JOSHUA .J.MWAKYUSA:
Why malaria still as problem as many organization giving out a lot of fund to fight againist it?
Suprotik Basu:
Well, that is an excellent question, Joshua, and thanks for it. I think I am going to combine this question with a number of others that asked why malaria is a problem and why people aren't doing more about it. I think we have to remember that malaria has been with us for centuries, particularly in Africa, and the frustrating thing is it is completely preventable and completely curable. However, no serious attempt at a large scale has ever been made before in Africa. Really it wasn't until the late 1990s whereby the African countries and the international community began to take malaria seriously and do something about it.
But at the same time we have a parasite that is constantly evolving and constantly changing. The parasite now, as you have noted, is growing resistant to the drugs that Africa has been using, chloroquine, and now has to be dealt with by a drug that is 15 times more expensive. On the one hand you have a neglect and now we are beginning to deal with it. On the other hand you have a very, very tricky parasite that is constantly adapting to what we are throwing at it. It is a battle between the two but now we have the money in place and the commitment in place to make a difference against it.
Lawrence Zumo:
What, after all these centuries, are the intellectual difficulties in tackling, treatment and eradicating this deadly scourge, malaria? Are there not enough intelligent people out there to solve this problem once and for all? Or is it intellectually easier to make different variations of Viagra, Cialis, etc.
Suprotik Basu:
Thanks, Lawrence, for the question. Malaria, despite its being completely preventable and completely treatable, as I mentioned before, is evolving and making it more difficult to grapple with. That said, I take your point, and feel that there does need to be a much greater focus on research into malaria drugs, into malaria vaccine, as well as a focus on getting things done at country level, particularly in Africa.
Rose Njiraini:
Maryse and Protik, thanks a lot for taking the time to have this discussion and for all your work in teh Bank's Booster program. A lot of research and programs have been set up in last few years to fight malaria. This disease is very preventable and is treatable. If the one sure way to prevent someone from getting malaria is an ITN and/or indoor spraying, why can't organizations involved make a commitment to provide an ITN to any person in need. Are there political obstacles that we do know of; there seems to be so much talk obout malaria yet such little action. So many programs on malaria yet such little results. Is the disease that difficult to fight? Is there an issue with scaling up successful programs? What exactly is going on? Thanks.
Suprotik Basu:
Well, Rose, you are getting at a frustration that many of us feel, and I want to thank you for highlighting that frustration. You are right, ITNs (insecticide treated bednets) and indoor spraying are effective. There is some good news. Over the past couple of years, there have been successes, maybe not that large of a scale as we would like. Eritrea has been greatly successfull in rapidly spreading ITNs. In Niger, over 2 million ITNs were distributed in the span of two weeks combined with a polio campaign. So I think that the fight is gaining momentum, and now with the additional money that is being brought to the table by the Global Fund and the World Bank and the U.S. presidents initiative and others, the time is now to move from small scale action to large scale programs and large scale results.
ifeanyi ikpeatusim:
do we have malaria vaccine, if yes where can one go and have it, and if not how possible can it be developed.
Suprotik Basu:
Well, unfortunately, as of yet we do not have a vaccine for malaria. There is a great deal of research going into the development of a malaria vaccine, and agencies such as the Bill and Melinda Gates Foundation and Johns Hopkins University and others are spending a great deal of time and energy in trying to get a vaccine available. There have been some successs, some preliminary successs from initial vaccines, but I think we are probably still around 10 or 15 years away from a malaria vaccine. Right now we have to focus on prevention and bed nets and spraying as well as more effective treatments.
Dale Ward:
How about using DDT to wipe-out malaria? This was successful in the past, before the misplaced hysteria of DDT came around.
Suprotik Basu:
Thanks for the question on DDT. I was hoping someone would ask it.
DDT is clearly a very effective tool against malaria, and the World Bank does, where appropriate, support the use of DDT. But the issue is broader than DDT. The issue is one of indoor spraying and indoor spraying can be done with many, many different insecticides. It is not just about DDT. It is about a number of different insecticides that can be used for indoor spraying. The choice of insecticide depends on what are the resistance patterns inside that country. It is not really so much do we or don't we use a particular insecticide. It is what is the appropriate insecticide in that particular country.
On DDT itself, you are right to note that there has been no scientific evidence that indoor spraying with DDT for malaria has resulted in negative health or environmental consequences. So the Bank's position is very pragmatic on its use. We will use insecticide, and that includes but is not limited to DDT. There is no room for dogma on this issue and we take a country by country decision.
Ronnie:
Hullo Mr. Maryse Pierre-Louis and Suprotik Basu. Mine is not a question but sort of a suggestion. In Uganda there is program going on to control Malaria and Nagana and there have developed away to sterlize male mosquitoes and after sent free. No mating and therefore less mosquitoes, less spread of Malaria and Nagana. Contact Ministry of healthy in Uganda for more explanation. I think it is cheap, easy, and effective reducing a number of female mosquitoes since are the carriers of malaria parasites. Then, awareness of people to make use of used up car oil by pouring little in stargnant water to kill developing mosquito's eggs. The fight should be everyone's concern thus need for public awareness and teaching.
Suprotik Basu:
Thanks, Ronnie, for giving us this information and making the suggestion. If there are any documents on how effective this has been, I would be grateful for them and certainly will follow up with the Ugandan Ministry of Health.
Christopher:
Maryse Peirre - Louis and Suprotil Basu. What do you think are the preventive measures that should be taken in africa to prevent malaria?. I say so because much efforts have been made on the treatment than controling the source of the disease. Environments such as waterlogged areas in schools and townships are a breeding grounds for moquistoes. An intitative to fund cleaning of such areas would do much just as the initiative to provide moquitoe nets. Malaria is a multi-sectoral development issue being a major cause of school absentieesim,work absenteesim and production loss. Can funding be extended to such preventive measures as spraying aganist mosquitoes in waterlogged areas near schools and townships in africa?
Suprotik Basu:
Doctor, thank you very much for the question. I couldn't agree with you more. Malaria control has to have the right balance between treatment and prevention, and certainly within the Bank and our booster program, we want to wage an upfront war against malaria to bring down transmission in Africa. So prevention plays a critical role and vector control plays a critical role. As you say, it is a multi-sectoral issue. It is funny you ask me this question. In a few hours now we are having a brainstorming session with our colleagues who develop infrastructure projects and what infrastructure projects can do, so I thank you for the question and hope we can do more on this front.
Matthew Mirkin:
To the people who control the money; Can you tell me how it is, after the hundreds of millions of dollars you claim to have spent, bed nets still aren't free?? Sent from china at maybe 30 cents at most, they are cheaper than the coffee cup you $4 mochachino is in. Hospitals have no running water, and a single doctor see's 300 patients a day?? I guess I want to know is if the money your spending results in bed nets being stacked in warehouses, having not a single malaria employee of the World Bank, nor the availability of cheap medication, how do you expect to fight this disease??
Suprotik Basu:
Matthew, I think we agree on this point totally. We at the Bank feel that costs should not be a barrier to access for bed nets. No one should not sleep under a bed net because they can't afford to have a bed net. So we are all working very hard country by country to ensure that bed nets are either subsidized enough or provided for free, such that they are available to the widest range of the population, particularly the poorest of the poor, who obviously have the least access and are least able to afford them.
As for not having a single malaria employee of the World Bank, I must beg to differ given that I am speaking with you now. We have about 40 other people working on malaria within the Bank, four of us who work full-time on it, and about 40 who are actually preparing projects as we speak. So we are certainly accelerating our efforts against malaria and hope to do more and do better.
Vanel Beuns:
Maryse Pierre-Louis and Suprotik Basu, thank you very much for this opportunity. The growth of civil society has been one of the most significant trends in international development. Today, the World Bank is interacting, consulting and collaborating with thousands of members of Civil Society Organizations (CSOs) throughout the world. Could you guide me on what needs to be done in order for my international CSO to develop well-designed programs with clear objectives, benchmarks to measure progress towards the battle against malaria in Sub-Saharan Africa? Is there a clear process to follow in order for my international CSO to design a plan for effective monitoring the malaria's impact on Africa, and to enable sustainable progress towards solutions to this problem? At CORCAH, an international CSO model, we focus on results
Suprotik Basu:
Vanel, thanks for asking the question and for highlighting the critical role that civil society place in implementing malaria control activities.
As you know, malaria is most dealt with at the community and the household level, and the reach of civil society at that level is something that must be harnessed in order to bring malaria under control. As for programs with clear objectives and benchmarks to measure progress, this refers to the important issue of monitoring and evaluation, and I encourage you to visit the rollback malaria at www.rollbackmalaria.org, where they do have a thing called Monitoring and Evaluation Research Group, the MERG, that sets benchmarks and provides suggestions for how one can use standard indicators in developing malaria control programs. Thanks again for the question.
Chrisropher Chewe:
I would like to commend Standard Chartered Bank Zambia Plc for the project they are introducing in Zambia called Malaria community Intiative, "Nets for Life". The intiative will be launched on 27th April 2006 by the Minister of Health ." Nets for Life" is an Africa-wide Malaria Prevention Programme aimed at reinforcing the bank's commitment to projects which are life-changing and which make a difeerence to local communities." Nets for Life" will primarily focus on vulnerable population mainly Children under 5, pregnant women, the chronically ill or immuno- compromised and the elderly.The Project is first being launched in Zambia and will later be rolled out in fifteen other african Countries. Standard Chartered Bank should be emulated by other multinationals for an exemplary intiative to Africa's achievement of the millennium Development Goals by 2015
Suprotik Basu:
Christopher, thanks for highlighting this important initiative taking by Standard Chartered Bank. I too would like to commend Standard Chartered on the support. I am aware of what they are doing in Zambia. As you may know, the World Bank has just begun supporting a malaria control project in Zambia as well. I hope along with you that other private sector partners follow the lead of Standard Chartered Bank and develop programs--so that they too can participate in the fight against malaria.
In terms of money, I think we need money certainly from the private sector, but also in terms of their expertise. The private sector has significant expertise in, for instance, managing supply chains, which, as you probably know, is a relatively difficult thing to do in Africa. But private sector companies make a living, eat or don't eat, based on whether supply chains work or don't work. I think we need to tap into the money of these institutions, but also the institutional knowledge they have should be brought to the table as well so that we all can work together in this fight against malaria. Thanks again for the question.
João Chamusse:
What World Bank has done in Mozambique for figting malaria in the last two years? If has done anything how much money did it cost?
Suprotik Basu:
Well, João, I don't know offhand - the Bank has supported the Government of Mozambique in the fight against malaria in the past two years. If you go to the World Bank's web site, and go to the section on
projects and operations, you should be able to find the existing projects that are going on in Mozambique. You can also e-mail the Bank's HNP advisory services, which is on the Bank's web site, and someone will get back to you with some more information on that.
The good news is I believe there is a mission, as we speak, in Mozambique that is supporting the health sector, and also there will be a mission going on--we will be coming to Mozambique once again in the next couple of months to really figure out how we might assist the Government of Mozambique in doing more to control malaria.
Maggy:
Thank you Maryse Pierre-Louis and Suprotik Basu for giving us chance to know more about malaria in Africa. I would like to know what is the real situation of Malaria in Ghana, and what have you done there to hepl them? How can local NGOs can take part in the fight against this epidemic. How can Youth participate in your programs?
Suprotik Basu:
Thank you, Maggie, for asking the question. The real situation is that malaria continues to be one of Ghana's leading killers, particularly killing young children, children under five.
As for what we have done to help them there, we provide financing to the Ministry of Health in Ghana, and the Ministry of Health does have a malaria control strategy that they are implementing. They have managed to increase the coverage, to increase the number of people sleeping under bed nets, for instance, so progress is being made, but I am sure we would like to see it go faster and spread across the country. As far as the NGOs taking part in this epidemic, there are, I suppose, at least two avenues I can think of at the moment. One is there is a crucial need for communities to understand that malaria can be prevented and can be treated. I think we have been living with malaria for so long that we sometimes grow complacent with it, and we forget that it doesn't have to be as bad as it is. So encouraging households and people to seek treatment quickly, to sleep under bed nets--I know there is a problem with access and affordability of nets, but we have to get the word out for people to want nets.
As for youth participating in programs, there is a large, large role for youth to do more about malaria, along the lines I have just mentioned. If there are bed net distribution schemes in a village or community, youth should be involved. Maybe it would be possible for the local government's--I know you have local governments in Ghana to take money out of the local government budget as well for bed nets and have the youth distribute them.
I think the first step is to develop perhaps a work plan of what you want to do and maybe discuss that with your local government officials, with your local district medical authorities and even with the government of Ghana to assist everyone in the fight against malaria. Thanks again for the question.
Holly:
Maryse i'd like to know what i can do as a student for my community in Uganda to stop the spread of Malaria. Its such a hassle when theres too much of a burden put on one's shoulder as a student to contribute to its prevention yet what i can think of right now minus the stress of school has already been done
Suprotik Basu:
Holly, thanks for your question and for your interest in this. Please see my response to Maggy, which I just gave, which perhaps could help out here. But I think schools have a very, very important role to play in the fight against malaria in Uganda. Schools can be used to distribute bed nets. So if it is possible for the schools to distribute bed nets, that would be one good way to expand the number of people using bed nets.
The other simple thing that people can do that schools can do are on communicationtion activities. For example, schools can be involved in developing skits and plays and communication materials to make sure that the communities and school children and adults are aware how quickly malaria can kill. If a child does not get treatment within 24 hours, the chance of that child doing well decreases dramatically.
The other method I have mentioned throughout this time is also the importance of sleeping under insecticide-treated bed nets. That is also a critical message to deliver. So if schools can deliver messages that your neighborhoods, that your community, will understand, that will be a very important step in the fight against malaria in Uganda.
Alex:
What are the future prospects for the Global Fund money in malaria control in countries like Uganda which has squandered the money remitted with impunity?
Suprotik Basu:
Alex, you have brought up obviously a critical question in malaria control and in development more broadly and one that is getting an increased amount of attention, particularly from institutions like the World Bank.
I cannot speak to the future prospects for Global Fund money, as I cannot speak for the Global Fund, but the question you raised I think is important to address. There must be accountability for those who receive monies to combat this life-threatening disease, and I think the role of civil society, communities and also a vibrant press are very important to ensure that those who receive monies are actually held accountable for outcomes and for impact.
I also thing that those who provide the money should be held accountable for doing as they have promised, and for being transparent themselves. So I encourage you and others to keep an eye on those who are responsible for the monies, and responsible for impact, and demand accountability.
Again, I thank you for the question and hope we can all do better in ensuring that the monies that are provided for this disease actually deliver on the results that we all want to see happen.
Joe Young:
Why have you not given the proper amount of money you promised to the fight on malaria? http://news.independent.co.uk/world/politics/article359977.ece
Suprotik Basu:
Joe, thank you for the question, and for bringing up what certainly seems to be a hot topic these days. You know, we at the Bank, ourselves, acknowledgeed this time last year, actually in 2005, that we had not lived up to what we should have done in the fight against malaria, particularly in Africa. As you note, there were promises made in 2000, and we were not pleased with our progress against our commitments. That is why we, ourselves, took an internal--looked very hard at ourselves, and developed a revised malaria approach, and a revised commitment to rollback malaria, particularly in Africa. The commitment is in the form of what we are calling a global strategy and booster program, which we launched this time last year, and since then, particularly in Africa, the Bank has committed over the next three years $500 million to an intensive phase to really bring down malaria, to really address malaria in Africa.
If I were answering this question this time last year, I would probably have a pretty difficult time with very valid questions such as yours, because you could always say, "We have heard these promises before, what is going to change this time?"
Well, I am very pleased to say that we have now had a year of progress in our booster program. Four countries have already begun to receive funding. The total is now $52 million. At the end of June it should be up to $200 million and by this time next year as much as $400 million across many more countries. We are trying to do more and trying to do better and trying to be more accountable in the way we do it.
One thing is for sure, countries have told us they demand that the Bank stay involved in malaria and help them accelerate their fight. The booster program is about exactly just that, and we encourage you to monitor our progress, monitor the progress of countries' fight against malaria and ensure that all donors and all countries keep the promises they have made.
Kurt Boggs:
The Los Angeles Times and New York Times both say that scientists in the Lancet found the World Bank bought patients a medicine that does not work on their malaria, the kind which is deadly. They also say the World Bank failed to spend the money for malaria it promised. The World Bank people denied everyting of course, but they would, wouldn't they? Do you really mean that the LA and NY Times and the Lancet are all wrong and you are right? These are some of the best newspapers in the world! Well, I thought I would ask you anyway for your side of the story.
Suprotik Basu:
Thanks, Kurt, for giving us the opportunity to provide a bit of information from our side. The first thing I would like to say on this issue is that the World Bank doesn't buy or not buy anything. We respond to our member countries' request for financing, and we finance their projects. For instance, in the case you are referring to, it is the Government of India's project, not the World Bank's project, and this brings up an important point that I really do want to stress. It is not the role of the Bank to dictate policies to member country governments. That is not the way we work and certainly not the way we work any more, if that were the case 20 or 30 years ago. We work in close partnership with the government of India and other member governments, to sit with them and sit with technical experts and look at the technical realities and the operational realities and find a way forward. So I personally would disagree that it should be some Western institution or the World Bank dictating policies to the developing world. I am not sure that developing countries and citizens of developing countries would appreciate being dictated to. That is just one point I wanted to get out there.
With regard to buying medicine that doesn't work against malaria, the situation is not quite as simple as one would like it to be. About half the malaria cases in the country in question - in India - do respond to the treatment that was purchased, and in a country of a billion people such as India, there is no such thing as one-size-fits-all policy. So what we are doing is working hard with the government of India to make sure that more effective treatments are expanded to areas where old treatments don't work anymore. So the Bank is certainly not interested in supporting treatments that don't work. Our interest is in controlling malaria and saving lives in countries such as India, and we are working closely with them to expand their options.
Again, the issue is not as sensational or simplistic as the papers would have it. We are committed to making sure that effective treatments reach those who need them but also recognize there are realities in countries, and that countries, particularly the size of India, can't and shouldn't probably do anything overnight.
Birgit Voigt:
In the latest edition of Lancet, a group of 12 well established experts from the field of Malaria control accuse the World Bank of massaging their data to report good progress, making but not keeping funding promises and signing off on the funding of inadequate malaria treatments in India. In a reply to those allegations Suprotik Basu wrote in Nature the treatment policy in India were in line with the WHO recommendations. However, WHO in the meantime denies this claim resolutely. Could it be the World Bank funds the production of ineffective Cloroquine by Indian companies in order not to annoy the Indian government who is one of the biggest borrower of the fund?
Suprotik Basu:
Birgit, thanks for the question, but it is not true, it is flat wrong, that we would support the ineffective chloroquine, or so-called ineffective chloroquine, in order to not annoy the Indian government.
It should be clear that the Bank--we don't put making money over saving lives here, and the monies we provide to countries like India for malaria, are not monies off which we make any profit. They are either straight grants or they are practically grants in that they are zero interest, 40-year maturity credits. So there is really no money to be made here.
What our consideration, when we fund or don't fund, or sign off or don't sign off, on certain drugs, is to look at the resistance patterns in a country, to see what the Government of India's data show, and what other experts have to say. And, again, as I said before, in a country like India, the situation is more complicated than people would have one believe. In a country of 1 billion people, resistance patterns do vary, and we are working closely with the government and with technical experts in India, to ensure that Bank support for malaria control and Bank support for malaria control are funding the most effective treatments as quickly as possible in a country of India's size. We support the Government of India's strategy and are working with them. We don't feel it is our role to impose--we feel that our role is not one of imposing, but one of dialogue and to help improve strategies to save lives in India.
Christopher:
Maryse Pierre-Louis and Suprotik Basu, thank you very much for this opportunity. What is your comments on the status of refugees in Africa where we have a number of refugees who are mostly not included in national development programmes.The trauma of war, violence and persecution, followed by the misery of exile, are often the sad destiny of refugees. The plight of the uprooted is even worse in parts of the world affected by HIV/AIDS like Africa. Not only are refugees accused of spreading HIV and other diseases, but they are often excluded from multi-million dollar HIV/AIDS and Malaria programmes.Is there any special funding for the UNHCR or a Government like Zambia which has been an exemplary host to refugees,co-operating with international humanitarian organisations and agencies.Zambia despite it's failing economy has played host to thousands of refugees for long time due to protracted nature of conflicts in countries such as Angola, Democratic Republic of Congo which have evidently resulted in a protracted refugee problem in the country.Is there any funding to ensure that refugees are also covered in these programmes?.UNHCR has also made calls on governments and international bodies to include refugees in national and international HIV/AIDS prevention and care programmes. What is the position of the World Bank on this issue?.
Suprotik Basu:
Christopher, thanks for asking this question on refugees. Clearly, controlling malaria in refugee populations must be a priority for governments and international agencies that support them. I think we all could be doing a much, much better job, as you rightly highlight in your message, to deal with the plight of refugees and their grappling with malaria and HIV.
I know we are working, for instance, at the moment with a number of countries and with governments, to ensure that refugees are included as part of development strategies and as part of donor financing support. It is not always an easy discussion, and I think you have rightly highlighted--but you rightly highlighted that it is one we increasingly need to pay attention to.
Thank you for taking part in the discussion. Here are some more resources and information on malaria:
