Some of the recent successes in malaria control policy have come about as a direct result of African leadership, much of that from SA. This country has successfully controlled malaria in the lowveld and by working with our neighbours, particularly Swaziland and Mozambique, has shown that malaria can be controlled and that deaths from the deadly Plasmodium parasite are preventable.

The experience in southern Africa in recent years has demonstrated that the careful application of insecticides inside houses is a highly effective and remarkably safe way of preventing malaria. This form of control, known as indoor residual spraying, uses a variety of insecticides. DDT, the totemic enemy of many environmentalists, continues to be used successfully to save lives in around ten African countries....

Against all this positive action sits the European Union (EU). The EU has been actively frustrating malaria control in Uganda by threatening to ban any agricultural exports from that country if they use DDT in malaria control. Their fear is that some DDT will be diverted from the public health programme to agriculture. The EU has chosen to ignore the fact that those countries that use DDT have set in place strict controls and regular audits to ensure that this dose not happen. No other country that uses DDT has been singled out like Uganda, pointing to the arbitrary and capricious nature of EU policies.

There is no logical or scientific basis to the threats made by the EU.

Most recently Tom Vens, the head of economic, trade and social sectors with the EU delegation to Uganda stated that DDT could cause cancer if ingested and that Uganda was taking a risk if it used it in malaria control.

These statements simply show how out of touch the EU is. First, DDT is rated as a possible human carcinogen, which may sound scary, but that is the same rating given to coffee and a host of other everyday products that we happily consume. Second, DDT is sprayed on the inside walls of houses and last time I visited Uganda, I saw no one licking the walls of their houses.

One thing is sure, if there were as many Europeans dying from malaria as there are Africans, Europeans politicians would not stand for the unscientific, ignorant and highly damaging statements of their officials. Tragically though, Europe is showing a callous disregard for the lives of Africans. African leaders can and should use their new found allies in the US and WHO to challenge Europe and put a stop to their absurd position on DDT.

We believe this [World Bank Global Strategy & Booster Program] plan is inadequate to reverse the Bank's troubling history of neglect for malaria. In the past 5 years, the Bank has failed to uphold a pledge to increase funding for malaria control in Africa, has claimed success in its malaria programmes by promulgating false epidemiological statistics, and has approved clinically obsolete treatments for a potentially deadly form of malaria. Crucially, the Bank also downsized its malaria staff, so that it cannot swiftly execute the restoration it plans under the Global Strategy & Booster Program. We summarise the evidence, show that the Bank possesses demonstrably little expertise in malaria, and argue that the Bank should relinquish its funding to other agencies better placed to control the disease.

Good morning, everybody, and thank you very much, Phil, for this introduction.  During the one minute or so that Phil took to introduce us, somewhere in the world two children have died of malaria.  So that's why we thought it would be extremely important for the Bank to recognize and to rededicate itself to fighting this disease.

As you have seen and as you will see in the report, we have been quite candid about the fact that we need to rededicate ourselves because some of the earlier commitments of the Bank have unfortunately not been always followed by action.  In large part because the Roll Back Malaria Partnership was launched in 1998 at a time when were also launching the Bank's campaign against HIV and AIDS, and our capacity and the capacity in the countries was not enough to fight on all fronts at the same time.

On the Lancet article, we believe that the diagnosis is right.  I mean our assessment of the situation in terms of the increase in cases is accurate, has been confirmed by recent studies.  Professor Snow from Oxford had an article published recently in Nature magazine showing that, in fact, the burden is higher than expected.  So it's factually right.  On the Roll Back Malaria partnership, if it has done more harm than good is a matter of judgment.  The point is that the program has to be improved; that we all agree.  There was a recent meeting of the board of Roll Back Malaria I believe two or three weeks ago, and there was a discussion about the future institutional arrangements of Roll Back Malaria in coordination with all partners.

Indeed malaria remains the number one killer disease of children in Africa--well ahead of AIDS, and equal to seven Boeing 747s loaded with kids, crashing every day.  Waiting for a vaccine far in the future is just inhumane.  For now, the leading options to control malaria are:

(1) kill the mosquitoes with insecticides that are sprayed indoors in homes, whether on walls of the home or on bed-nets, or by draining the wetlands where mosquitoes breed (note that it is a thing of the past to spray big quantities of insecticides outdoors); or

(2) cure the patients using medicines for severe clinical malaria and which, if they are the newest and best medicines called "artemisinin combination therapies" (ACT), also break the chain of transmission from the infected person to the next victim.

Those are the three main interventions to prevent or to cure--insecticides, bednets, medicines--and everyone agrees on this.  But everyone does not agree on whether USAID should spend its money buying these things for poor people....
Let me give you some examples, and perhaps dive deeper into these during questions:

1.    USAID tells the public it "strongly support[s]" the use of ACT medicines as the best to cure malaria.   But under pressure, it admitted that it "typically does not purchase drugs or medicines other than in exceptional or emergency circumstances for any of [its] programs"--not a single pill for a single patient, anywhere.   Yet even though they don't pay the medicine bill USAID often meddles in African countries affairs, as it did in telling Zambia to "go slow" and not use ACT, but to use a different medicine (called SP) that scientists know is inadequate and quickly leads to large scale childhood death.  

If this is USAID's idea of "strong support", what would opposition look like?  We see this same refusal to buy and supply also with insecticides like DDT--USAID says they support insecticide spraying, but they don't actually supply the goods, and have even blocked others who want to spend their own money on DDT.

2.    So where does the money go, if not to giving poor people the tools to survive malaria?  Mostly to American contractors.  For example, USAID has a $65  million project called NetMark, but instead of using that money to give away bednets to the poor as the Red Cross does, NetMark advertises and sells bednets to them.   NetMark is overseen by a USAID contractor called the Academy for Educational Development, which although a non-profit organization has some pretty hefty salaries and operating costs: their CEO paid himself $400,000 in salary and benefits in 2003--more than President Bush.   Getting transparent glimpses into this and other USAID contracts is almost impossible, since USAID had not published a list of its contracts since 2001, is not cooperative, and admits that details of many contracts "are not reported or collected centrally" in Washington.2  

The situation is so untransparent that if NetMark is good value--and I think giving away the nets probably is better value--nobody knows, because USAID doesn't keep even the most rudimentary details about its contracts where people can see them.

So as I said: poor Africans don't get even basic tools against malaria, while Americans get untransparent contracts for questionable work.  Meanwhile the malaria deaths in Africa are increasing--soaring, actually.  I thank you, and hope to be of service answering your questions.