Well, you certainly can’t fault Obama for aiming high. Via satellite, Obama announced at yesterday’s Clinton Global Initiative forum that he would provide support to end malaria deaths in Africa by 2015–a lofty goal, but is it even close to attainable?
Obama provided the basics of his plan here, laying out why he feels this is such an important goal:
Malaria needlessly kills 900,000 people each year. In Africa, a child dies from a mosquito bite every thirty seconds. Beyond this devastating human toll, malaria undermines the economic potential of local economies and overwhelms public health systems – accounting for up to 40% of health spending in many African countries. As global warming and population displacement trends accelerate, an additional 260-320 million people worldwide could be living in malaria-infested areas by 2080.
He then discusses multiple approaches necessary to quickly reduce the mortality from this infection. Is this attainable? More after the jump…
First, Obama notes that his plan will bring together private and public entities in a partnership, envisioning a global effort rather than simply a U.S.-centric one. This is already a good start. Next, he lays out his multi-pronged attack. He envisions much of the work being done at the local level, providing not only independence for the countries involved, but also the opportunity to create jobs in these areas. He cites an example already up and running in Tanzania that could serve as a model for other locations:
In Tanzania, local bed net production has already begun making a meaningful contribution to fighting malaria. For example, A to Z Textile, a local company first funded in 2003 by Acumen Fund is now manufacturing 10 million insecticide-treated bed nets per year and
employing over 6,000 female workers. A to Z represents the model that Obama would seek to expand and replicate, in his effort to both end deaths from malaria and develop local economies.
Next, he tackles a big impediment to any public health issue in developing countries: infrastructure development. As Laurie Garrett noted in a recent talk here at the University of Iowa, the infrastructure–both in terms of human service and physical structures–simply isn’t present.
You can’t just go out and deliver medicine–you need to develop a delivery system, and sometimes even build roads to travel on–no small feat. Additionally, even if the infrastructure is somewhat in place, health care workers may not be…health care workers are leaving their native countries for higher-paying jobs in other countries (or even leaving hospital or Ministry of Health jobs in their native countries to work for NGOs which typically pay better). Those workers who stay in their original countries or jobs are frequently demoralized, as they lack the supplies and funding to adequately care for patients.
Obama realizes this needs to be tackled for any program to be sustained in these countries, and puts forth a plan to work on this:
To realize his commitment to end all deaths from malaria while working to build health infrastructures, Obama will make a significant effort to improve primary healthcare facilities abroad. Effective primary healthcare is critical to the fight against malaria because it is the mechanism through which rural populations receive anti-malarial medicines, prevention services, as well as effective counseling regarding proper drug usage. Obama will also work with developing nations to strengthen their public health education programs, to develop an educated healthcare workforce, and to improve healthcare supply chains.
Good, but pretty generic. Unfortunately the problem goes well beyond an improvement in primary healthcare facilities (though it’s a good start). Many people don’t have any access to even the most basic health care, not only due to poverty (inability to afford such health care), but also due to proximity (no good providers in their area) and transportation issues (poor roads, few buses, etc.) There’s also the basic issue of lack of access to clean water, which affects 1.1 billion people worldwide (while 2.6 billion lack access to adequate sanitation). These can also play a role in malaria transmission by providing breeding grounds for the insects that transmit the parasite, but this goes unaddressed in Obama’s plan.
In addition to increased access to healthcare and preventatives such as bed nets, Obama also outlines increased R&D funding for malaria treatments and vaccines:
One critical problem exacerbating malaria’s health impact globally is that rural populations in developing countries are becoming increasingly resistant to several of the malaria drugs currently available. Federal support for drug R&D–both for early-stage research and product development as well–is critical to providing drugs that can control and treat the malaria epidemic. Moreover, we still lack a successful malaria vaccine. Just as the U.S. was a leader in eradicating major diseases of our time (such as smallpox), Obama believes that the government should partner with the private and non-profit sector to create a second generation vaccine.
This all sounds good, but malaria is really a bitch when it comes to treatment and vaccine development. Because it’s an eukaryotic parasite rather than our traditional bacterial or viral pathogens, it goes through a number of life cycle stages, expressing different proteins during each. To complicate matters even more, malaria can be caused by several different species of Plasmodium. This makes it incredibly difficult both to prevent the disease via vaccination, and to treat it with drugs, as I noted previously:
Though vaccines may be available in the future, prevention today is largely via control of the mosquito vectors using insecticides and mosquito netting. However, mosquitoes are growing increasingly resistant to the insecticides, and many people living in at-risk areas lack the financial means to purchase bed nets.
There are anti-malarial drugs to treat the patient once they’ve already been infected, but these, too, are losing their effectiveness due to parasite evolution. Additionally, a single infection does not confer life-long immunity. Not only can an individual be infected with different species of Plasmodium, but the parasite can switch the antigens it presents–the proteins on the parasite surface that the immune system recognizes.
Obama’s plan doesn’t specify the dollar amount, but notes he will build on funds already pledged by private and public sponsors:
The new funding commitments include: $1.6 billion from the Global Fund to Fight AIDS, Tuberculosis and Malaria; $1.1 billion from the World Bank; $168.7 million from the Bill and Melinda Gates Foundation; $2 million from Ted Turner’s United Nations Foundation; and $100 million from a coalition of corporations, including $28 million from Houston-based Marathon Oil to extend its malaria-prevention program across Equatorial Guinea.
Finally, Obama notes that other areas that will help reduce the burden of malarial disease need to be addressed as well: access to education, local capacity building, corruption, and social justice. Plans are laid out to tackle some of these areas as well, including a $2 billion commitment to establish a Global Education Fund. He also notes that funding and efforts to fight other diseases of poverty are necessary as well, getting in a jab at President Bush’s prior HIV/AIDS policies along the way:
Our first priority should be to implement the recently signed President’s Emergency Plan for AIDS Relief (PEPFAR), legislation Barack Obama long-supported, to ensure that best practices – not ideology – to drive funding for HIV/AIDS programs.
All in all, Obama does a good job in laying out the groundwork for a plan, but the devil is always in the details. Luckily, he’s not the only one who would be working them out if elected president; the Global Malaria Action Plan already has a template plan in place “how countries and global players can work together on control, elimination and research to fight malaria.”
And yes, McCain has also supported an attack on malaria:
I will establish the goal of eradicating malaria — the number one killer of African children under the age of five — on the continent.
However, I’ve not found anything more specific than that, along the lines of Obama’s plan. If it’s out there somewhere, I’d be happy to look at it and compare them…