"It's consciousness-raising and movement building 2.0", said Arianna Huffington, co-founder and editor-in-chief of the Huffington Post. She went a step further by saying "...the goal of eradicating deaths from malaria by 2015 is smart, forward-thinking, and, given the growing reach of social platforms, very pragmatic". These words went along with the UN's start of a social media campaign that was launched on 15 March. Today, two weeks later, many more than 28 million people have heard about malaria from high-profile individuals. That’s impressive.
But what is the impact of all this? Tweets are nice but won't save lives, right? Following on from my previous post 'Malaria: When sudden beats chronic', I decided to dig a little deeper below the surface of the impact of news and reporting about malaria.
"Health for all by 2000"
It is June 1995. As I walk through the corridors of the St. Francis hospital in Ifakara, southern Tanzania, I see a beautiful poster with a picture of our planet, taken from space, taped to the wall in one of the wards. Above it the text "Health for all by 2000". A slogan that was masterminded in WHO's headquarters in Geneva, thousands of miles away. But I don't see any health around me. Ifakara had been struck recently by a devastating cholera epidemic, and without the necessary oral rehydration solutions available, people were dying like flies all around me. Army tents were erected outside the hospital to deal with the stream of patients coming in from just about everywhere in the district. In the malaria ward I then witnessed a shocking scene. I saw a wooden box, with eight babies lying in it, all in a row. Each of them had a needle stuck into their heads as a means to connect them to a drip with quinine. Their arms were simply too thin to stick a needle into. Six of them would not survive the vicious attack by malaria parasites. As the year progressed, the poster in the ward started fading, and eventually it fell off and nothing more than a piece of tape, left behind on the wall, reminded me of the "Health for all by 2000" campaign.
But that didn't matter. In Geneva a new initiative was on its way: The Roll Back Malaria initiative. It was launched in 1998. Followed by the Global Fund for HIV/AIDS, TB and Malaria, and then the Millennium Development Goals. And then the Grand Challenges in Global Health initiative of the Bill and Melinda Gates Foundation. On an ever bigger scale we aim to fight the diseases affecting the poorest on the planet. And as time progressed, advertising and marketing specialists got involved. The messages became more gripping, the websites more flashy. Malaria became a business in itself, an industry.
Today, more than 800 million people live in countries where formerly they ran the risk of contracting malaria. Europe, Russia, Australia, Taiwan, the USA. This is because shortly after WWII, two powerful weapons to combat malaria became widely available: the miracle drug chloroquine and the miracle insecticide DDT. The combined power of these weapons resulted in a total collapse of disease transmission and ultimately eradication in the aforementioned countries. Patients could be cured, mosquitoes could be killed. Cheap, effectively, and easily. The WHO launched its global malaria eradication campaign in 1955, with the aim, well, to eradicate malaria from the face of the planet. But by 1969 it was all over. Malaria parasites had become resistant to the miracle drug. Mosquitoes were no longer affected by the miracle insecticide. Africa missed the boat. In fact, it had never been a major player in the global eradication campaign. Two decades followed where nothing much happened. Malaria came back, and conquered new terrain. Millions died, but no longer in the North. Malaria had become a disease of impoverished countries, the developing world.
In the early 1980s, in West Africa, a French scientist named Phillipe Ranque, undertook an experiment that would have an incredible impact on the way we control malaria today. A few years earlier, the Chinese had succeeded in synthesising pyrethroid insecticides. These had become widely available for agricultural pest control, and Ranque decided to study the effect of impregnating a bednet with these chemicals on mosquitoes. Not only were mosquitoes killed when contacting the net in pursuit of the person sleeping under it, the pyrethroid also repelled them. This meant that even torn nets, or holed ones, gave protection.
Large-scale trials with impregnated nets in the 1990s, the first of which was conducted in The Gambia, yielded astonishing results. Mortality dropped by 63% in the group of Gambian kids sleeping under the nets. WHO-sponsored trials in Burkina Faso, Ghana, Kenya, and Tanzania, fuelled optimism. A new weapon against malaria entered the public health arena. The insecticide-treated bednet.
Small message, small donation, big impact
Bednet manufacturers starting making overtime. When I talked to Torben Vestergaard, former Director of the Vestergaard-Frandsen company, back in 2005, he told me that net production had increased ten-fold that year, from 1,8 to 18 million nets.
Dr. Gerhard Hesse, Head of Global Vector Control at the Bayer company, informed me last week that by 2009, some 192 million nets had found their way into African households. Pledges for another 103 million have been secured and hopefully these nets will be in use by the end of 2010. Universal coverage of vulnerable groups (children <5 yrs of age and pregnant women) will require 350 million nets in total, so we're still 55 million nets short of target.
Most of these nets have been funded by large organisations like UNICEF, the Global Fund, and the US President's malaria initiative. But a weapon this small in size and cost did not go unnoticed by the public at large. Numerous small-scale initiatives have been undertaken in recent years, by schools, churches, sports clubs, women’s groups, and so on. Considering that the cost of a net is only 4 €, this is a contribution many in the developed world can afford. Raise money, divide the amount by 4 (€), and here is the number of African children receiving protection from a deadly disease. This weapon is simple, tangible, and can be ‘sold’ to the masses with a one-liner. Perfect.
It is no surprise that NGO’s that jumped on raising public funds for bednets, like ‘Nothing but nets’, ‘Malaria No More’, and ‘Against Malaria’, mushroomed. ‘Save a life for 4€’ is the perfect slogan. Nets sell well.
Last night I watched a documentary ‘When the night comes’ that will be launched the end of April. It was sent to us for previewing and for us to write an editorial on our platform MalariaWorld. The story is gripping. A Ugandan boy, Ivan, dies of malaria in front of the camera. I have seen much suffering in Africa, but this made me swallow once again. It ends with nets. Nets to protect, nets to alleviate suffering, nets that bring happy faces. Nets, nets, nets.
Can it be concluded, therefore, that short and simple messages that ask for small sums of money work? Moreover, can it work via Twitter? The answer is…