Recent efforts, spearheaded in large part by the U.S. government, have reduced the annual malaria death toll from around 1 million to 800,000. There has also been an impressive increase in funding for research and development (R&D) into new malaria-fighting tools. Yet there may be trouble ahead. R&D spending to date has been skewed away from some of the most useful anti-malaria tools and the donor nations that have been picking up the tab face an avalanche of debt. This potential problem provides an important opportunity for malarial countries to show some leadership of their own.
According to a recent report by the Program for Appropriate Technology in Health (PATH), annual funding for malaria R&D quadrupled between 1993 and 2009 to over $600 million. Most of this money has been spent on drugs (38%) and in finding a malaria vaccine (28%). Drug and vaccine development is expensive and so this is hardly surprising, but it is shocking to note that only 4% of these funds have been spent on finding ways to control mosquitoes.
Malaria is a vector-borne disease — the mosquito, or vector, transmits the malaria parasite. Effective vector control, which is the very foundation of malaria control, relies on public health insecticides that are either used to treat bed nets or sprayed on the inside walls of houses. And herein lies the reason for the funding bias. People, including legislators who appropriate taxpayers’ money, understand and appreciate the value of vaccines and medicines. Getting people to understand that insecticides save lives in the same way is almost impossible, thanks to decades of successful anti-insecticides campaigns.
In recent years the Gates Foundation funded a new innovative partnership designed to bring new vector control products to market. While this is obviously good news, much more can and should be done. The growing evidence of insecticide resistance means that the tools we have to fight malaria are less effective than they once were. Unless new tools are found with far greater urgency, lives will be lost and progress against malaria will be set back.
The problem of insecticide resistance is not exactly being ignored. The African heads of state who comprise the African Leaders’ Malaria Alliance recently raised it as a problem and highlighted the need for new insecticides. The fact that these heads of state have taken note of this problem should give us some hope. Africa bears most of the malaria burden and any lasting solution to the problem will require better African leadership as well as funding.
The PATH report didn’t only expose the bias against insecticides, it also revealed the worrying fact that most of the malaria R&D funding comes from the U.S. government and the Gates Foundation. These two entities were responsible for 85% of the steep increase in malaria funding between 2007 and 2009. To sustain the fight against malaria, we must have more variety among donors.
In 2006 the French government, along with Brazil, Chile, Norway and the UK, launched an effort to sustain funding for developing country drug purchases with a tax on airline tickets. This was widely hailed as an innovative financing solution. But this “innovation” is merely a tax. Taxes have been around since the early Egyptian pharaohs, so it is stretching credulity to consider this scheme an innovation.
A truly innovative solution could, like the French plan, involve air travel but would avoid further taxes on already cash-strapped consumers during an economic slump.
Most African heads of state have their own private jets to ferry them and their entourages around the globe. Some presidents, such as Uganda’s Yoweri Museveni and Ghana’s John Kufuor, have splashed out on new jets to the tune of around $30 million each. If 30 African heads of state were to give up their private jets, a fund of well over $500 million could be generated. These state assets could be sold and the revenues deposited in an independently managed and audited trust fund to provide sustainable funding for malaria control and R&D.
If African presidents have any difficulty with their travel schedules, they could surely be advised by David Cameron’s office. The UK prime minister has no private jet, flies commercial and has also been a champion for increased donor funding for malaria control in Africa.
Should there be any shortfalls, the African Leaders’ Private Jet Fund could always be augmented by donations from heads of state themselves. Some African heads of state are recognized as among the richest men in the world. For instance, although he recently denied it, estimates put the personal fortune of Angola’s president, Jose Eduardo dos Santos, at over $20 billion. Even if his wealth amounts to half this figure, a Warren Buffett-esque donation would still provide a valuable boost for African malaria control and earn dos Santos a seat at the table of the great philanthropists.
Several benefits would arise were African leaders to put their money where their mouths are. First, it would help U.S. congressmen to convince the remarkably generous but hard-hit U.S. taxpayers that we have true partners in the fight against malaria and that it is worth appropriating money for this noble cause. Second, it would probably help to reduce the bias in R&D funding, directing money to areas, such as improved vector control, that are recognized as more important for African countries. Third, it would help in creating a much-needed culture of accountability and responsiveness in African politics.
There is a desperate need for African leaders to demonstrate that they are willing to invest their own resources to solve their own problems. Were African leaders to recognize that there is something deeply distasteful in flying around in private jets while their citizens die needlessly of preventable diseases, their credibility might soar as high as their luxurious private jets.
Richard Tren is director of Africa Fighting Malaria, a Washington, D.C.-based health advocacy group.