December 20, 2006

As the Christmas season approaches, our thoughts turn to the birth of a special child and the tremendous impact that this one life has had on the world. What gifts and talents are being denied the world today when millions of children in developing countries do not live to see their fifth birthday? In this piece we examine one of the leading causes of those deaths - malaria - and how easy it could be to end this scourge.

Biblical Reflection

"What do you think? A man had two sons; and he went to the first and said, 'Son, go and work in the vineyard today.' And he answered, 'I will not'; but later he changed his mind and went. The father went to the second and said the same; and he answered, 'I will, sir,' but he did not go. Which of the two did the will of his father?" They said, "The first."

Matthew 21: 28-31

Government budgets are one of the most tangible and telling expressions of a nation's values. Each new year -- as the president and Congress begin the process of deciding our nation's spending - our elected officials have an opportunity to make financial decisions that more authentically reflect who we are as a people and the vision and values we hold in common.

Sometimes it is a question of how our elected officials choose to allocate funds. Sometimes it involves holding our officials accountable to financial promises made.

This parable from Matthew came to mind as I think about how the U.S. government has dealt with malaria - one of the world's deadliest diseases, but also one of the most preventable, and one of the easiest and cheapest to treat.

In June 2005, President George W. Bush launched his Presidential Malaria Initiative (PMI). He promised a U.S. contribution to global malaria efforts of $1.2 billion dollars spread over five years. However, the amount the President's Malaria Initiative actually spent this fiscal year on malaria was $30 million - far less than the $230 million that one might expect based on Mr. Bush's promise of 1.2 billion over five years.

Furthermore, it turns out that the financial assumptions behind the PMI's $1.2 billion involve slowly rolling out a program - finding and spending most of the money in later years - after President Bush has already left office. Such a slow roll out may be the way to go for other diseases, but with malaria, immediate access to inexpensive commodities will successfully prevent and treat the disease.

Moreover, the U.S. fair share of total malaria expenditures needed - which is estimated by the World Health Organization to be approximately 3.1 billion annually for prevention and treatment -- is roughly $1 billion per year. (The U.S. economy is about one-third of the total global economy).

The Disease That Robs Us of Our Future

Every year between 300 million and 500 million people are bitten by the Anopheles mosquito that carries the malaria parasite. More than one million people die from the disease each year - with the vast majority being children. In Africa, malaria is the leading cause of death for children under five. In fact, one African child dies every 30 seconds from it - some 800,000 a year.

Those who survive a severe case of malaria may suffer from learning disabilities or other forms of brain damage. Additionally, pregnant women who contract the disease are at particular risk for anemia and giving birth to underweight babies, and children who suffer from malnutrition. These children are more likely to die from malaria because their bodies are already weaker. Malnutrition also makes it more difficult to diagnose the disease because it disguises its symptoms.

Malaria is an economic justice issue for families and nations. Families living in extreme poverty cannot afford the simple measures like sleeping under bed nets or taking medicine to prevent or treat malaria. Furthermore, a family's status may become more precarious if an adult falls ill - losing income and/or precious time and energy for planting and cultivating food crops.

Economists have noted that malaria is a major deterrent to development. It puts the brakes on growth. The World Health Organization points out that there is now a clear "prosperity gap" between countries with and without malaria - and the gap is growing bigger every year. In Africa, malaria related illness and death cost the continent's economy $12 billion per year.

What Is Required

In a world where problems and their solutions are often complex and expensive, malaria offers us the possibility of a relatively easy success. Bed nets from the World Health Organization cost $2- $5, yet, presently only 2 to 5 percent of African children sleep under them.

ACT - Artemisinin Combination Therapy - a highly effective malaria medicine is available for as little as $1 for a full course of treatment for a young child and between $2 and $ 3 for an adult.

Given this picture of how easy it is to respond to the deadly threat of malaria, it is especially painful to see that meager resources have been squandered.

The New York Times recently reported that in 2004, 1 percent of U.S. Agency for International Development (USAID) funding on malaria went to pay for medicines, another 1 percent was spent on insecticides, and 6 percent on bed nets. That meant 92 percent went to consultants for research, evaluation, administration, education and other costs. A Senate probe of this abuse led to a dramatic change in USAID internal guidelines on malaria spending so that as much as 60 percent of the budget would be allocated for malaria-fighting commodities.

Most world donors channel malaria assistance through the Global Fund to Fight AIDS, Tuberculosis, and Malaria. Given its built-in mechanisms for financial transparency and accountability, the Global Fund is considered the best vehicle for dispensing government contributions. Given the problems of accountability with bilateral assistance, the U.S. should continue to direct the bulk of our monies through this fund.

Congress has not yet finalized FY 2007 budget and it will soon begin discussions for the FY 2008 budget. On December 14, the President held a Malaria Summit to spark greater public awareness and boost "public-private" partnerships. At the closing of the Malaria Summit the President remarked that "for many illnesses there is no relief….Yet for malaria, we know exactly what it takes to prevent and treat the disease. The only question is whether we have the will to act."

For those children who suffer the ravages of malaria, promises that come and go mean absolutely nothing, only action makes a difference.

At this season of light, we can call upon our President and Congress to make a serious promise to the world's children and keep it. We can urge them to provide the $1 billion needed to help make malaria history and insist on greater institutional integrity to guarantee that it is spent appropriately. Our children deserve nothing less.

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