PRESS CONFERENCE ON 'ROLL BACK MALARIA' CAMPAIGN

Press Briefing

PRESS CONFERENCE ON 'ROLL BACK MALARIA' CAMPAIGN

"Roll Back Malaria", a new campaign designed by the World Health Organization (WHO), was officially launched today at a Headquarters press conference. The campaign is being undertaken in partnership with the United Nations Children's Fund (UNICEF), the United Nations Development Programme (UNDP) and the World Bank.

The four agencies initiated the programme because of their concern over the increased human suffering caused by malaria on all continents, particularly Africa, said WHO Director-General Dr. Gro Harlem Brundtland. She was joined at the press conference by UNICEF Executive Director Carol Bellamy, World Bank President James Wolfensohn; and UNDP Administrator James Gustave Speth.

Fred Eckhard, Spokesman for Secretary-General Kofi Annan, read out a statement from the Secretary-General noting that malaria killed 3,000 children every day and afflicted 300 to 500 million people a year. Three quarters of all malaria cases -- the vast majority of them in children -- occurred in Africa.

The Secretary-General warmly welcomed the Roll Back Malaria initiative, Mr. Eckhard said, because it enabled efforts to focus on an issue that had caused so much suffering in Africa and other developing regions for too long; and because it brought together four key entities of the United Nations system in a closer and more permanent form of partnership than seen before to alleviate suffering and remove a crucial obstacle to development.

Dr. Brundtland said the initiative demonstrated how the United Nations agencies could work closely with the Bretton Woods institutions on an issue which directly affected the lives of so many.

Malaria, a re-emerging and increasingly burdensome disease, accounted for 10 per cent of all diseases in Africa, she continued. It was above all a disease of the poor, killing the young and the weak, mostly in sub-Saharan Africa. Apart from human suffering, the agencies were also concerned about the impact on economic and social development. Income was reduced by an estimated 12 per cent because of malaria's effect on economic output. By working together, the agencies believed they could significantly reduce morbidity and mortality.

She said the campaign would call on the combined efforts of WHO experts in tropical disease, child health, environmental health and pharmaceuticals. Institutions, non-governmental organizations, the private sector and the scientific community all needed to pull together to make a difference. There must be a sustained effort. She said, "We need to reach a child with fever within hours with simple and inexpensive medication" -- something that was still unavailable in many homes and communities in Africa. The technology was

inexpensive and could have a concrete impact. Prevention and bednets would help reduce mortality, which was highest in children under five years.

Mr. Wolfensohn said that the World Bank had significant activities in India, Sri Lanka and Bangladesh. It had been carrying out eight country assessment studies with governments in Africa. Although those efforts were part of the World Bank's overall health programmes, they focused on malaria as the single most significant problem in Africa. The Bank looked at the problem in terms of its economic and social implications. Bednets were needed along with geographic mapping to find out what areas were drug and insecticide resistant. The Bank would also examine how to mobilize additional funds. It would try and make the case to financiers that the issue was central to development, especially in Africa.

Mr. Speth said that although it was the first time Dr. Brundtland had asked the UNDP to work with her agency, he had such high regard for her, that he would have responded willingly, even if asked to be a guinea pig in a malaria drug experiment. The UNDP and the United Nations Development Group could mobilize the network of resident coordinators to integrate the initiative's concerns into the new country-level planning tool, known as the United Nations Development Assistance Framework (UNDAF). It could also create theme groups at the country level -- as it had done with its AIDS programme.

He said UNDP's main concern was the social fallout on families affected by malaria -- the social and environmental setting of the disease and its spread -- rather than immediate public health issues.

Ms. Bellamy said malaria fell particularly hard on women and children, killing one child every 30 seconds. Complications from malaria also contributed to the extraordinarily high rates of maternal mortality and were a major cause of anaemia in young adults and women -- a factor which led to a greater susceptibility to disease and a lack of cognitive growth. The UNICEF currently supported malaria programmes in 32 countries, including 27 in Africa, but the pace and scale of the effort had to be accelerated. Each agency would take a lead responsibility at a different level. UNICEF's responsibility would be at the community level, to ensure treated bednets were available, particularly for pregnant women and children, and that they remained appropriately treated. The agency would also make sure appropriate drugs were available in local clinics.

A correspondent asked about the impact of other efforts over the last 50 years to fight malaria. Dr. Brundtland said, if nothing had been done over the last 50 years, the situation would have been much worse. The development of new insecticides 30 years ago had generated a lot of enthusiasm about the possibility of eradicating the disease. However, the situation was more complicated. Malaria had been eradicated in some countries, but it was returning in others and was increasing in countries were it had been endemic. A broader effort was needed to research vaccines. Meanwhile, appropriate

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drugs and prevention tools could be made available to communities and homes. The disease could not be eradicated in the next 10 years, but there might be new drugs or vaccines that could make a difference.

Tore Goal, the WHO's Acting Project Manager on the campaign, said many areas of the world, particularly huge swaths of China, were now free of malaria. There were a number of simple, do-it-yourself tools that would help bring the battle against malaria from the health centres to the home. Those included a drug pack which allowed mothers to administer an accurate dose and reduced drug costs by 50 per cent. There were also rectal packs to help treat children who were unconscious or vomiting. Mapping out malaria at the community level also showed the effectiveness of bednets in preventing the disease.

Asked if the fight against malaria would be as daunting as the battle against smallpox, Dr. Brundtland said, yes, because malaria was a major killer. Although no one knew how to eradicate malaria, halving the number of deaths would be a major success story. It was important to try and develop a vaccine and improve drug treatment, because the existing battery of tools was not enough. The world needed new breakthroughs.

How important was improved sanitation and ground water to the campaign? a correspondent asked. Dr. Brundtland said she had written to African leaders about that issue, because national and community involvement was important. Environmental efforts were part of the programme and would have to draw on both local knowledge and experience and expert advice.

Ms. Bellamy said improved hygiene and sanitation were part of UNICEF's child focus. Although there was greater access to clean water, there had not been similar improvements in sanitation.

Mr. Speth said the environmental setting, including standing water and sanitation, was very important and more could be done in those areas.

In response to a question on how the campaign would be financed, Mr. Goal said the involvement of stakeholders at the country level and the governments was an important part of the partnership. It was, therefore, important to get their estimate of what they could achieve with current funding levels and what they could achieve with a 10 or 50 per cent increase in funding. For example, in coming years, an estimated 30 million bednets at a cost of $4 to $5 each would be needed in Africa.

Mr. Wolfensohn said funding was less of an issue than getting governments to focus on malaria. The prevention tools were not expensive, but they did require money, organization and focus. Bednets had to be distributed and treated regularly with insecticide. There must also be appropriate training and availability of quick and effective treatment for children -- all issues which UNICEF, the UNDP and the other partners were working on. The financial issue could be dealt with. The other issue was systemic: the problem had to be

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approached in an orderly and concentrated way, either as stand alone projects or as part of an overall national health programme. The current campaign would increase visibility and allow the agencies to get government agreement. However, research funding was needed and the drug companies would have to be approached for large amounts of money.

Ms. Bellamy said Uganda and the United Republic of Tanzania had recently drastically reduced taxes on mosquito nets and insecticides, and that was one example of how governments could have an impact on helping reduce malaria.

Drug companies were not interested in malaria research because there was not much money in it, a correspondent said. How could that attitude be changed? he asked. Mr. Goal said there had been concern about that issue for about three years. He had been working with a group from the private sector and a public sector foundation to facilitate finance.

A correspondent asked if it was possible to create a kind of Turner Fund made up of the large drug companies. Dr. Brundtland said she had had a dinner last night with representatives of foundations and the pharmaceutical industry to explain WHO priorities and the effort to raise interest in the Roll Back Malaria and anti-tobacco initiative. She was trying to get information out there about the broader effort. The Turner Foundation had sponsored cross agency efforts.

David Nabarro, currently head of health at the United Kingdom Department for International Development and incoming WHO project manager for the Roll Back Malaria campaign, said that when the leaders of the G-8 had met in Birmingham earlier this year, the United Kingdom had committed about $90 million to the campaign over the next few years. There was evidence that several other countries would also get behind it. Leaders of the donor nations realized they could no longer ignore the calls for help from leaders of African countries and others affected by malaria. They also realized there was now a real opportunity to make a difference.

In response to another question, Mr. Goal said there had been a steady decline in the involvement of drug companies in vaccine and drug development, because malaria was, above all, a disease of poor people in poor countries. Currently, SmithKline Biologicals was the only company still active in the field. It was sponsoring a trial in the Gambia, and the results would be available within six to 12 months.

After the massive campaign in the 1950s by the WHO and UNICEF to eradicate malaria, many had concluded that the battle was a drain on resources. Was the new campaign a reflection of a new reality? he asked. Dr. Brundtland said many had believed malaria could be eradicated, but experience had shown it was an impossible task. Now, new tools, such as the bednet and new medications to treat sick children, made it possible to get good results.

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