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Why Consensus In Malaria Policy Is a Killer Font Size: 
By Roger Bate : BIO| 10 Nov 2020
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Last week the Roll Back Malaria (RBM) Partnership, a coalition of multilateral organizations whose aim is to halve malaria by 2010, joined World Bank chief Paul Wolfowitz in musical concert at the Bank to remind the public that the disease is still the leading killer of African children. They called upon development experts and anti-malaria advocates to "Unite Against Malaria," a disease which kills at least a million people worldwide each year. Yet RBM is unlikely to revive its failing campaign by demanding consensus.

Irreconcilable differences are fundamental to human nature because so much of life itself is uncertain. Malaria is no different. It is a complex disease whose control strategies must be tailored to a specific context, location, parasite and vector. Debates about which tools and strategies work best are fraught, but there are some things that can be agreed upon.

To this end, RBM's follow-up to the World Bank event was a "messaging meeting" intended to get US and global anti-malaria advocates speaking with one voice on the basics of malaria. Controversial topics about which organizations would likely disagree were avoided. Instead, the very basics of malaria, its dangers, and methods of control were paraded around the group by an expensive P.R. firm. The very same end could have been achieved by emailing a summary paragraph to the group from RBM's 2005 World Malaria Report. Ultimately, RBM spent a huge amount of money over two days to achieve little, including few news headlines.

This effort was typical of the way the United Nations (UN) system works. Consensus is required to initiate action, and so irreconcilable differences among countries routinely impede progress. What RBM neglects to realize is that controversy has driven the most significant evolutions of malaria control efforts in the past eight years.

The Abuja Summit to Roll Back Malaria in 2000 brought together 44 African countries to agree on specific malaria control targets for 2005, notably covering 60% of at-risk populations with nets and drugs and allocating 15% of country budgets to healthcare. Everyone signed up and almost no one met any of the targets, few even really bothering to try.

In 2004, a team of researchers looking into failing malaria control policies published evidence that the Global Fund to Fight AIDS, TB and Malaria, in conjunction with other partners, were routinely funding outdated drugs. The study made headlines around the world and the result was a dramatic change in the way donors set treatment policy and fund drugs. In 2005, I was involved with a different group of researchers in a study of USAID's malaria control spending, revealing that it devoted around 90% to consultants and technical advice instead of life-saving nets, drugs and insecticides. Various Congressional hearings used this information to put pressure on USAID to account for its policies. The result was a complete redesign of the organization's malaria control operation.

In 2006, Dr. Arata Kochi, new head of WHO's Global Malaria Program, successfully courted controversy from within the RBM Partnership. He made public a list of drug companies producing Artemisinin monotherapy drugs, arguing that this defied WHO's revised malaria treatment guidelines, and would lead to drug resistance and the loss of a valuable weapon against malaria. The result was that about half of the companies agreed to start making the drugs in combination. More recently Dr. Kochi reissued WHO's indoor residual spraying (IRS) guidelines, noting correctly that IRS with DDT was uniquely effective against malaria but consciously sidelined by donors wishing to avoid environmentalist scorn.

RBM's response has been to marginalize Dr. Kochi. Shockingly, neither he nor the Washington, D.C. WHO representative were initially invited to the RBM event at the World Bank last week. Although this author has published more about the World Bank and malaria over the past year, perhaps than anyone else, he was also not invited. The obvious reason for the WHO omission is that in spite of pushing consensus RBM does not want the WHO - a founding RBM partner - involved in its public relations efforts.

Indeed, the woeful RBM partnership (including the reforming USAID, the obstinate World Bank, the dysfunctional UNICEF and many from the private sector) continues to promote its ludicrous target of halving malaria deaths. I say ludicrous because RBM has no real idea of what constitutes malaria rates today (something most accept when you ask them), so halving rates is just a PR gimmick. It set the target in 1998, to be reached in 2010, and still hasn't tried to estimate death rates properly in 2006 - the World Bank at least is trying to measure death rates. But far more damaging is RBM and the Bank's search for consensus; the consensus desired is more of the same policy (bed nets and drugs), which hasn't worked (or at least not noticeably) since the best estimates show malaria rates are increasing.

RBM is currently undergoing a much needed and anticipated "change process." But instead of employing expensive consultants to help it change, it should just allow divergent views on policy. RBM seems to stick its head in the sand, and simply doesn't invite those with different ideas. As long as consensus remains, policies will stay the same, and more African children die.

I had hoped that with major change occurring at USAID, with policies being enacted that will save lives and with the new head of malaria at WHO making lots of sense, and with a rational head of the World Bank, that RBM would embrace change. But apparently not.

Its time to Roll Back RBM. Scrap it and let WHO's Dr. Arata Kochi lead on disease control policy.

Dr Roger Bate is a Resident Fellow of the American Enterprise Institute.

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