•Written by William T. Dowell• ••Sunday•, 17 •May• 2009 17:10•
GENEVA -- Dr. Awa Marie Coll-Seck, who heads the Roll Back malaria Partnership, had her first epiphany about malaria when she was a four-year old girl at home in Senegal. Her father, a doctor, forced each of his children to swallow a spoonful of the anti-malarial drug chloroquine daily. “The kids would run in all directions when we saw it coming,” she recalls. Her brother, who was just under three years old at the time, mastered the art of holding the bitter–tasting medicine in his mouth, and then spitting it out when no one was looking. That was until he developed cerebral malaria. Coll-Seck watched in horror as his body went into convulsions. He survived, but Coll-Seck says that after that everyone in her family became a believer. Not everyone has been as lucky as Dr. Coll-Seck. In sub-Saharan Africa, malaria kills roughly 3,000 children a day. “You can think of the two twin towers of the New York World Trade Center, filled with five-year olds, going down every day,” says Prudence Smith, an advocacy specialist at the Roll Back Malaria Partnership, “that is basically what we are talking about.” Coll-Seck, the partnership’s executive director, compares the casualty figure to the equivalent of four Indian Ocean tsunamis every year. “It is a million children dying each year, without anyone being shocked or feeling that they need to do anything concrete,” says Coll-Seck.
The economic cost is estimated at around $12 billion a year in lost productivity. While malaria is more prevalent in Asia, 80-90% of the children who actually die from it are in Africa. It is a vicious circle. The poor are the most affected, but malaria itself is also largely responsible for keeping them in poverty. A major reason that more was not done earlier is that malaria has been virtually non-existent in Europe and the United States since the early 1950s. In contrast to a HIV/AIDS there is hardly anyone who has had direct experience pushing for immediate action.
Even for Coll-Seck, it took a while for the full impact of malaria to sink in. After finishing medical school, she went to work in one of Senegal’s district hospitals. She realized that on a daily basis nearly half the cases she dealt with involved malaria. A desperate parent would rush up to her holding an infant in her arms, not realizing that it was already dead. The stress on the doctors was enormous. But Coll-Seck realized that the problem was also greater than the parasite responsible for the disease. “It was the weaknesses in our health system,” she says. Patients had to be sent to a referral center for medicine, but often there was no ambulance, or if one was available there was no gasoline. 60% of the medicine had to be bought in the private sector, but by the time parents had raised the money, the child was already dead.
When Coll-Seck became a professor specializing in infectious diseases at Senegal’s university teaching hospital, she began to see the full impact. For six months during the rainy season, the hospital would take in upwards of a hundred new patients a day. Children were sleeping on tabletops because the beds were filled. “You put them where ever you could,” she recalls. Then HIV/AIDS struck. “The adults all had AIDS,” she says,” but the children were still dying from malaria.”
Coll-Seck took a brief hiatus from malaria to become the director of policy and strategy for UNAIDS in Geneva. Then she was called back to Senegal to become minister of health. She soon realized that malaria was by far the country’s biggest health problem. It was so prevalent, so much a part of every day life, that it was constantly being overlooked. People had adapted to its presence. She also realized that effectively fighting malaria required more than medical knowledge.
Pharmacists in Senegal were still selling an old anti-malaria drug, chloroquine, even though the malaria parasite had developed immunity to it. “To change policy, you needed to make everyone own the change,” says Coll-Seck. “If the pharmacists didn’t care, they would continue selling a drug that no longer worked.” The next problem was to raise money. “We had everyone convinced,” she explains, “but most people couldn’t afford to buy the new drugs that were 20 times more expensive than the old ones.”
Instead of pleading with international donors, Coll-Seck opted for a fund raising drive in Senegal. She enlisted local movie stars, celebrities and anyone else that she could rope into the program. The campaign raised $1 million—enough to pay for the treatment of every child who needed it during the next rainy season.
Not long after that Coll-Seck was named executive director of the Roll Back Malaria Partnership. The partnership, which grew out of the Global Health Fund’s decision to spread its mandate beyond HIV/AIDS to include tuberculosis and malaria, is a novel concept that may provide a new model for other major international problems.
Launched in 1998 by the World Health Organization, UNICEF, the World Bank and the UN Development Program, its secretariat works out of the World Health Organization’s headquarters in Geneva, under the same rules as any other UN organization. The difference is that it also includes a loose coalition of countries most affected by malaria, as well as NGOs, pharmaceutical companies and just about anyone else involved in malaria. “We realized,” says Coll-Seck, that no one could do it alone. “We needed everyone to work together on this.”
A major theme is to make sure that everyone involved in fighting malaria is headed in the same direction, and to see that no one goes off on a tangent or starts to implement policies that might make the situation worse.
The decision to expand the Global Fund’s mandate to include malaria and tuberculosis as well as HIV/AIDS, however, has given a boost to what had seemed like a forgotten struggle. Where previously only about $60 million was dedicated to fighting malaria, the figure is now around $1.2 billion. Coll-Seck feels that $5 billion a year is needed to get the job done. Basically, what is needed is enough financing and a distribution system to see that people in infected areas get insecticide-treated mosquito nets, and that there is enough medicine to treat patients. The results are already impressive. With increased resources, Ethiopia launched a campaign to distribute 20 million mosquito nets in 18 months and saw a 60% decrease in deaths from malaria. In some countries the deaths have dropped off by 90%. More important, the investment in malaria is strengthening management and logistics in many health systems, making them better able to handle other diseases.
Given the amount it is already costing the international community to cope with the economic fallout from malaria, the money spent on malaria looks like a good investment. In contrast to diseases such as HIV/AIDS, where the cure is less certain, malaria looks like a relatively easy win. More than that, dealing with malaria will have a direct impact on at least five of the Millennium Development Goals, while failing to do so is likely to make those goals unachievable.
Coll-Seck’s biggest concern now is that the financial crisis could cut funding just as victory is in sight. Coll-Seck warns against a false economizing. “Just think how much it costs,” she says,” to have half one’s population sick.”
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