Malaria

As I inteviewed many people in Tanzania about their experiences with Malaria, I was often asked how my home country deals with malaria. "Does your family in the US sleep under a mosquito net? How many people do you know who died from malaria? Have you had malaria when you were a child? How much does medicine cost in the US to treat malaria?"

Some Tanzanians were shocked to know that malaria is not an isssue at all in my home country. It used to be. What helped America abolish malaria many years ago was the agressive indoor spraying of pesticides such as DDT alongside other measures.

A huge debate has been going on now for years. Why shouldn't this massive killer in Africa be stopped by the same methods America used? Some people argue that the spraying of DDT is an inexpensive and highly effective method of combating malaria and that it has been approved by the World Health Organization. Others argue that being exposed to DDT early in life might lead to harmful effects and thus is not a viable malaria control method. This is what has paralyzed the large scale use of it for many years.

A friend of mine sent a documentary called DDT Wars that I thought I would share with you here:

Tanzania’s government rolled out a new treatment for malaria nationwide this year:  Artemisinin-based Combination Therapy (ACT).  The introduction of ACTs is due to the major problem with resistance of malaria parasites to the most common and affordable antimalarial drugs such as chloroquine, Sulfadoxine-Pryimethamine and amodiaquine. 

Drug resistance is mainly the result of inappropriate use of antimalarial drugs.  The drugs were deployed on a large scale, always as monotherapies, introduced in sequence and generally poorly managed (used even after high levels of resistance were found).  The primary challenge in getting this new solution of ACTs administered throughout Africa now is simply the cost as they are ten times more expensive than the conventional drugs used as monotherapies (one drug alone rather than a mix).

As I mentioned in a previous post, Acumen Fund has invested in an interesting social venture, Advanced Bio Extracts (ABE), which trains farmers in Kenya and Tanzania and then manufactures the raw material (Artemisia annua- sweet worm) used to make these new malaria drugs.  This herb was actually used in Chinese traditional medicine for over 200 years to treat malaria fevers.  Globally, its doses in the form of ACTs have increased from 4 million in 2004 to 45 million in 2006.

Acumen Fund Fellow in Kenya, Jocelyn Wyatt, just created a short video of her work with ABE (click arrow below to view):

If you have problems viewing it above, you can also find it by clicking here.  Jocelyn and I have talked about how impressive ABE's process of taking the company to scale has been.  In just a few years, ABE has develped a supplier network of 7, 500 farmers.  Why has ABE been so successful at scaling?  Here is a quote from Jocelyn:

"What can other social enterprises learn from ABE’s example? My sense is that a primary advantage ABE had was an enormous influx of capital (in the form of a loan) from Novartis who pushed the company to expand rapidly. With millions of dollars up-front, ABE could open country offices, hire extension workers, purchase vehicles, and procure the inputs necessary to enable the farmers to begin growing artemisia.

Second, the company’s founders and directors knew they had to reach scale to succeed. A small producer of artemisinin was not going to sell its products to the largest pharmaceutical companies in the world and a measured approach to growth would not work. Therefore, they scaled quickly because that was the only option.

Third, artemisia offers returns to farmers that are far greater to what they previously saw growing maize, wheat, beans, or other crops. Without having to work much harder, farmers could double or quadruple their incomes. This was an easy conversion to convince farmers to try and farmers were encouraged to continue using some of their land to continue growing the staple crops.

Finally, ABE has seen that once the early adopters in a region do well, the followers are eager to jump onboard. Other models, like Scojo and SHEF, can only take on one entrepreneur in an area, limiting the bandwagon phenomenon that ABE could take advantage of.

Some of these factors are particular to ABE’s case, but I do believe it can be viewed as a good example of rapid growth in the social enterprise space. I would love to hear comments from others about what we can learn from this example and how it could be adapted to other organizations."

What were you doing in the last 30 seconds? Every 30 seconds a child dies of malaria unnecessarily. Crazy, isn’t it?

Malaria is one of the world’s deadliest diseases- killing three times more children than

HIV/AIDS. Malaria is an infection caused by a parasite and carried from person to person by mosquitoes. It is preventable and curable yet over 500 million people contract it per year and more than one million people die from it annually —most of them young children living in Africa.

Once contracted, you start to get a headache, feel hot with a fever and tired; you begin vomiting and have mostly flu-like symptoms. If not treated, you die.

There is no vaccine to prevent this.

The economic effects are huge, too. A Reuters report says that a single bout of malaria in Africa leads to a loss of around ten working days. Additionally, malaria can lead to loss of tourist revenue and international investment. The Roll Back Malaria Campaign reports that malaria has been estimated to cost Africa more than US$ 12 billion every year in lost GDP, even though it could be controlled for a fraction of that sum.

Prevention

You can take daily or weekly pills that reduce your chances of contracting malaria. I spent $1,400 on medication for the nine months I will be in Tanzania. I also sprayed my clothing with a repellent and insecticide that lasts 6 weeks even with several washes; these spray cans cost me about $55. If you make less than $2 a day (as many of the people in high malaria zones do), you certainly could not afford these options (which are not even full-proof), especially since you would have to use them not for months like I will, but for every day of your life. So what to do?

There are many ways to reduce the transmission of malaria. In fact, simple things such as using a bednet treated with insecticide have proven to reduce transmission by 50%. A more controversial activity is the spraying of DDT indoors. This has been banned for over 30 years sparked by the book, Silent Spring, which highlighted concerns for DDT’s effect on the environment. The WHO recently lifted the ban citing little evidence of major environmental harm (in comparison to the tragedy of malaria). Beyond finding a vaccine cure, other prevention methods proposed by scientists have even included genetic mutation of the mosquitoes which transmit malaria. To learn more about malaria and specifically the types of solutions being implemented to eradicate it, click here.

Seems so daunting.

So why should we care? Beyond the fact that our hearts hurt when we see a child dying an unnecessary death or we think about the loss of potential innovation and economic productivity from malaria ridden regions. Some scientists predict that in the US and Europe, a re-emergence of malaria will soon come about even though it is mostly eradicated now.

This is everyone’s problem.

What a wonderful adventure this will be…and malaria is certainly an important inspiration for action.