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New Initiatives Taken to Combat Malaria and AIDS

December 14, 2006 at 3:05 PM EDT
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JEFFREY BROWN: Spread by just a mosquito bite, malaria sickens up to 500 million people and kills more than a million each year. Most of the deaths are among children, and around 90 percent of them are African.

This human toll also has a high economic cost, an estimated $12 billion annually in lost growth in Africa. But it’s also clear to experts in the field that malaria is both treatable and preventable, through relatively simple and low-cost measures.

Today, President and Mrs. Bush held a White House summit to discuss what the U.S. is doing to combat the disease in Africa. Eight new countries were added to the U.S. initiative, bringing the total to 15.

GEORGE W. BUSH, President of the United States: We’re spending $1.2 billion over five years to provide bed nets, and indoor spraying, and anti-malaria medicine in 15 African countries.

This project is measurable. We can determine whether or not nets are being distributed or medicine is being provided. But, more importantly, we can measure whether or not we’re saving lives. We work toward this historic goal to cut the number of malaria-related deaths in half.

JEFFREY BROWN: In addition to the president’s initiative, the Global Fund to Fight AIDS, Tuberculosis and Malaria, created in 2002, has pledged $2.6 billion over five years to fight the disease in 85 countries.

There was also some important news yesterday on preventing AIDS. A pair of studies found that circumcision substantially reduces the risk of HIV among young men.

Fighting malaria in Africa

JEFFREY BROWN: For more on both developments, I'm joined by Richard Feachem, executive director of the Global Fund. Welcome to you.

RICHARD FEACHEM, The Global Fund: Good evening.

JEFFREY BROWN: Let's start on malaria. Why, if it is so preventable, does it kill so many young people?

RICHARD FEACHEM: Because we've neglected it for two decades. If we go back to the late colonial period and the first decade of independence, countries had effective malaria control programs, and malaria was controlled to a considerable degree.

But in the 1980s and 1990s, the developing countries themselves and the international community completely took their eye off the ball. Malaria-control programs around the world, in Africa particularly, collapsed. And malaria resurged.

So, for the last couple of decades, malaria has been worsening. The good news is that there is now the international momentum and commitment to fight back against malaria and to impose control.

JEFFREY BROWN: And just to be clear, while we are focusing on Africa, this has spread around the world, at least in tropical regions?

RICHARD FEACHEM: Exactly. There are about 1.5 million, maybe 2 million deaths per year from malaria, most in under 5-year-old children. Most of them occur in Africa. But right around the tropical belts, we find malaria. So countries like India, Laos, Papua New Guinea, Central American countries all suffer from malaria, but the worst malaria is found in Africa.

JEFFREY BROWN: So what should happen now with this new momentum? What should be done to prevent malaria?

RICHARD FEACHEM: Well, the new momentum is based on a scientific reality that malaria is preventable and malaria is treatable. And it's no longer satisfactory to be fatalistic about malaria. We've got to tackle it; we've got to fight it.

The Global Fund has built up a large array of investments across 84 countries against malaria. More recently, the president's malaria initiative has launched, focusing now on 15 countries. And it's a question of mobilizing effective programs to do the four things that we know really work against malaria.

JEFFREY BROWN: The four things, OK, what are they?

RICHARD FEACHEM: The four things: Firstly, prompt diagnosis and treatment. So when a child or an adult has a fever that might be malaria, diagnose it accurately with the new diagnostic kits, and treat it effectively with the new malaria drugs, not the old ones that don't work anymore, because the parasite is resistant, but the new ones, which are based on a Chinese herb and are extremely effective. So that's number one.

Number two is treating pregnant women presumptively, which means, in high transmission areas, assume that pregnant women have the parasite, even if they're not having symptoms, and treat them, which is very good for the woman and very good for her newborn baby.

Thirdly, in the prevention area, using the new insecticide-treated bed nets, so encouraging as many women, and children, and others in the family as possible to sleep under a bed net, which has the insecticide built into the fabric and doesn't just stop the mosquito physically, but repels the mosquito because of the vapor of the insecticide.

And lastly, again, in high-transmission areas, with a lot of mosquitoes biting every night, indoor residual spraying, which means spray a very thin film, usually of DDT, on the inside of the houses, which brings down the mosquito population a lot.

When we do those four things, malaria collapses in one or two rainy seasons, and we have a huge reduction in infection rates and death rates, particularly in children.

Goal: cut malaria deaths by half

JEFFREY BROWN: And the Global Fund is the largest contributor to this effort. Are you confident that the money that you distribute is used correctly? Is the distribution system on the ground, I mean, in place?

RICHARD FEACHEM: Well, country by country, you get a different answer to that question. So, so far, the Global Fund has committed $2.6 billion to malaria across 84 countries. About $1.4 billion of that is in Africa.

And we have to bear in mind that a third of all that money comes from the U.S. taxpayer, because the U.S. is by far the largest individual supporter of the Global Fund.

Now, we see some countries where that money is used very effectively and very quickly. They're scaling up; they're gearing up, not just governments, but NGOs, faith-based organizations doing the good work.

In other countries, usually due to management problems rather than technical problems, the pace is much slower. And one of the discussions that we were having today is how to mobilize that scientific, and technical, and managerial assistance to help the countries that are making slower progress to make more rapid progress.

JEFFREY BROWN: Well, we heard President Bush in that clip talk about a goal of cutting the number of malaria-related deaths in half. Now, is that realistic? And what kind of timetable?

RICHARD FEACHEM: No, that is certainly a realistic goal. I mean, let me give you an example of southern Mozambique.

Mozambique is a very poor country. Malaria is very bad in Mozambique, but in southern Mozambique, infection rates and death rates in children have been reduced by over 80 percent in five years, not 50 percent, but over 80 percent.

So that we know from that example and other examples, such as Eritrea, that when we implement those four things on a big scale seriously, and we manage them effectively, malaria rates go down. And a 50 percent decrease in the death rate within, shall we say, four or five years is absolutely achievable in those countries where we focus our attention.

Circumcision may dull spread of HIV

JEFFREY BROWN: All right, let's turn to the news on AIDS. Now, there has been evidence, I gather, for a while that circumcision might have some impact, but this was quite strong news or strong impact from trials, right?

RICHARD FEACHEM: Well, it was. The evidence has been growing for about 10 years that male circumcision is protective against HIV infection, not only to the man, but also to the partner of the man, if the man is HIV positive and his partner is not.

We had an important trial about a year ago in South Africa that showed a big impact of circumcision. And then we now have two trials -- one from Kenya, one from Uganda -- which have added more and consistent evidence. So I think the case is now bomb-proof that male circumcision is highly protective, and it helps to explain the pattern of HIV-AIDS that we see around the world.

JEFFREY BROWN: Is it understood why circumcision has that impact?

RICHARD FEACHEM: Yes, it is. And I think there are three elements to it. And I don't think we fully understand the relative role of the three elements, but I think we do understand that these are the three components.

One is that the male foreskin has receptor cells for HIV and can be thought of as an HIV sponge. It's very good at taking up HIV, which is then introduced into the body.

Secondly, particularly in situations of poverty where there's inadequate water and people can't afford soap, genital hygiene is poorer in uncircumcised males than in circumcised males, and that also promotes transmission.

And thirdly, males with foreskins may be more likely to have a tear, a scratch, a genital legion, and that also provides a point of entry for the virus.

And what we're learning is, not only is a man at less risk of acquiring infection if he is circumcised, but his partner is also at a lower risk. So there's good news for women here, as well as good news for men.

Paying for circumcision

JEFFREY BROWN: So the obvious next step would be to promote circumcision and to find ways to pay for it, as well, I gather, something that there has been some reluctance to do up to now. Would your fund now step in and find ways to help pay for it?

RICHARD FEACHEM: Well, the Global Fund responds to applications coming from countries. So the question now is: What do the policymakers in individual countries want to do?

And, of course, there's some tricky ground here. Are we talking about making the circumcision of infant boys more popular, with a long-term benefit when those boys become adults and sexually active? Or are we talking about mass adult male circumcision programs? Now, if we're talking about the second, one has to be cautious. There are cultural issues.

JEFFREY BROWN: As always, in these matters.

RICHARD FEACHEM: Absolutely. And also, there are issues of hygiene and the operative -- I mean, we've got to make sure that, if there is a lot of adult male circumcision being done, it's done in sterile and proper conditions, and so we don't get a lot of unnecessary infections caused by this.

But my hunch is that we will soon be receiving applications from African countries to begin to develop male circumcision programs. And, in principle, we'd be happy to finance those.

JEFFREY BROWN: And just to be clear, as we sum up here, this is not being touted as a cure-all, but this is a major step that people should know about.

RICHARD FEACHEM: It's very far from a cure-all; I think we have to emphasize that. It might reduce the risk by about 50 percent, but there's still a big risk.

And one of the dangers out there is that a circumcised man may now believe that he's immune, that he's got a sort of biological vaccine. And that's not the case at all, so all those other measures that we're promoting have to continue to be promoted.