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2002/12 Malaria (Embassies)
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In addition to the usual Action Sheet, Background and Speaking Points, this page also contains details of an extra action on TB - see the bottom of the page.
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EXTRA URGENT ACTION ON TB AND THE EU
URGENT ACTION
The European Union and TB control
Background
One-third of the world's population carries the organism causing TB although most are not actually ill from the active form of the disease. However, TB kills nearly two million people a year. It orphans millions of children and is the cause of death in more than a third of all AIDS patients. TB is today the single greatest infectious killer of women of reproductive age (15-44). Yet TB can be cured cheaply ($10 per patient) and reliably (95% cure rates) using the WHO’s DOTS strategy.
The Global Fund Against Aids, TB and Malaria (GFATM)
Set up in 2001 by Kofi Annan, this fund needs $7-10 billion per year to fight the three worst infectious diseases. So far it has just over $2 billion (total).
The Global Plan to Stop TB
This comprehensive, country-by-country assessment gives an estimate of the resources needed to tackle TB, mainly in the 22 high-burden TB countries (HBCs).
The European Union’s response so far
The EU has so far made encouraging noises, but little concrete contribution. They recently made a donation of $106.9 million to GFATM, which, in the context of an aid budget of $5.91 billion, fails to live up to the urgency of the situation. They have not yet contributed anything at all to the Global Plan to Stop TB.
What is in the pipeline?
Partly as a response to Results’ promptings, things are beginning to move in a more encouraging direction:
* - The Greens have put forward an amendment to the Commission’s budget proposal of 350 million Euros, increasing the figure to 512 million Euros. Part of this would include an increase of up to 128 million Euros to fight infectious diseases, of which 43 million Euros are to go to the Global Plan (over 4 years) and 85 million Euros to the Global Health Fund. The amendment has been accepted by the Development Committee, but not yet by the Budget Committee, making it possible that the Commission will reject it. A final figure of 400-450 million is likely.
* - A Proposal for a Regulation of the European Parliament and of the Council on aid for poverty diseases (HIV/AIDS, malaria and tuberculosis) in developing countries (Rapporteur Anders Wijkman) will be voted on by the plenary session of the European Parliament on Tuesday, December 17th. Once adopted this will provide an annual budget line for funding the fight against communicable diseases, and could offer a potential source of direct funding for the Global Plan.
* - Lib Dem MEP Elspeth Attwooll has tabled a priority question to the Commission addressing the shortfall in funding of the DOTS programme and asking “....does the Commission intend to take more immediate action to address this shortfall? Is the Commission aware of any action taken by Member States that is intended to fill this funding gap?”
* - The European Liberal Democrat and Reform Group is considering whether to put an oral question to the Council of Ministers at the Parliament’s next plenary session in January (13th-16th). If successful, this question would be followed by a debate in the chamber. Whether such a question will make it onto the agenda is a matter for negotiation with other groups.
ACTION
1. Write a letter or an email to your local MEP(s)
2. If you have not written about TB before, let them know about the urgency of the situation; if you have, refer back to your previous letter(s) and their replies
3. Bring them up to date on what is happening on TB in the European Parliament
4. Request that they vote for the ‘Proposal for a Regulation’ when it comes before the plenary session of Parliament on December 17th.
5. Make them aware that a further vote and debate on TB may happen in January
6. Ask for a reply
SPEAKING POINTS
EASY LEARNING EXERCISE - DECEMBER 2002
The Fight against Malaria
Malaria causes more than 300 million acute illnesses and at least one million deaths annually.
90% of deaths occur in Africa. Most are children.
An African child dies of malaria every 30 seconds and many who survive may suffer from learning impairment or brain damage.
Malaria has been estimated to cost Africa more than 12 billion US dollars every year in lost GDP, even though it could be controlled for a fraction of that sum.
The Abuja Declaration signed in April 2000 by many heads of state included a promise to reduce or waive taxes and tariffs for insecticide-treated bed nets (ITNs).
Unfortunately, 26 countries have failed to do this - including Malawi and South Africa.
Together with HIV/AIDS and TB, malaria is one of the major public health challenges undermining development in the world's poorest countries.
Taxes on ITNs must be eliminated if they are to be affordable to those most at risk.
MORE BACKGROUND
BACKGROUND SHEET - DECEMBER 2002
SUCCESS STORY - VIETNAM
Government commitment to malaria control in Vietnam, largely through the supply of free insecticide-treated bednets and the use of locally produced, high quality antimalarial drugs, has reduced the malaria death toll by 97% over a 5-year period from 1992-97. Meanwhile, epidemics of malaria declined by over 90%, with only 11 small outbreaks recorded during 1997.
The concerted drive against malaria has involved major investment in training and disease reporting systems, the use of mobile teams to supervise health workers in malaria-endemic areas, and the mobilisation of volunteer health workers.
A decade earlier, the prospects for malaria control were far from promising. Primary health care and malaria control networks were weak and malaria control was ineffective in many areas. The country was in the grip of an economic recession, donated supplies of insecticide had dried up, and migrant workers were carrying malaria into areas where it had once been eliminated. In 1991 alone, there were 144 epidemics of malaria. Over one million people were affected. To make matters worse, the drugs used to treat malaria were rapidly losing their effectiveness. Resistance to first-line malaria drugs was reported in all southern provinces and in some northern provinces as well. Malaria threatened to spiral out of control.
In the early 1990s, the Vietnamese Government took advantage of an upturn in the economy, increasing its investment in malaria control and identified the drive against malaria as a national priority. Coordination of malaria control efforts was stepped up and village health care networks improved. There was a major investment in training and supervision and mobile teams were set up to supervise health workers in malaria-endemic areas. Volunteer health workers were mobilised at community level. Disease reporting and epidemic forecasting systems were strengthened and supported by 400 mobile teams.
The first major breakthrough was the development and manufacture of a "new" drug - artemisinin - to treat severe and multidrug-resistant cases of malaria. The antimalarial drug, extracted from the indigenous Thanh Hao tree, had been used in traditional Chinese and Vietnamese medicine for centuries. It was rediscovered by Chinese scientists in the 1970s. In Vietnam, collaboration between industry and researchers led to local production of high quality artemisinin and other derivatives at low cost. The new drugs had a major impact on severe and complicated cases of malaria and helped reduce the number of deaths.
At the same time, there was a major expansion in efforts to prevent malaria. The number of people protected from mosquito bites by indoor house spraying with insecticides increased from 4.3 million in 1991 to 13 million by 1997. Meanwhile, the number of people sleeping under insecticide-treated bednets soared from 300,000 to over 10 million by 1997. Insecticide treatment of bednets is provided free of charge for people living in malaria-endemic areas.
Despite the recent successes, continued vigilance will be needed to prevent a resurgence of malaria in Vietnam. More than one-third of the population - over 26 million people - live in malaria-endemic areas. The country is prone to natural disasters, including drought, typhoons, and most recently storms and floods - all of which can spark off epidemics of malaria. Today the malaria control programme is working in close collaboration with malaria researchers in efforts to improve control measures and develop new drugs and treatment regimens for malaria. And Vietnam has also joined a regional initiative -- under the umbrella of Roll Back Malaria - aimed at reducing malaria deaths throughout the Mekong region by at least 50% between 1998 and 2010.
BACKGROUND
BACKGROUND SHEET - DECEMBER 2002
Children and Malaria
OF THE ONE MILLION or more deaths from malaria that occur worldwide each year, most are in African children under the age of five. Children in Africa south of the Sahara are vulnerable to malaria from about four months of age. In areas of intense transmission, young children may have as many as six episodes of malaria each year.
Of the more than 500,000 African children who develop cerebral malaria (a severe form of the disease that affects the brain) each year, 10-20% die and approximately 7% are left with permanent neurological damage. Children with malaria typically develop fever, vomiting, headache and flu-like symptoms. If untreated, the disease may progress rapidly (often within 24 hours) to convulsions, coma, and death.
Malaria is a major cause of anaemia in many parts of the world. Chronic anaemia may adversely affect a child’s growth and intellectual development. Repeated episodes of malaria may lead to severe, life-threatening anaemia. Blood transfusions may save lives in these circumstances, but also expose the child to the risk of HIV and other blood-borne infections.
The Roll Back Malaria global partnership is working to reduce illness and death in young children through:
* - Prevention: Children must be protected from the mosquitoes that transmit malaria. The best way to do this is to ensure that they sleep under insecticide-treated nets (ITNs). Studies in Africa have shown that ITNs can reduce deaths among under-fives by up to one-third.
* - Prompt recognition and effective treatment: There is an urgent need to ensure that effective and affordable antimalarial drugs or drug combinations are widely available to all individuals living in malaria-endemic areas. Since, in Africa, many people first go to their local store for antimalarial drugs, shopkeepers are now being trained to supply the appropriate dose and duration of treatment.
* - Anaemia: Parents and healthcare workers must be trained to recognise the clinical signs of anaemia, and to seek treatment. Malaria, nutritional iron deficiency and intestinal parasites (such as hookworm) are the most common and preventable causes of anaemia in much of the developing world.
* - Prevention of malaria-related low birth weight: Pregnant mothers must be encouraged to use ITNs and take advantage of Intermittent Preventive Treatment. This has been shown to increase birth weight, a major determinant of child survival.
ACTION SHEET
TAKE ACTION - DECEMBER 2002
The Fight Against Malaria - The Failed Promises of African Leaders
"To drop the tax would make no difference to the Government revenues, but a BIG difference to thousands of poor people. Come on Governments, act now! "
A comment from Malawi
ACTION:
1. Write a letter to the Ambassadors of Malawi and South Africa . Send a copy to Clare Short and to a newspaper of your choice.
2. Share your concern that African Leaders are not keeping their promises made at the Abuja Summit to drop Mosquito net taxes.
3. Say that over the past three years many countries have done so - but that 26 African nations are still charging taxes on treated nets, including Malawi and South Africa.
4. Call on Malawi, as one of the countries with the highest rate of malaria, to drop all taxes now.
5. Call on South Africa to drop taxes immediately and urge its government to demonstrate political leadership amongst African nations and ensure that profits are not being made from parents who are trying to protect their children from malaria.
6. Ask for a response.
WHAT IS MALARIA?
Malaria is a life-threatening parasitic disease transmitted by the female mosquito.
Today approximately 40% of the world's population, mostly those living in the world's poorest countries, are at risk of malaria. Typically, malaria produces fever, headache, vomiting and other flu-like symptoms. If drugs are not available for treatment or the parasites are resistant to them, the infection can progress rapidly to become life threatening.
Malaria causes more than 300 million acute illnesses and at least one million deaths annually. Together with HIV/AIDS and TB, malaria is one of the major public health challenges undermining development in the world's poorest countries.
MALARIA IN AFRICA
Ninety per cent of deaths from malaria occur in Africa, south of the Sahara, mostly among young children.
* - Malaria kills an African child every 30 seconds. Many children who survive a severe episode of malaria may suffer from learning impairments or brain damage.
* - Pregnant women and their unborn children are also particularly vulnerable. Malaria is a major cause of perinatal mortality, low birth weight and maternal anaemia.
Malaria is Africa's leading cause of under-five mortality (20%) and constitutes 10% of the continent's overall disease burden.
THE COST
In Africa today, malaria is understood to be both a disease of poverty and a cause of poverty. Annual economic growth in countries with high malaria transmission has historically been lower than in countries without malaria. Economists believe that malaria is responsible for a ‘growth penalty’ of up to 1.3% per year in some African countries. Malaria accounts for 40% of public health expenditure, 30-50% of inpatient admissions, and up to 50% of outpatient visits in areas with high malaria transmission. Malaria has been estimated to cost Africa more than US$12 billion every year in lost GDP, even though it could be controlled for a fraction of that sum.
GROWING POLITICAL COMMITMENT?
The Abuja Declaration signed in April 2000 endorsed a concerted strategy to tackle the problem of malaria across Africa. It endorsed Roll Back Malaria's goal (to halve the world's malaria burden by 2010) and established a series of interim targets - for the number of people having access to treatment, protective measures or, in the case of pregnant women, receiving intermittent preventive treatment, to ensure that progress would be made towards the goal.
Since Abuja more than a dozen countries have reduced or eliminated taxes and tariffs on insecticide-treated mosquito nets (ITNs) to make them more affordable. Close to a third of African countries, representing almost half the population at risk have established ‘Country Strategic Plans' to achieve the RBM goal and the targets set in Abuja.
INSECTICIDE-TREATED NETS (ITNs)
Most malaria-carrying mosquitoes bite at night. ITNs provide a physical barrier to hungry mosquitoes. They tend to repel or deter mosquitoes from biting and shorten the mosquito's life span so that she cannot spread the malaria infection. ITNs therefore are considered one of the most effective methods for reducing malaria transmission and death. The cost of an ITN averages US$4.00. Research in sub-Saharan Africa shows that using ITNs can reduce significantly the number of deaths among children and pregnant woman. Surveys carried out in Gambia, Ghana and Kenya showed that sleeping under an ITN reduced the number of children dying from malaria by 25%, 17% and 33%, respectively.
One of the targets set at Abuja was to have 60% of populations at risk sleeping under ITNs by 2005. This will require 32 million nets and a similar number of insecticide re-treatments each year. To achieve this ITNs will need to be affordable.
However, cost and availability are two of the major barriers to the use of ITNs. Removing the taxes and tariffs on these products and the materials required to produce them would ensure a lower retail price, making them more affordable and more likely to be used. For instance, if a tariff of 40% is removed, then the retail price is likely to fall by 10% to 20%. In practice, taxes and tariffs on ITNs and their raw materials generates a very small amount of revenue for governments concerned. However, the cost in human misery and suffering caused by the unavailability of nets is significant.
ACTION NEEDED NOW BY MALAWI AND SOUTH AFRICA
Malawi and South Africa are two countries still imposing taxes and tariffs on ITNs thereby restricting their affordability and use, and ultimately leading to increased illness and death.
Malawi has the highest rate of malaria incidence on the African continent. The elimination of taxes and tariffs on ITNs is essential if lives are to be saved.
South Africa has the opportunity to lead the way amongst those countries still imposing tariffs on ITNs thereby setting an example to the rest of the African continent that few could fail to follow.
_________________________________________________________
RESULTS, 13 Dormer Place, Leamington Spa, CV32 5AA.
This action sheet uses material from Roll Back Malaria (www.rbm.who.int) and the Massive Effort Campaign (www.massiveeffort.org).
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