Disease weighs heavy on continent, but tools ease burden

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Special correspondent John Zarocostas interviewed Dr. Allan Shapira, the World Health Organization's coordinator of strategy and policy for Rollback Malaria, on Tuesday in Geneva. Dr. Shapira, of Denmark, was lead author of the joint WHO/UNICEF "World Malaria Report 2005."

Question: Dr. Shapira, why has Africa lagged behind in the fight against malaria compared with other malaria regions like the Americas and Asia, down by 20 percent? Are you confident looking forward you can also achieve this in sub-Saharan Africa?

Answer: Conceptually, we need to think differently. It's not so much containing the spread as reducing the burden that we are talking about in Africa. And here in terms of reducing the burden in Africa, we have data that indicates it's definitely possible. Eritrea, by getting the number of bed nets up to 60 percent, has had substantial reduction in malaria morbidity and mortality. We have recent local data on malaria mortality. In areas where they've used home-based treatment, mortality has gone down. In areas with high bed net coverage in Tanzania, mortality has gone down. In Zambia, where they've started using [Artemisinin-based combination therapy] all over the country, the overall mortality -- a good indicator of malaria mortality when there are no other major changes -- has gone down. There is absolutely no doubt that we have the tools simple, practicable to use for reducing malaria mortality and eventually also the number of malaria cases in Africa. But what's important to realize is that we will need to maintain the effort for many years.

Q: What about the health infrastructure? Do you think it's a handicap?

A: Yes, it is a handicap, but now with the kinds of investments that we are able to make thanks to the attention of donors, the existence of the global fund, we are able, not only to buy commodities but also to provide what is needed for improving the health infrastructure. We do not need very sophisticated things. We do not need more hospitals. In fact, we are going to need much less hospital beds for malaria.

Q: Is it a question of training the staff and the health workers?

A: Exactly. The key thing is to train the health staff and the health workers and also to take measures in terms of management so that they are supported and supervised and keep on doing their job.

Q: How much is logistics a problem? Some countries can take up to 16 months to complete the procurement of the drugs that are needed, while others can do it in less than six weeks. Is that one area where there can be substantial improvement, and secondly assisted by more funds from the international donor community? Could that help, as well?

A: These are managerial problems that can be solved, and the global fund is really showing now greater flexibility and innovation in solving these problems, and we are seeing countries responding very positively also. So, it's just doing it.

Q: This year, you have $600 million for the fight against malaria but you need at least $3 billion to manage the problem globally. That's quite a gap.

A: Yes, it's a big gap. Nobody says this is going to be easy. But what we can say is that of the major health problems in the world, malaria is the one that is now ripe for attack. So, I think that the rich countries and other donors are really highly motivated for stepping up their contributions.

Q: Do you hope to get some stimulus from this year's Group of Eight meeting on this with leaders from the world's richest countries to chip in with more cash?

A: I definitely hope, yes, that the G-8 meeting will be an opportunity where the rich countries will get together and see the light and make a strong commitment.