On May 12, the Senate Homeland Security and Governmental Affairs Subcommittee on Federal Financial Management, Government Information, and International Security held a hearing to examine the U.S. Agency for International Development’s (USAID) efforts to combat malaria.
Sen. Sam Brownback (R-KS) testified before the subcommittee and summarized his legislation to combat malaria. The Elimination of Neglected Diseases (END) Act (S. 950) would direct the secretaries of state and health and human services to develop a comprehensive, integrated, five-year strategy to set priorities for the use of U.S. assistance for programs to combat malaria, tuberculosis, and other infectious diseases in developing countries. Under the bill, a coordinator of United States government activities to combat malaria globally would be established within the Department of State to coordinate all programs, projects, and activities related to malaria. In a press releasing announcing the introduction of S. 950, Sen. Brownback stated, “To the world’s shame, the treatable and preventable infection of malaria has been largely ignored…Drugs to cure the infection cost about $2. But we also know how to prevent the disease. Spraying tiny amounts of insecticides inside homes, and placing insecticide-treated bed-nets for people to sleep under would stop malaria in its tracks. Many people don’t know that the U.S. and most of Europe were once malaria hot spots. In rich countries, we eliminated the disease with concerted effort. Now it is time to apply the same effort to poorer countries.”
USAID Deputy Administrator for Global Health Michael Miller summarized the agency’s comprehensive strategy to battle malaria, which incorporates three components: prompt and effective treatment with an anti-malarial drug within 24 hours of onset and fever, prevention of malaria through the use of insecticide-treated mosquito nets (ITNs) targeted to young children and pregnant women, and the provision of intermittent preventive therapy (IPT) for pregnant women as a part of standard antenatal services. Stressing the need to treat pregnant women, he stated, “Each year, more than 30 million African women are at risk for Plasmodium falciparum malaria infection during pregnancy. Infection during pregnancy leads to anemia in the mother and the presence of parasites in the placenta. The resulting impairment of fetal nutrition contributing to low birth weight (LBW) is a leading cause of young infant deaths and fetal underdevelopment in Africa. The prevalence and intensity of malaria infection during pregnancy is higher in women who are HIV-infected. Women with HIV infection are more likely to have symptomatic infections and to have an increased risk for malaria-associated adverse birth outcomes.” Mr. Miller explained that USAID is working in a coalition to help African countries “implement IPT and distribute ITNs as part of a package of health interventions at the antenatal clinic level,” adding, “Over the last year this technical assistance contributed significantly to revision of outdated policies in Senegal, Ghana, Rwanda, and Zambia, and to increased implementation of revised policies in the Democratic Republic of Congo, Tanzania, and Kenya.”
Roger Bate, U.S. director for Africa Fighting Malaria, criticized USAID’s anti-malarial programs, stating that the agency “has influenced the construction of a system wherein the vast majority of funding for malaria either never leaves the United States or funds the employment of US citizens; it ensures Congressional support by maintaining key beltway contractors who lobby for increased funding; it spends less than five percent of its malaria budget purchasing actual life-saving interventions; and lastly, it bases its choice of malaria interventions on extraneous political consideration, not on best practice, unnecessarily costing lives.” Pointing to Ghana, where USAID grants were mostly provided for technical assistance, he noted that “an additional $200,000 line item is allocated to another popular spending destination, ‘malaria in pregnancy.’ The description for this activity read, ‘Provide direct support to policy revision that included introduction of intermittent preventive therapy [IPT] for pregnant woman during routine antenatal visits.’ As in nearly every description in the USAID report, no indication of the manner of ‘support’ (or ‘assistance,’ ‘strengthening’ etc….) is provided. What is certain, however, is that USAID did not use the funds to buy the medicine that IPT uses to protect pregnant women from malaria.”
Malaria Control and Evaluation Program in Africa Director Carlos Campbell addressed the END Act: “The appointment of a malaria coordinator, the creation of a Malaria Scientific Review Board, identification of CDC [Centers for Disease Control and Prevention] as a key agency on public health initiatives, the requirement for a strategic plan, and an emphasis on reduction in disease burden are excellent. However, some of the proposed components should be strengthened or eliminated, and this could result in a truly major step forward in the U.S. global leadership.” Explaining that the bill would emphasize the procurement of specific treatment and prevention methods, he stated, “The requirement for 55% of funding to be applied to indoor residual spraying is potentially a self-defeating and limiting approach. The important discussion should not be on DDT or the efficacy of IRS [indoor residual spraying]. It could appear that the U.S. is dictating to countries what their national policy should be. Second, and more importantly, while the U.S. may provide indoor residual spraying materials, who will provide the infrastructure support required to deliver indoor residual spraying? This stipulation might preclude the most malarious areas of Africa from accessing malaria control support.”
