One of the goals of the Roll Back Malaria (RBM) Partnership – launched in 1998 by the World Health Organization, the United Nations Children's Fund (Unicef), the UN Development Program (UNDP) and the World Bank – is to mark 2015 as the year in which malaria is eliminated as a major cause of mortality and as a barrier to social and economic development growth anywhere in the world. AllAfrica's Cindy Shiner asked Dr. Awa Marie Coll-Seck, executive director of the partnership, about its campaign.
You grew up in Senegal – what is your personal experience with malaria?
Everybody living in endemic countries has had experience with malaria. I myself had malaria several times, but I grew up in a family where my father was a medical doctor and my mother a teacher. Because of that they took care of us, using all possible means for prevention.
We took chloroquine (as a prophylactic) every day in the rainy season. This worked very well, which is why we have resistance [to the drug] now – because people were taking too much. My brother was always crying he didn't want it. One day he had cerebral malaria and we went very quickly to the hospital – we were lucky because he was saved.
As a medical doctor and also and as a pregnant woman – I had four children - malaria and how to protect myself and my children was always on my mind. I specialized [as a physician] in infectious diseases and I worked at a clinic to which more severe cases of malaria were referred. Forty to 50 percent of the beds in the infectious clinic were [occupied by malaria patients].
On the international level I have worked with AIDS but when I came back to my country as minister of health for three years… malaria was a priority.
What excites you about the Roll Back Malaria campaign?
At the beginning, in 2000, malaria wasn't on the development agenda or the international agenda. Today malaria is on the agenda. We had 60 million [U.S. dollars] for malaria at the international level and now we have almost a billion dollars and we have more and more partners. RBM has been working to make sure they are coordinated and that they try to harmonize their work.
We are now implementing what the Aids community was calling the "three ones": one plan for a country, one coordinating mechanism and one monitoring and evaluation system. This is something we are pushing at the country level more and more. Today we are starting to see success stories – some countries went from two percent of coverage by long-lasting [treated] bednets to 80 percent today… [In others] we also have [malaria-related] morbidity going down, mortality going down."
A lot of things need to be done, but at least people today can have hope that control is possible. We will be working hard to do that for more countries and maybe one day be more ambitious and decide to eliminate malaria. Ten years ago and five years ago it was difficult to see concrete progress.
How would you describe RBM in its battle against malaria? Are you where you want to be?
I think we are really on the way to success for countries. It is thanks to all the RBM partners supporting countries in their work. But we need to increase what we are doing, scale up all of the interventions. A lot of work remains, but at least now we know how to do things, we know how to work together.
You have been working on the Affordable Medicines Facility for Malaria for more than a year and are looking to launch it in six months. How would it work?
We are doing the Affordable Medicines Facility because we have seen that two-thirds of people are getting medication in the private sector. We have a system to support the public sector with new drugs like ACTs (artemisinin-based combination therapies) and if we want to be really efficient we have to reach the whole population.
Chloroquine is not working anymore and mono therapies of artemisinin are not good because they will create resistance. One of the problems of ACTs is the price. We want a subsidy… so that ACT will arrive in the country at the price of chloroquine and the facility will put up money for the difference. We think that if ACTs are the price of chloroquine this will increase access and will diminish mono therapies.
Today in the private sector an ACT costs 10 dollars, the mono therapy six dollars and chloroquine less than 10 cents. With the subsidy people will have access to good medicine but at the price of chloroquine, which they can afford.
How instrumental is the private sector in the fight against malaria?
The private sector is part of RBM and is playing a role on at least two levels. The first one is that the private sector is in charge of producing commodities. We would like, and we are pushing them, to have quality products that are affordable for the population and to have production at the level of demand. We are working a lot on demand forecasting.
The second role for the private sector is through the people they are working with. For example, ExxonMobil has many thousands of people working in their industry. They have all the good treatment with the ACTs, they also work on prevention and they give bednets to their workers. Often if they can use indoor spraying, they do that in the community in which they are working.
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The private sector also works in partnership with the government in a lot of countries. In Ghana, when pregnant women visit the health facilities they can be given a voucher and they can go to a place – a gas station just near their home – where they buy a net for half price.
In conclusion?
I don't want to be misunderstood that everything is fine and rosy. We have a lot of challenges. The first is for people to realize that control is possible, because without that confidence fundraising for countries will be difficult. We need to communicate success.
We need also to raise money in a sustainable way. Also we have some problems with human resources in countries. All of this needs to be taken into account if we want to scale up and have an impact on malaria.
If we do not receive technical support, money for intervention and to buy commodities… we will continue to lose [economically]. We will continue to see people dying, we will continue to have health systems overburdened because of the numbers of people coming in with malaria. Productivity will continue to be impacted and we will not meet the Millennium Development Goals. All of this is necessary for people to understand that investing in malaria is investing in development.
