Charles Cobb, Jr.
11 January 2008
interview
Washington, DC — Every day, 3,000 African mothers bury children killed by malaria. It is the leading cause of death for children under five in the continent and last year an estimated 1.2 million lost their lives to it.
Yet in many ways a disease that arguably wreaks more havoc than any other seems almost forgotten. Two years ago, in June 2005, President George W. Bush launched a "Malaria Initiative"—a five-year US $1.2 billion effort to fight malaria in Africa. Its goal is to reach 85 percent of the most vulnerable groups – children under five and pregnant women – with proven and effective prevention and treatment measures.
The head of this effort — Admiral R. Timothy Ziemer — the first-ever U.S. Malaria Coordinator – says the goal has been achieved in 15 targeted African nations. AllAfrica's Charles Cobb Jr. spoke with him.
Was there some specific trigger for the malaria initiative? Malaria could almost be called an ancient disease, so why now?
In 2005, just before the G8 (Group of Eight) conference, the President was contemplating health on the G-8 agenda and wanted to keep it there. He has consistently brought international health to the agenda… I think it's really important strategically… HIV and Aids has been one of his key priorities and he has funded that from the very beginning. In 2005, I can't attribute it to any person, but the malaria problem hit his radar screen and when he understood the impact that it was having economically, socially [and] healthwise, it became clear to him that he wanted to elevate that on his priorities.
So he basically set, above and beyond his current agenda, 1.2 billion dollars [for malaria] from 2005 to 2010. There was little money coming in in 2005, but If you look at the funding projection we have accelerated in 2008, 2009, 2010, with 300, 300 and 500 million dollars, so it's a ramp-up through 2010 with specific targets and goals – very much like Pepfar (the President's Aids initiative).
We learned from the Pepfar experience and took away a lot of the best practices. We focused in on 15 of the most endemic countries: on countries that had demonstrated leadership on the national level, that understood and wanted to take care of their people, had strong national malaria control plans, could manage finances with other financial instruments like the Global Fund and the World Bank – so the U.S wouldn't be the only partner but could be a major partner and leverage funding with these other funding sources – and lastly be willing to work with the United States.
The goal of the President's Malaria Initiative (PMI) is to reduce mortality in those 15 countries by 50 percent over the five years. Now those weren't U.S targets, those targets are consistent with the Abuja targets, the Millennium Development Goals and the World Bank malaria goals. Basically the funding was to target the most vulnerable population groups: kids under five years – they are very, very vulnerable to malaria because they haven't built up immunity – and of course pregnant women – as they go through their pregnancy cycle they also are vulnerable, not just getting sick and getting anemic but also it affects development and healthy birth. And so we target the money to cover the entire population group in a country and our coverage is 85 percent of those two population groups.
Your coverage goal is 85 percent, Are you achieving that sort of coverage?
We have met it to date. We're going to be able to [continue meeting] that easily. One other thing from the big picture: the President realized that 1.2 billion is just a drop in the bucket. When you look at the international World Health Organization and the Roll Bank Malaria costs and requirements per year, we're at about four billion a year to try to get a handle on malaria.
So with U.S. Government money and Global Fund money – of which 30 percent is U.S money anyway – it still isn't sufficient to bring enough resources to the table. So President Bush challenged the private sector to step up to the plate… to see if they would match the 1.2 billion. This is an operating principle that he's injected throughout…
I am the new kid on the block here but I have seen that the private and the business sector is stepping up to the plate. Certainly the Gates Foundation is there and has been significantly but also other organizations like the UN Foundation and Nothing But Nets [campaign of providing mosquito nets to save children from malaria], Malaria No More and Exxon Mobil. Some of these other corporate partners are stepping up not only with cash but also contributions in kind that are helping to round out, focusing in on the national malaria control plan. So it's really kind of neat to see all the partners coming in together to take on our host countries' malaria requirements and do what we can to fill those gaps.
What about other governments, their primary contribution is via the Global Fund? Is that basically correct?
As a generalization, I would say yes.
What about additional funding from other governments, particularly governments in the G8? Is that part of your effort?
I would say through the G8 and through our bilateral efforts through the State Department and by the President himself, he is encouraging everybody , all governments to step up to the plate as they can. If they want to fund through the Global Fund or through the World Bank, that's fine. There are numbers of different vehicles that countries prefer to use and that's okay.
You were in Africa recently, Mali, Madagascar, where else?
We were in eight countries and every country we've gone to we try to have a jump start. A jump start is either just a media launch or more preferably to team up with an existing health day [event].
In Angola we teamed up with the Red Cross, and… a measles vaccination and deworming and Vitamin A [effort], and so since the government had already communicated with the media and the networks were in place, the US government, USAID, PMI then came along with our net distribution money and we just piggy-backed on that whole network. What was interesting in Angola was the business interests – they also participated and they made a significant contribution of several millions of dollars which brought a lot of nets and so they also complemented the net distribution campaign.
We've also done this in Uganda and Tanzania. The countries you have just mentioned – Madagascar, Benin and most recently Mali – have used that model and we've found it to be very successful and we intend to do that as often as we can. In fact we are looking right now at four to five additional campaigns next year with the Red Cross and our multilateral partners.
This is good for two points: it allows our business and our private partners to jump in and be part of something significant and they can do it very well because this is a kind of a "onefer". When you get in to program development and trying to tackle some of the systemic problems, HR, buildings , training, it's more difficult for the private funders to jump in and do that. So the national campaigns are real good for awareness and catch up, and to fill existing gaps and then make the long haul a little less long because we are filling some of these holes.
On these journeys, did you learn something that you didn't know in terms of the impact of the disease or how the disease is being fought?
We're always learning different things. What I have seen here is the different lead partners in every place. In Benin the lead partner was the World Bank, where the majority of the funds came from the World Bank because Benin was their first booster country. In Madagascar the lead funder was the U.S. Red Cross and UNICEF. In Mali it was the Canadian Red Cross and CIDA (Canadian International Development Agency). What I learned is that there are multiple partners out there all with the same intent and if we collaborate early enough we can actually leverage everybody's resources really to benefit the host countries' needs.
Other lessons learned are real simple – it's just the logistics. Can we in fact move two million nets in a week in a country like Benin or Mali? That is no insignificant task and it took the Canadian Red Cross staff six months of in-country planning to man, to rehearse to get four to five thousand distribution sites up and running.
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