Malaria experts cite progress at Seattle forum

Group efforts make gains in Africa

By TOM PAULSON
P-I REPORTER

More than 300 scientists, physicians, public health leaders and top government officials from all corners of the planet have gathered in Seattle this week, by invitation of the Bill & Melinda Gates Foundation, to discuss how best to combine forces and beat malaria.

Though many came to celebrate progress being made against this deadly disease, some questioned the ability to measure that progress because of the lack of reliable information in the developing world -- even as to whether malaria rates are going up or down.

Still, progress against this once-neglected disease has been extraordinary in the past few years, experts agree.

"There's a new momentum in the fight against malaria," said Dr. Regina Rabinovich, director of the infectious disease program at the Gates Foundation.

Malaria has long been one of the world's leading killers, Rabinovich said, and today takes a life -- usually the life of a young child in Africa -- every 30 seconds. For many years, she said, malaria was an "orphan" disease with little research funding or international support for efforts to combat it.

"Things have changed in the last 10 years," Rabinovich said at the opening session of the meeting, which runs through Thursday at the Sheraton Seattle Hotel.

More than $3.6 billion has been committed to controlling malaria in the developing world using insecticide, bed nets and drug therapy, she said. "The research pipeline," Rabinovich added, coming up with new drugs and vaccines, is bigger than it's ever been.

Much of the new money is the many hundreds of millions donated by the Seattle philanthropy to fight malaria -- most of it focused on finding a malaria vaccine. But the new momentum is not just because of the Gates Foundation. The Global Fund for AIDS, Tuberculosis and Malaria, the President's Malaria Initiative and the United Nation's Roll Back Malaria partnership are also major players.

"Africa is gaining ground on malaria," said Dr. Tedros Adhanom Ghebreyesus health minister of Ethiopia and a leading participant in the U.N.'s Roll Back Malaria campaign.

In Seattle on Tuesday, Ghebreyesus, UNICEF Executive Director Ann Veneman and Rear Adm. Tim Ziemer, head of President Bush's Malaria Initiative, released a report, "Malaria & Children," in which they documented massive increases in the use of treated bed nets and anti-malarial insecticides in many parts of sub-Saharan Africa.

Ghebreyesus said Ethiopia set out in 2005 to distribute 20 million treated mosquito nets by 2010. Given how poor the country is, he said, many criticized the goal as "crazy." But as of August, working with Roll Back Malaria and others, they had distributed more than 18 million.

"We are changing the reality of malaria in Africa," said Ziemer, noting that the federal government's program has distributed nets to 30 million people in Africa. "Our collective efforts are making a huge difference."

But the UNICEF and Roll Back Malaria report, while documenting success in distributing nets, offers little on malaria mortality or morbidity. Are these efforts actually reducing disease and death rates? Ghebreyesus and others say malaria disease rates and deaths appear to be falling, but all acknowledge that this is not yet clear.

"It's really too early to be able measure the impact on mortality," said Tessa Wardlaw, an epidemiologist for UNICEF.

Dr. Brian Greenwood, a renowned malaria expert at the London School of Hygiene and Tropical Medicine, spoke at the conference and urged the audience not to neglect the perhaps less-exciting activity of disease surveillance and monitoring.

"A surveillance network is absolutely critical," Greenwood said. Without it, he said, it will be impossible to know if rates are going down or up. In addition, Greenwood said, the parasite's infamous ability to develop resistance to drugs or chemicals may go unnoticed far too long -- eventually undermining these efforts to control malaria.

Others at the conference, including Ghebreyesus, said that for the malaria efforts to succeed long-term they must be incorporated into broader efforts aimed at improving the overall public health and health care delivery systems of poor countries.