Wednesday, June 28, 2006


A disease long off American radar, it came onto mine a year ago as I prepared to travel to India. Now, it seems, the US is starting to get serious about fighting the disease worldwide. One might assume that a great deal of money is already spent on the fight, and one would be right. But as Senators discovered the money doesn't always make it down to the people who might actually catch it:
At Congressional hearings last year, Senator Tom Coburn, a Republican and a doctor from Oklahoma, argued that Washington-based consultants and contractors have consumed too much of the malaria budget.

He called on Amir Attaran, a law professor at the University of Ottawa and fiery advocate on malaria, who testified that the United States Agency for International Development was too cozy with "the foreign aid industrial complex."

Only 1 percent of the agency's 2004 malaria budget went for medicines, 1 percent for insecticides and 6 percent for mosquito nets. The rest was spent on research, education, evaluation, administration and other costs.

The reality is, we know exactly how to defeat it. Consultants don't really seem necessary:
First, the A.I.D. is shifting its focus from mainly backing the sale of subsidized mosquito nets in Africa to giving more of them away to poor people.

It is also committed to buying combination drugs like Coartem because the disease is proving increasingly resistant to older, cheaper medicines. A dose of Coartem, produced by the Swiss company Novartis, now costs 55 cents for a child up to age 3.

Finally, the United States is also getting behind the use of DDT and other insecticides and will pay for large-scale programs to spray small amounts of them inside homes.

"We pretty well do know what the silver set of bullets are," Senator Brownback said at his 2004 hearing.

The decisive push for change in malaria programs has come from the White House. Michael Gerson, one of the president's closest advisers, described malaria in an interview as "maybe the main source of unnecessary suffering in the world."

If we're going to dump large amounts of money in foreign aid at least this is a useful place to do it.

As for me, I'm switching from mefloquine to malarone this year as my malaria preventative of choice. Just read about the possible side effects of mefloquine and you'll understand why.


susanna in alabama said...

"Administrative costs" suck up a lot of gov't funds in ways that should be reviewed. For example, when the fed. govt gives out grants, especially for research, there is a line item called "indirect costs" - that's administrative costs that are not directly a part of the grant project. So it would pay for things like part of the grant writer's salary, part of the school president's salary, part of the fundraising costs, etc. The indirect cost rate is negotiated between each individual institution and the govt. A non-profit may be in the 20-30% range, a university in the 40-50% range. Harvard, however, has a negotiated indirect cost rate of OVER 90%!!! In 2000, Harvard received $320 million in federal research grants. Of that, about $290 million went for "indirect costs", and less than $30 million went to the actual research. So your research dollars are funding the infrastructure of Harvard much more than the research that is trumpeted.

I understand the need for institutional indirect costs, but 90% is just highway robbery. Sounds like another area where the US govt needs a good cleanup.

John said...

I used malarone when I was in India in 2004 and it was great. No side effects that I was aware of.

All the best, and God bless your efforts wherever your feet land.


John Maddocks