By Carlton Cofie - Ghana

The inclusion of African leaders in the protracted war against malaria has long been anticipated by experts who argued rightly that except the leaders joined in the campaign other stakeholders labour in vain to control the Africa’s biggest killer.

The promise of good results from this development actuated the WHO Malaria Programme Manager for Africa, Dr George, Ki-Zerbo, to describe the creation of an African Leaders Malaria Alliance, ALMA, as crucial and timely, coming just at the juncture of the decade to roll back malaria, when the continent is pursuing the attainment of health-related Millennium Development Goals (MDGs).

ALMA’s raison d’ etre, he said,  is in line with the UN Secretary General’s call to ensure universal access to essential interventions, as it will promote action and knowledge sharing in malaria and documenting progress made.

         Dr George Ki-Zerbo, WHO Malaria
          Programme Manager for Africa

In an interview with EYES ON MALARIA, Dr Ki-Zerbo said WHO has issued resolutions at the World Health Assembly and the regional community of ministers of Health in the African region requiring the commitment of more domestic and external resources with health and development partners to help achieve the MDGs.

“It is important that regulatory and policy issues are  implemented at country level to deal with problems of  taxes  and tariffs on malaria commodities and the banning of monotherapies that are no longer effective in curing malaria. These require action at country level and regional economic communities, like the African Union (AU)  and also engaging with industry and urging everybody to consider these tariffs as a threat to the control and eventual elimination of malaria” Dr Ki-Zerbo said.

The Malaria Programme Manager for Africa said the actions are there and clearly outlined with the various resolutions but what is needed now is the political commitment.

                                    African leaders

ALMA, an alliance of 39 African leaders, is chaired by Tanzanian President Jakaya Kikwete and recently elected Ellen Johnson Sirleaf, President of Liberia, as Deputy Chair.

It was launched in 2009 as a collaborative effort of African leaders to work together with the AU, United Nations and other local and international partners to combat malaria in Africa. The alliance seeks to complement efforts that address the challenges of malaria and aims to raise malaria awareness at the global, national and local levels.

The criticism against African leaders is that they are a few steps behind reality. They speak of substantial success in malaria control when in fact mosquito-net coverage in some 20 African countries is merely five times higher today than in 2000.

The reports of significant decline in malaria cases and deaths of up to 80% are coming mainly from low transmission areas. And so the challenges remain.

It is agreed that involving ALMA in the malaria struggle gives the problem a high profile. But for how long will the momentum be sustained?

The general knowledge is that we might have another year or so of a focused battle and then with the vicissitudes of political elections, the heads of state will succumb to other pressures. Not to mention the common practice of politicians to discontinue programmes of their predecessors just to please members of the ruling party and to spite the opposition.

The leadership of ALMA has set itself objectives far higher than the Millennium Development Goal to "halt and begin to reverse the incidence of malaria".

Malaria control is vital to achieving the health-related MDGs. Success against malaria directly impacts MDG 4 which focuses on child mortality and MDG 5 which is on maternal health.  A lot depends on political action rather than words if Africa is to halt this major killer of children and the cause of morbidity among pregnant women.

        Tanzanian President Jakaya Kikwete,
                       Chairman of ALMA

In the words of ALMA Chairman President Kikwete “We have two primary strategic goals: achieve universal mosquito-net coverage by the end of this year; and eliminate preventable malaria deaths by 2015 by scaling up coverage of all other available interventions (including access to rapid diagnostic tests, treatment with artemisinin-based combination therapy (ACT), intermittent preventive treatment, and indoor residual spraying).”

One issue worth considering is the fact that some of these leaders were around at the signing of the Abuja declaration of 2000. It is begging the question to ask how much those leaders have changed in the way they view malaria.

Bill Gates takes issue

The big spender on malaria, Bill Gates, has condemned some African countries for failing to deliver life-saving vaccines to children, hampering billion-dollar efforts to save millions of lives and stamp out deadly diseases. His gripe was about African leaders’ ambivalence to the polio vaccine.

Having invested 17 million US dollars in the Malaria Clinical Trials Alliance (MCTA) project on the RTS,S malaria candidate vaccine now awaiting initial efficacy reports later this year, the  Microsoft founder has every reason to be dismayed at the African leaders.

The magnate, who is now known to spend more time talking about the "miracle of vaccines" than software, said in Senegal ahead of an address to the 64^th World Health Assembly in Geneva that, “ Technology is only as effective as the leaders delivering it.”

“Once you have vaccines invented and manufactured at low cost, and rich donors paying for them, "you have to have developing countries act to take the vaccines and get them out to all the kids. It is tragic when the last delivery piece holds it back," Bill Gates said.

"You have some areas like Northern Nigeria, Chad or the Democratic Republic of Congo where less than half the kids are getting the vaccines," Gates said, referring to polio immunisation in those countries.

Bill Gates rightly blamed the problem in Nigeria, on the "distraction of the elections."  

"They are just not putting good people on it, not tracking their results, not even getting out to parts of the country. The message has to be clear. They have to see this as their top priority. It hasn't been."

Now, Heaven forbid the same thing should happen to the RTS,S malaria candidate vaccine when it becomes licensed. But then it begs the question as to why politics which is meant to bring development, end up causing a disruption in vital vaccines being given to vulnerable children.

The Microsoft founder has donated $10bn of his sizeable fortune to bring vaccines to children in the next decade, calling on others to invest in vaccines as a cost-effective way to save lives and boost development.

All that is required of political leaders is that their countries have efficient systems to deliver these vaccines to all children.

"For kids the malaria vaccine would be the next best thing. The funders need to stay behind that research despite the budget challenges they face" said Gates.

Benefit of the Doubt

It is good though that the ALMA acknowledges how ‘morally imperative’ it is to save the 800, 000 children who perish annually from malaria.

What Rwanda has done is worth emulating. With large-scale mosquito-net distribution and increased availability of ACTs, the former war-torn country has reported a 40% reduction in childhood malaria deaths between 2001 and 2008.

On the Tanzanian island of Zanzibar, the combination of high mosquito-net coverage, ACT availability, and indoor residual spraying reduced malaria deaths by over 90%. More importantly, under-five deaths from all cases fell by almost three-fifths.

Other leaders are being urged to take a leaf from their malaria-savvy neighbours and give meaning to the old saying about health being tantamount to wealth.

It is refreshing however to hear ALMA’s declaration that when malaria prevention and treatment methods become widespread, childhood deaths will fall dramatically, and resources can then be directed to other causes.

Is this a new beginning?