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- 10/21/08: Remarks by Henrietta Fore, Administrator, USAID and Director of U.S. Foreign Assistance at the White House Development Summit
- 10/08/08: Remarks by Henrietta Fore, USAID Administrator and Director of U.S. Foreign Assistance at The President's Freedom Agenda
- 10/01/08: Remarks by Henrietta H. Fore, Administrator, USAID and Director of U.S. Foreign Assistance, at the Ceremony Marking the Full Operational Capacity of Africa Command (AFRICOM)
- 09/25/08: Remarks by Henrietta H. Fore, Administrator, USAID and Director of U.S. Foreign Assistance, at 2008 Millennium Development Goal Malaria Summit, New York - "U.S. Leadership in the Fight Against Malaria"
- 09/22/08: Remarks by Henrietta H. Fore, Administrator, USAID and Director of U.S. Foreign Assistance, at the White House Symposium on Advancing Global Literacy - "U.S. Commitment to Advancing Global Literacy"
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Remarks by Dr. Bernard Nahlen
Deputy Coordinator, President's Malaria Initiative
World Malaria Day Symposium
Georgetown University, Gaston Hall
April 25, 2008
Before I begin, I would first like to thank Georgetown University, the Mortara Center for International Studies, the Center for Infectious Disease, and the O'Neill Institute for hosting this event in recognition of the first annual World Malaria Day. I've been working in this field for more than 20 years. But unfortunately during most of this time we were sort of wandering in a desert of scant resources for malaria research, prevention and control. So, to continue to draw international attention to the global crisis of malaria, much of our effort was focused on further documentation of the tremendous negative impact of malaria on the health and economic development of people in very remote rural areas, far beyond the reach of health care systems and donor attention. The good news is that also during this time we were able to demonstrate that wide-scale implementation of even partially effective tools could have a major impact on reducing the negative effects of malaria.
But, no matter how much we tried, there was just no global commitment to provide resources to battle this devastating disease. I speak on behalf of all of us involved in the fight against malaria when I say that we find ourselves extremely grateful that the tide of political commitment has indeed now turned. We see this having an impact in galvanizing action at all levels of not only our own government but the governments of the other G8 countries and, most importantly, the national governments of countries most severely affected by malaria as well. Believe me, even a few years ago I would have never expected to be invited to a major university in the United States to celebrate World Malaria Day.
So what has brought us to this point in the long battle against this ancient disease? As Melinda Gates pointed out in her address to the Malaria Forum held last October in Seattle, in the history of humanity, it's likely that no other disease has ever caused more suffering, more sickness, and more death than malaria, Malaria symptoms were described in Chinese medial texts nearly 5,000 years ago. The disease caused the decline of city-state populations in Ancient Greece, and untold deaths in wars throughout history.
Even here in the United States, and especially in Washington, D.C., malaria was once a serious problem. For much of its history, the marshy environment of Washington provided a dangerous breeding ground for mosquitoes, and Washington's hot and humid summers provide a perfect climate for malaria transmission. In those days, the district was considered so dangerous to health that foreign diplomats earned hardship pay just to live here.
George Washington himself developed his first bout of malaria at age 17 and had periodic attacks. Several of our other presidents, from Monroe to Jackson and Lincoln all the way to Theodore Roosevelt and John F. Kennedy had their own experiences with this deadly parasite. Throughout history malaria has counted not only Presidents but also Emperors, Popes and poets among its victims. And even Georgetown University students. William Gaston, Georgetown College's first student in 1791, and the individual that this very hall is named after, almost certainly suffered from malaria. He cited the unfavorable climate as a reason for his early departure.
One of my favorite characters in the history of malaria in Washington DC is Dr. Albert Freeman Africanus King, a gynecologist at George Washington University. On February 10, 1882, Dr. King presented his ideas on malaria to the Philosophical Society in Washington. The characteristic of malaria, Dr King said, "may be explicable by the supposition that the mosquito is the real source of the disease rather than the inhalation or cutaneous absorption of a marsh vapor." Dr. King's statement was made during a time when marsh vapors were still believed by many to be the cause of malaria transmission. The very term "malaria" comes from the Italian for "bad air". His assertion that malaria was transmitted by mosquitoes was even more remarkable since it was made 6 years before Charles Laveran, a French physician working in Algeria and a student of Louis Pasteur, identified the malaria parasite in 1888, and more than a decade before Ronald Ross working in Secunderabad, India, confirmed mosquito transmission of malaria. However, while Drs Laveran and Ross went on to be awarded Nobel Prizes for their work on malaria, Dr King did not receive any scientific accolades. Following up on his theory of mosquito transmission, Dr King proposed a grandiose and impractical plan for malaria control in Washington DC. He claimed that Washington could be ridden of malaria by surrounding the entire city with an enormous screen of fine mosquito netting as high as the Washington Monument. This was greeted with an enormous guffaw and even today no one is certain whether King was serious or attempting a joke. But this certainly discouraged anyone reading his paper from testing the highly sensible mosquito hypothesis.
Malaria is no longer a threat to US Presidents or to Georgetown University students. During the 1950's, malaria was eradicated here in the U.S. Since then, malaria has largely been forgotten here and throughout most of the northern hemisphere where it no longer poses a risk to health. However, even now, a century after Nobel prizes awarded to Laveran and Ross, malaria remains endemic in more than 100 countries and territories. You will hear these astounding, sad numbers facts repeated many times today: that each year 300-500 million people suffer from malaria, that this results in at least 1 million deaths, and that 90% of these deaths are among children in impoverished areas of rural Africa. As we sit here now it is the middle of the night in villages throughout Africa. And the anopheline mosquitoes are going about their nightly ritual, taking blood meals and injecting malaria parasites into sleeping children. So, although today malaria does not threaten those of us sitting in this room, in Africa and similar areas of the tropical world future Presidents, scientists and poets are having their young lives cut short and their hopes for a better future dimmed even as I speak.
Yesterday I was on Capitol Hill for the ceremony launching the Congressional Malaria Caucus on Malaria. Admiral Tim Ziemer, the Coordinator of the President's Malaria Initiative, reminded us that "For too many years the world seems to have turned its back on malaria - especially in Africa - as though we were hoping the problem might go away. It didn't. Millions continue to suffer and die." And as the First Lady Laura Bush reminded us so eloquently, "No mother should have to watch her child die from a disease that was caused by a mosquito bite-and a disease that's preventable and treatable. Yet that's exactly what happens every thirty seconds in Africa…" Over the past two years the First Lady's compassion and personal commitment as she travels throughout Africa has attracted global attention, galvanized action, and spurred grass roots and private-sector efforts to begin to roll back the intolerable burden of malaria.
Malaria casts a shadow not only over health, but also on educational achievement, worker productivity, and economic development in sub-Sahara Africa. Recognizing the grave threat presented by malaria in Africa, in June 2005, the U.S. renewed its interest in the fight against malaria when President Bush announced a new US Government malaria initiative, providing an additional $1.2 billion of funding over five years to support malaria prevention and treatment activities in Africa. The goal of President's Malaria Initiative, or the PMI as it is known, is ambitious: to cut by 50% the malaria-related deaths in 15 target African countries. This will be achieved by reaching 85 percent of the most vulnerable groups - children under five years of age and pregnant women - with proven prevention and treatment measures. These measures include distribution of insecticide-treated nets to prevent mosquito bites, indoor residual spraying with insecticides to kill mosquitoes, intermittent preventive treatment to reduce malaria during pregnancy, and the treatment of malaria with highly effective artemisinin-based combination therapies. The PMI is an interagency initiative led by the United States Agency for International Development, USAID, with the Department of Health and Human Services' Centers for Disease Control and Prevention as its major partner.
The PMI has moved ahead rapidly and built on almost two decades of US government work and experience. USAID and CDC collaborated on much of the original research related to insecticide-treated mosquito nets, intermittent preventive treatment of malaria in pregnancy, and artemisinin-based combination therapies. In addition, USAID and CDC helped many African countries to modify their malaria control policies and begin implementing these new tools.
When African Ministers of Health met in Senegal two years ago, they declared malaria an "African crisis" and urged global leaders to once again take action against this deadly disease. We have rapidly responded to this call to action. Within six months of the President's announcement, we launched high impact Year One activities in Angola, Tanzania, and Uganda. In Year Two, PMI expanded to four additional countries (Malawi, Mozambique, Rwanda, and Senegal). And, early "jump start" activities have already begun in the eight new PMI focus countries (Benin, Ethiopia, Ghana, Kenya, Liberia, Madagascar, Mali, and Zambia) that joined the initiative for our Year Three activities.
In the first year, PMI reached over 6 million people in the initial 3 countries with malaria prevention and treatment activities. In just its second year of operation, more than 25 million people have benefited from PMI interventions. To summarize in more detail some of the progress that has been made to-date:
- Indoor residual spraying programs have been conducted in ten countries, and they protected over 17 million people.
- More than 6 million long-lasting insecticide-treated mosquito nets were bought and around two-thirds have already been distributed;
- More than 12 million treatments of the most effective drugs combinations of treatment of malaria -- artemisinin-based combination therapies -- have been purchased;
- More 1.3 million preventive treatments for pregnant women have been procured, with more than 500,000 distributed; and
- Finally, PMI has supported training for more than 5,000 health workers on preventive treatment for pregnant women and for more than 29,000 health workers on artemisinin-based combination therapies.
In just two years since we started supporting national malaria control programs, we are now starting to see early evidence in several countries that our collective efforts are beginning to have an impact on malaria transmission:
- In Zanzibar last year, a survey showed that the percentage of children who tested positive for malaria dropped by over 90% over the course of two years from 22 percent in 2005 to less than 1 percent after the distribution of long-lasting insecticide-treated nets and indoor residual spraying.
- Malaria infections are one of the major contributing causes of severe anemia in young children in Africa, and severe anemia is a major cause of deaths in these children. In Malawi, where coverage with insecticide-treated nets has increased rapidly over the past three years, a 2007 household survey in six districts showed a 43% relative decline in severe anemia among children aged 6 to 30 months, when compared with 2005.
- In Uganda and Tanzania, where PMI and the national malaria control program supported indoor residual spraying campaigns, 2007 health facility records document reductions in the proportion of blood slides positive for malaria of 58% in Uganda and 37% in Tanzania, when compared to previous years.
Given the enormous burden of malaria, we recognize that we can only achieve our goal through partnerships, which are at the heart of our strategy. We work directly with African ministries of health, and our annual plans directly support their national malaria control plans by filling in gaps in funding. Over the past two years, PMI has forged broad collaborative efforts in all PMI focus countries with a variety of partners.
The fight to reduce the burden of malaria is indeed a collaborative effort. Under the umbrella of the Roll Back Malaria Partnership, we coordinate PMI efforts with the Global Fund to fight AIDS, Tuberculosis and Malaria, the World Bank, the Bill and Melinda Gates Foundation and other donors and often co-fund activities. For example, the Global Fund procured more than 8.7 million ACT treatments in Uganda, while PMI resources were used to support the distribution of those ACTs to local health facilities and community drug distributors. This past year alone, PMI partnered with donors in seven mass campaigns to procure and distribute insecticide-treated mosquito nets. In some cases PMI procured nets for these campaigns, filling gaps not covered by other partners, or providing resources for logistics or follow-up surveys.
We are also working closely with the private sector. In Angola, the ExxonMobil Foundation donated $1 million to support PMI objectives in the country. In Zambia, PMI partnered with the President's Emergency Plan for AIDS Relief and the Global Business Coalition to distribute over 500,000 nets to persons living with HIV. With the support of PMI, Malawi expanded its indoor residual spraying program through a successful public-private partnership with the Dwangwa Sugar Estates. We also worked with many private sector partners to implement the integrated mosquito net distribution campaigns that took place this past year.
The participation of NGOs, faith-based, and community organizations is crucial to the success of malaria control efforts. Currently we work with more than 70 non profit organizations. The Malaria Communities Program, managed by the PMI, was launched in December 2006 by First Lady Laura Bush, to provide grants to these types of grass roots organizations. With $30 million of funding over five years, the MCP hopes to support the efforts of communities and indigenous organizations to combat malaria in Africa. In its first year, the MCP awarded a total of nearly $7 million through five grants to new partner organizations. These grants will expand prevention and control activities to the communities where they are needed most.
We are also programming PMI resources in ways that will directly and indirectly strengthen overall maternal and child health programs as well as health systems. For example:
- Our support of pharmaceutical management systems helps to improve the management of malaria commodities and other essential medicines.
- We are also supporting supervision, and monitoring and evaluation across all levels of the health system.
- We are strengthening malaria diagnosis, and in so doing will help enhance the overall quality of laboratory services.
- We are helping expand services, outreach, and volunteer programs at the community level.
Sustainability of malaria programs is a high priority for us. Towards this end, we are working to promote:
- Increased funding by host governments of their own national malaria control programs. All host national malaria control programs in each of our PMI focus countries are engaged throughout the assessment, planning and implementation phases of the in-country malaria control strategy to promote host country investment;
- Increased diversification and long-term funding by donors and partners;
- Improved quality of malaria services;
- Achievement of high and sustained national coverage rates for malaria prevention and treatment; and
- Active involvement of community, NGO, and private sector organizations in malaria control at all levels.
As a result of progress in these critical areas, national malaria control programs in Africa are becoming more effective, sustainable, and accountable. As with child vaccines, there should be an international mandate that no high burden malaria country will run out of essential malaria commodities.
The PMI places a high priority on accountability and transparency. Through regular postings to our website, we provide information to the public on funding allocations, procurements, program activities, milestones, and results. This includes copies of contracts and grants, annual reports from PMI implementers, and program audits. We believe that we are at the forefront of development programs in this important area.
In conclusion, in just over two years, our government's commitment to the fight against malaria, though support to the PMI and other partners, together with our partners, is already having major impact. We are beginning to see a change in attitudes towards malaria in Africa. No more is malaria accepted as a "fact of life" or an "intractable problem." With continued concerted action, we now have no doubt that that the surge in malaria, our common enemy, can indeed be beaten back.
And I invite all of you here in Georgetown to join this global effort. You are not only an incredibly talented and energetic group of students, but you also benefit from an amazing faculty. In fact, Admiral Ziemer and I are both are appreciative for Georgetown having sent us one of your recent garduates, Jesse Patterson, who does a great job working with us to support PMI. And recently I was contacted by the son of my former roommate at Notre Dame, John-Paul Furey, who is finishing his first year here at Georgetown and intends to write his final paper on malaria. He has made a sudden change in career choice after having taken an introductory course to international health taught by Professor Katherine Leonhardy, who I understand from Jesse and others is an inspiring teacher. So, my sincerest thanks to Professor Leonhardy and other outstanding faculty here at Georgetown for continuing to inspire this new generation of global health leaders who take up the baton long after my generation has ridden into the sunset.
Thank you.
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