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CIDA's malaria meltdown

By Amir Attaran
web posted November 6, 2006

"The poor," Jesus Christ said, "will always be with us." He did not say anything about whether the poor would suffer always from malaria. The inaction of the Canadian International Development Agency suggests that they will.
Malaria is a dreadful disease. Annually it kills more children in Africa than any other, and about 1 million children worldwide. When it does not quite kill, it has a repulsive efficiency to stunt children's growth and damage their brains.

Because it also targets pregnant women, it often kills mothers and orphans the children.  The sacrifice of so much life, security and brainpower in the next generation is foolish, and evades palpable understanding.  To imagine just part of it, visualize seven Boeing 747s – the biggest plane in the sky – full of children, crashing every day.

Yet with the proper, inexpensive tools, like household insecticides and treated bednets, malaria is a mostly preventable disease.  In the unlucky cases where prevention fails, medicines can treat it, one hundred percent.

Nobody – absolutely nobody – need die of malaria.

So why is CIDA not buying those tools, and shunning the Canadians who want to help?

This past February, CIDA minister Josée Verner said she would give UNICEF $9 million to buy bednets for Ethiopia. That sounds good, but what Ms. Verner failed to mention is that this grant comes as CIDA appears to be abandoning an earlier, $26 million bednet program led by the Canadian Red Cross.  Her happy-sounding commitment, really, is a swingeing budget cut.

As a biologist and lawyer who studies the problems of the world's poorest people, I have watched the politics and science of malaria programs for a decade.  Never have I found a bednet program that is as efficient at saving children's lives as that of the Canadian Red Cross.  The reason for their success is simple: unlike UNICEF, which in Ethiopia plans to sell bednets to families whose household income is often only a dollar a day, the Canadian Red Cross gives them away free. 

This is really true: UNICEF's elite, highly paid, tax-exempt staff have turned humanitarianism into a business of selling things to people who have no money. Predictably, it doesn't work. Five years after spearheading a campaign to put 60 per cent of Africa's children under properly treated bednets, UNICEF had to admit that only 3 per cent of African children are covered.

Now compare that to the Canadian Red Cross, which in Togo cleverly linked its bednet giveaway to pediatric health services. In one tightly choreographed week – not 5 years – the Red Cross distributed 900,000 bednets, enough for 100 per cent of Togo's children under 5.

With such breathtaking results, you might imagine CIDA would be eager to continue, and even expand, the Canadian Red Cross' funding before their final bednet giveaway in Sierra Leone next month. But you would be wrong.  In far more than just malaria, CIDA's management is so consumed in processes and in reacting to the latest trends in international aid that evaluating results is subordinate. The disconnect is so profound that CIDA sometimes overlooks even huge successes, as in Togo. 

This is possibly why, though the Canadian Red Cross asked – begged – CIDA to continue its funding, eighteen months later CIDA still has not made a decision. What a shabby way to treat these Canadian heroes, and Africa's children.

CIDA's torpor to what works seems almost total.  Last month, the World Health Organization decided that it had been wrong to let politics squeeze a famous insecticide, DDT, out of malaria control programs.  Courageously, WHO admitted its error and called for DDT's return. I started the global campaign eight years ago that led WHO to reinstate DDT, and though unpopular, I did so because scientifically and ethically it is a no-brainer.  

As WHO recommends, DDT is sprayed on the insides of homes only.  It therefore causes no harm to the outside environment, as it protects a home's inhabitants from malaria-carrying mosquitoes for up to a year at time.  Where DDT works (it is not the right choice for everywhere) it is spectacularly effective.  With DDT and the right medicines, South Africa beat back malaria cases 89 per cent in one year, and deaths 97 per cent in four years.

Think if it: 97 per cent fewer dead children and women. That is why even former opponents, such as Greenpeace or the World Wildlife Fund, now agree DDT may be used for malaria control. 

CIDA's excellent health staff understand this, and agree that DDT needs an urgent second look.  But troublingly, the organization is not reacting.  CIDA says it is "very interested in better understanding how the WHO's new policy can best be operationalized." But when the WHO's tireless malaria chief, Dr Arata Kochi, came to town pleading for funds to make DDT spraying operational, CIDA sent him away penniless. 

If that counts as CIDA being "very interested," one wonders what being disinterested looks like.

As of this week, CIDA's spokeswoman says the agency has "no plans to purchase DDT."  CIDA also says it "does not normally engage in the direct procurement of drugs or products" – that is, CIDA does not buy the actual tools of malaria control.  Sometimes CIDA funds partners, like the Canadian Red Cross, to buy those products, but that funding is snarled in unending discussions.  Meanwhile, CIDA promises it "will work with … partner organizations to advance [its] understanding."

With 2,700 children dying each day, I hope CIDA advances its understanding soon.  Ms. Verner and the Prime Minister could help by instructing its management to bet more on CIDA's and the Canadian Red Cross' achievement in the world's greatest bednet program, and to fund WHO's urgent call for DDT.  A ten year commitment of $100 million annually would be huge by CIDA standards, but justified. 

With heroes like the Canadian Red Cross on our doorstep, CIDA should not be penny-pinching, but helping them to save poor children, or perhaps to bring home a Nobel prize, as is deserved.  The poor will still be with us, but Canada can help them live better, healthier, longer lives. ESR

Dr. Amir Attaran is Canada Research Chair in Law, Population Health and Global Development Policy at the University of Ottawa, and a former Sierra Club Legal Defense Fund lawyer.


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