Will talk of eradicating malaria lead to failure to control it? Will we repeat the experience of the 1950s when malaria was significantly reduced worldwide only to return stronger and more resistant than ever when the world slackened its commitment and failed to finish the task of eradication?
The disease, which is preventable and treatable if caught early enough, takes a million lives a year, ridiculously unnecessary.
These questions are bubbling through conversations among scientists who have long worked on this disease. Priya Shetty presents an overview in an article on SciDev network blog.
The concern is significant. The risk of losing momentum and falling back is too great to contemplate. And it appears this risk is even greater as the Obama administration scales back funding for global health.
The challenge facing global health advocates is to communicate more effectively to a growing audience of constituents that the effects of the diseases of poverty can be reduced and this is beneficial in multiple ways and that we need a sustained global commitment to comprehensive approaches, not just a single approach to individual diseases.
Malaria is related to poverty so directly and intimately that the disease ought not to be separated from economic development and empowerment. If it’s true that a quarter of the adult workforce is disabled by malaria in some African countries at any given moment, then malaria is a tremendous drain on productivity and a significant impediment to a strong economy. To treat the disease in isolation from this context is myopic.
Similarly, if significant numbers of children miss school due to the disease it’s an educational barrier, and if mothers must care for their sick children and are unable to carry out other tasks, it’s detrimental to healthy families. How can one speak of these social costs apart from treatment, prevention and control?
There is also considerable discussion about social entrepreneurship as an approach to economic development that will replace traditional humanitarian bureaucratic responses. The storyline here is that traditional approaches are slow, unable to adapt when new circumstances present themselves, focus on scale to the loss of unique solutions to local needs, and wasteful. In contrast it is said that social entrepreneurs can move quickly, receive instant feedback, change and adapt.
This either/or thinking frames strategies and tactics by reducing possible solutions to a single methodology. This may work in some instances and be too limiting in others. Just as large bureaucracies lose flexibility, so too, may single solution approaches.
I would argue that we need to view poverty and the diseases of poverty with flexibility, recognizing that a multitude of approaches is needed. But what is not needed is destructive competition that sets one disease against another for funding, research and treatment. Nor competition for funds for control, research or treatment. They are all part of a whole as malaria is part of a social and economic context.
The debate should not be about whether the world supports bednets or eradication research. The challenge we must take up is to communicate to people of goodwill that these diseases and their reduction is part of a holistic approach to how we live in this interrelated global environment and we all need to be helping each other in concrete, specific ways because it’s in our best interest. And, a side benefit is that we’ll feel better ourselves if we do it well and even better when we succeed.