hcghr

Two Bills for Health

In Current Issue, Panorama on October 29, 2009 at 8:31 pm

Foundational Approaches to Global Health

Rajarshi Banerjee, Staff Writer

459px-Bill_Clinton

Courtesy Wikimedia Commons

Bill Gates made headlines earlier this year when he released a jar of mosquitoes onto an influential and unsuspecting audience during a talk on malaria at the Technology Entertainment Design (TED) Conference in Long Beach, California. After a few moments of nervous laughter from around the auditorium, Gates had to assure everyone the insects were not infected, drawing his loudest round of applause.  Over the last couple of years his foundation, as well as The Clinton Foundation, has invested heavily in the fight against a disease that continues to affect millions annually. While both non-governmental organizations (NGOs) claim they will achieve significant success against malaria by 2015, they have taken very different approaches to eradicating the disease.

Malaria is a leading cause of morbidity and mortality in many countries: there were over 247 million cases in 2006 alone, compared to 3.2 million cases of HIV/AIDS the previous year.  The Gates Foundation carries out malaria control programs in several sub-Saharan countries, and Gates-funded initiatives have led to progress in malaria control in Zambia and Ethiopia. However, the foundation focuses much of its efforts on researching drugs, developing vaccines, and exploring new prevention strategies. This has occasionally led to controversy.

In a leaked internal memo in February 2008, Dr. Arata Kochi, the chief of malaria for the World Health Organization complained that the Gates Foundation’s tendency to spend heavily on a select few projects was stifling diversity in malaria research.  This need not be a cause for alarm. “Whether or not that’s a good thing depends on what you think of the Foundation’s research priorities,” says Dr. Jon Clardy of the Harvard Malaria Initiative. WHO scientists are also concerned about the NGO’s promotion of Intermittent Preventive Treatment for infants (IPTi) in Africa, which involves giving infants doses of anti-malaria drugs. Early studies have shown that this only offers short-term protection, and the adverse health effects of giving babies sulfa drugs could outweigh the benefits.

Disputes aside, the Gates Foundation’s focus on research and new preventive strategies is noteworthy. The Foundation recognizes the need to delve into the underlying causes of malaria. Dr. Clardy told the HCGHR that although its 2015 deadline may divert funds away from “more basic research that could eventually have an impact” the Gates Foundation remains “the only source for significant and sustained funding” for many scientists.

Courtesy Wikimedia Commons

The Clinton Foundation has also set itself a deadline for 2015, but it focuses its relatively fewer anti-malaria resources on shorter-term, more economical measures. Last year President Clinton noted, “Nearly every life lost to malaria could have been saved with access to effective [available] medicines.”  His NGO had previously led efforts to increase access to affordable HIV medication, and applied the same strategies to malaria last year with great success.

Currently, the most effective anti-malaria drugs — known as ACTs, for artemisinin-based combination therapies – cost as much as $10 per treatment in many African countries. One of the reasons for this high price was that over the last few years the key ingredient, artemisinin, has fluctuated from between $150 and $1100 per kilogram.

Last July, The Clinton Foundation unveiled a consortium of artemisinin suppliers and generic drug companies that would sell ACTs at a low price to developing countries. Together with supply-side subsidies, the NGO claims this innovation could reduce the price of ACTs to as little as $0.50.

Supply-side efforts alone cannot increase access to cheap drugs. In an interview with the HCGHR Inder Singh, who designed the price-stabilization plan for the Clinton Foundation, the NGO’s approach has been a “simultaneous engagement of both supply side and demand side issues”. Although Mr. Singh stresses that the Foundation is primarily focused on tangible on-the-ground measures like helping local governments implement malaria elimination plans, he admits that their high-impact economic achievements, especially in drug pricing, have made for better press.

Despite their different focuses, the Clinton and Gates Foundation’s present efforts against malaria are complementary. Moreover, both foundations are heavily involved in simple, community-based prevention measures. Dr. Paul Campbell of the Harvard School of Public Health believes that “strategies to reduce the incidence and mortality from malaria need to include the reduction of standing water, the spraying of insecticide and the use of insecticide-soaked bed nets.” Neither the Clinton nor the Gates Foundation has lost sight of this.

As we head towards 2015, it is important to note the significant impact these foundations have already had: “Great progress has been made against malaria and should be celebrated even as advocates re-double their efforts to eradicate the disease,” says an optimistic Dr. Campbell.

References

http://www.youtube.com/watch?v=ppDWD3VwxVg Accessed 3/3/09

Sarah Boseley “World leaders announce $3bn plan to end malaria deaths by 2015” The Guardian 25 Sep 2008 http://www.guardian.co.uk/society/2008/sep/25/internationalaidanddevelopment.infectiousdiseases Accessed 3/3/09

Philip Rucker “World Leaders Embrace Goal of Ending Malaria Deaths by 2015” Washington Post 26 Sep 2008 http://www.washingtonpost.com/wp-dyn/content/article/2008/09/25/AR2008092501815.html Accessed 3/3/09

WHO World Malaria Report 2008 http://www.who.int/malaria/wmr2008/WMR08-news-summary.pdf. Accessed 3/3/09

BBC http://news.bbc.co.uk/2/hi/health/4456900.stm Accessed 3/10/09Gates Foundation Press Release Sep. 25, 2008 http://www.gatesfoundation.org/press-releases/Pages/develop-next-generation-malaria-vaccine-080925.aspx Accessed 3/3/09

Donald G McNeil “Gates Foundation’s Influence Criticized” NYT Feb 16 2008 http://www.nytimes.com/2008/02/16/science/16malaria.html Accessed 3/3/09

Aziz Haniffa “Inder Singh heads Clinton Foundation’s malaria drug initiative” Rediff News Sep 04 2008 http://www.rediff.com/news/2008/sep/04malaria.htm Accessed 3/3/09

Mark Schoofs “Clinton Foundation Sets Up Malaria-Drug Price Plan” WSJ July 17 2008 http://online.wsj.com/article/SB121626447476161201.html Accessed 3/3/09

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