- The Washington Times - Wednesday, May 4, 2005

Special correspondent John Zarocostas asked Dr. Edward Hoekstra, UNICEF senior health adviser, about the global campaign against malaria, especially in heavily affected sub-Saharan Africa.

Question: What is UNICEF doing in sub-Saharan Africa to combat malaria?

Answer: Well, malaria is one of the worst diseases we have. Nearly 3,000 children die every day of malaria, and UNICEF is putting a lot of its people on the ground to make it disappear.

We have projects in Malawi, in Mali and 14 other West African countries, where we basically provide pregnant women with bed nets. It’s a community-based program, and as soon as a baby is born, we make sure that baby also gets a bed net. We provide vaccinations at the same time.

And if youngsters do get ill, we make sure that the health care workers have access to the anti-malaria drugs that are needed.

Q: A lot of the people live in isolated rural areas. How are you overcoming this logistical problem of getting medicines to the people in need?

A: This is absolutely true — most of the people at risk are in very difficult areas. They are the poorest of the poorest in the world. This is what UNICEF does best. We work with communities to make all this happen, and we are there in these communities working with their leaders and the health care professionals, training them and providing them with the drugs and the bed nets.

Q: There’s been growing resistance of mosquitoes to standard anti-malaria drugs. Is this increasing the cost of combating malaria?

A: At this moment, we see more and more malaria from mosquitoes specifically resistant to older anti-malaria drugs, so we need to use newer drugs. They cost $2.50 per treatment at first, and that was 10 times as expensive as in the past.

But these prices are already going down to around $1 [per treatment], so its getting more and more affordable. There is still a shortfall. We have about $600 million this year to combat malaria, but we need up to $3 billion to do the job as it should be done.

Q: The Americas and Asia have done well in the past few years in reducing the number of cases of malaria, but Africa is trailing behind. Why is that?

A: The main reason Africa is trailing is that it is dealing with a different kind of malaria. The malaria parasite is different in Africa, and more deadly. So, of the people who get malaria, more people in Africa that have it will die than in the other regions. That’s why it’s more difficult to stop malaria in African countries.

Q: Are they also more drug-resistant varieties?

A: The specific killer mosquito, let’s say, is also more or less affected by drugs that are used against malaria in Africa.

Q: There’s been some controversy about the shortage of Artemisinin-based combination therapy (ACT) drugs. Can you elaborate on this?

A: I think that with the ACT drugs, one of the issues was that it was more expensive. We know that it is more effective.

In areas where you have malaria and old ways of giving anti-malaria drugs are not very effective, kids continue having malaria and are not getting better. Of course, having a better drug is more important. If they can’t afford it — and that was the fear in a lot of countries — and you ask countries to buy only the new drug, you may not have the old drug available in a few years, and there would be no treatment.

The problem is that if you use drugs for malaria that are not effective, the child will remain ill or even die. By using more expensive anti-malaria pills, you may be more effective but they may not be affordable or accessible for the poorest populations. So countries have to have a financial transition from the old drugs to the new drugs.

But it is definitely true that the new drugs are more effective for those areas where malaria has become resistant.

Q: What about more simple measures like pesticide-treated bed nets. How effective are they in protecting people, especially children younger than 5?

A: They are very effective. If you have more than 60 percent of children under 5 years old dying of malaria, you actually find a mortality reduction of 50 percent [by using pesticide-treated bed nets]. That’s quite a lot.

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