The World Health Organization (WHO) and the United Nations Children's Fund (UNICEF) say more people than ever are getting malaria treatment and prevention services, offering hope that the rising number of illnesses and deaths from the parasite will begin to decline. The statement comes in the World Malaria Report for 2005. But critics argue that the WHO, UNICEF and its partners in the Roll Back Malaria program have been ineffective in fighting the disease.
The World Malaria Report says progress has been made in preventing and treating malaria since 2000, when African heads of state set a goal of cutting malaria deaths on the continent in half by 2010.
Up to 90 percent of the world's one million malaria deaths and 300 million acute illnesses each year occur among African children under five years old. Those statistics have not changed since 2000.
But the report finds that more countries have intensified their anti-malaria campaigns by introducing the newest medicines, and that bed nets treated with long-lasting insecticides are being distributed to more people than ever before. The World Health Organization's Assistant Director General for AIDS, Tuberculosis, and Malaria, Jack Chow, says with help from the Roll Back Malaria partners, bed net use increased tenfold over the last three years among all African countries reporting such data.
"Already that partnership has seen compelling results by introducing innovative practices like combining measles vaccination with the distribution of bed nets,” he noted. “Already this partnership has distributed bed nets to 98 percent of families in Togo with a child under five years of age. It has in five districts in Zambia gotten bed nets to 60 percent of targeted families."
Dr. Chow cites the malaria partnership's efforts to coordinate the delivery of the newest malaria medicines where the demand is highest. These are compounds based on the Chinese herb Artemisinin, which can treat cases that has developed resistance to established, cheaper drugs.
But the Roll Back Malaria partnership has come under stinging criticism. The private relief group, Doctors Without Borders, says only nine of 33 African countries that have decided to use the new drugs have actually done so.
In addition, a recent editorial in the medical journal Lancet charges that the consortium has done more harm than good. It says malaria rates have actually increased, and blames the partnership's poor coordination and lack of accountability.
Jack Chow says part of the problem is that the Roll Back Malaria program is underfunded.
"We estimate that we need at $3.2 billion annually, with $2 billion in Africa to defeat malaria. Right now, we have an eighth of that, $400 million," he added.
One critic of the program agrees that more money would mean few malaria illnesses and deaths. But this critic, Roger Bate of the Washington policy research organization, the American Enterprise Institute, argues that the money that is available is not being spent on the best interventions. He favors the addition of indoor spraying, which, he says, is more effective than insecticide-treated bed nets.
"Bed nets are very good from the hours when you're actually underneath the net, but the anopheles mosquito, which spreads the disease, is active between dusk and dawn. There are many hours when a mosquito will be active between dusk and you going to bed, so the disease can be spread, which is why I favor the indoor residual spraying approach," he explained.
Mr. Bate also accuses the Roll Back Malaria partners of focusing on the wrong statistics. He says they measure the number of bed nets or drugs distributed instead of the effect these measures have.
"No doctor in the world would be satisfied by saying, 'I gave some patients some pills' and then not actually find out whether the patient gets better," he added.
But the World Malaria Report says it is too soon to measure the impact of malaria control strategies because countries have intensified their efforts only in the past few years. It also says it is having trouble getting reliable information about malaria in the most affected countries, where poor infrastructure makes data gathering difficult. The report predicts that a measurable effect should become apparent about three years after efforts become widespread.
In the U.S. Congress, Senator Sam Brownback of Kansas has introduced legislation to address what he calls the failure of the Roll Back Malaria program and the lack of U.S. contribution to malaria control. His measure would change the Bush administration's bilateral programs to require funding for proven interventions, including indoor insecticide spraying, effective medicines, and free bed nets. It would also require reporting of results in terms of illnesses avoided and lives saved.
"This is an enormous problem. We're not doing enough about it, period. I think we need to do less talk and more interventions," Mr. Brownback said.
