made the connection between investing in malaria control and making profits (e.g. mining companies in Africa) Now we need to embrace this thinking at all levels

Steve Conklin, Worldwatch Institute: Thank you Anne for joining us today and providing answers to our visitors questions on malaria. Thank you to all our visitors, and be sure to stop in next friday for Worldwatch State of the World Chat #6: Charting a New Energy Future.

Anne Platt McGinn: Thanks to all for some good questions. I appreciate your time and attention.