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Sun May 29 09:46:36 CAT 2016

Obama’s goal to wipe out malaria may be a dream too far

GARDINER HARRIS | 18 January, 2016 13:19
The pledge sent a frisson of excitement through researchers and philanthropic organizations focused on malaria, a disease that remains one of the top killers of children around the world. File photo
Image by: HANDOUT / REUTERS

Two days before delivering his last State of the Union address, President Barack Obama called one of his top advisers into the Oval Office and said he had decided to add a major pledge to the speech that his team had neither discussed nor vetted: to rid the world of malaria.

“It was his belief that we were nearing a kind of tipping point when we should set a major goal of eradicating malaria,” said the aide, Benjamin J. Rhodes, a deputy national security adviser.

Rhodes was given 48 hours to make sure the president could follow through on his commitment.

The result was two sentences about how, in part through American commitment, the world could soon “end the scourge of HIV/AIDS.”

“And we have the chance to accomplish the same thing with malaria — something I’ll be pushing this Congress to fund this year,” Obama said.

The pledge sent a frisson of excitement through researchers and philanthropic organizations focused on malaria, a disease that remains one of the top killers of children around the world.

“What the president said in the State of the Union really matters,” said Martin Edlund, the chief executive of Malaria No More, an advocacy group. “It’s a really big deal.”

Other experts were skeptical. Dyann F. Wirth, the director of the Harvard Malaria Initiative, is one of many malaria experts who have expressed doubts that the disease can be eradicated in the near future.

“I do not believe that we have the arsenal that could lead to eradication,” Wirth said. “But it is true that the disease is interruptible. That’s been done in many places, and that is not trivial.”

Obama’s fight against malaria builds on that of President George W. Bush, who as an outgrowth of his work against HIV/AIDS in Africa began the President’s Malaria Initiative with a five-year, $1.2 billion initiative that received $30 million its first year to, among other things, distribute insecticide-treated mosquito nets in Angola, Tanzania and Uganda.

Under Obama, the President’s Malaria Initiative has grown into a $618 million program that works in 19 African countries as well as the Mekong River region of Southeast Asia. The program continues to distribute mosquito nets and pays for household insecticide spraying and the rapid diagnosis and treatment of the sick.

The program accounts for a significant portion of global spending on anti-malaria efforts, which reached $2.5 billion in 2014. The U.S. government is responsible for about half of the total, and about half of America’s spending comes from the president’s initiative.

Despite undeniable progress, serious challenges remain. Malaria deaths have fallen by about two-thirds since 2000 — in large measure because more than half of Africa’s population now sleeps under mosquito nets, compared with just 2 percent in 2000 — and 6.2 million lives have been saved. Even so, last year the world had an estimated 214 million new malaria cases and 438,000 deaths. Of those fatalities, 91 percent were in Africa.

Experts note that the decades spent on the as-yet unsuccessful campaign to eradicate polio demonstrate the profound challenges of ridding the world of a disease, and malaria could prove an even tougher fight. Nets wear out, for example, and resistance develops to pesticides and drugs. Resistance to artemisinin, a recently discovered malaria-fighting compound, is already widespread in Southeast Asia.

More important, there is no malaria vaccine — several are in development, but none is consistently effective. Some experts believe a vaccine will never be made, in part because surviving a natural infection does not produce lifelong immunity.

But Obama’s anti-malaria pledge is optimistic, and perhaps was influenced by the remarkable success over the past year of efforts to fight the Ebola virus and climate change. Rhodes said that somewhere in the stack of books and briefing documents that Obama took on vacation to Martha’s Vineyard this past August is the reason he became aware of the success of previous anti-malarial efforts.

Yet Obama’s travels in Southeast Asia and his relatives in Africa gave him “a human understanding of the toll that malaria takes on communities,” Rhodes said.

Obama subsequently mentioned malaria in his speech to the U.N. General Assembly in September, calling it “a moral outrage” that “many children are just one mosquito bite away from death.” But his focus on achieving a climate deal in Paris in December left him little room for a new major international commitment, Rhodes said.

Once that was done, along with the Iran nuclear deal and the Trans-Pacific Partnership trade accord, Obama “wanted to set out the next areas where we have a sense of mission, and malaria was ripe to take that place,” Rhodes said.

Interestingly, while Obama made his malaria pledge in part because he had finished a global climate accord, one of Bush’s advisers said he had tackled malaria in part because he had renounced one.

As Michael Gerson, a top White House adviser to Bush, tells it, in preparations for a 2005 summit meeting of big industrial nations in Scotland, Tony Blair, the prime minister of Britain at the time, listed two priorities for the talks: climate change and Africa. Having renounced the Kyoto Protocol on emissions within months of taking office in 2001, an action that outraged some Western allies, Bush knew he could not do anything on that issue to mollify the Europeans, Gerson said. So that left Africa.

Gerson, who had traveled extensively in Africa to oversee the Bush administration’s fight against HIV/AIDS, said that when he returned from his trips, “I would have lunch with the president and talk with him about malaria as part of the discussion of what I saw and found.”

Bush, he said, became interested in the mosquito-driven scourge and, looking for something to take to Scotland, decided to attack malaria.

For Obama, the success of the campaign against the Ebola virus was an additional inspiration, said Gayle E. Smith, the administrator of the U.S. Agency for International Development.

The United Nations declared on Thursday an end to the Ebola epidemic in West Africa, although the World Health Organization said the next day that a body in Sierra Leone had tested positive for the virus.

Smith said Obama had “looked at malaria and concluded that if we combine the continued progress, our leadership and another big international push, we can actually get to the point of eradication.”

One challenge that remains is the task of getting new money from Congress, although Sen. John Boozman, R-Ark., who has long been interested in malaria, said he was supportive.

“We need to build upon the success that we’ve had starting under President George W. Bush and continuing into this administration,” he said.

(c) 2016 New York Times News Service

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