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# African heads of state promise action against malaria

BMJ 2000; 320 (Published 06 May 2000) Cite this as: BMJ 2000;320:1228
1. Gavin Yamey
1. BMJ

A pledge to halve Africa's malaria deaths by 2010 was signed by more than 50 of the continent's heads of state last week. The declaration was made at an international summit on malaria, in Abuja, Nigeria, hosted jointly by the World Health Organization (WHO) and the country's president, Olusegun Obasanjo.

The disease causes at least one million deaths worldwide each year, of which 90% are in sub-Saharan Africa. The summit coincided with the launch of the WHO's Roll-Back Malaria project in Africa.

Opening the summit, Tim Menakaya, Nigeria's health minister, said: “Malaria keeps societies poor, undermines development, and reduces the incomes of families who are already the poorest in the world. Every family in Africa pays a malaria tax.” Previous efforts to eradicate malaria in Africa, he said, have been “fragmented and uncoordinated.”

The main focus of the new control programme will be bed nets that have been treated with insecticide. A recent Cochrane review found that children who slept under treated bed nets were half as likely to develop malaria as controls. David Alnwick, chief of health for Unicef, said: “It is scandalous that 700000 children died last year from malaria when a $4 (£2.50) bednet could have saved them.” The WHO wants a 30-fold increase in the availability of nets in the next five years. It also wants every family at risk of malaria to have immediate access to cheap and effective antimalarial combination therapy, and every pregnant woman in high risk areas to receive drug treatment. The organisation believes that the pharmaceutical industry is willing to lower the price of antimalarial drugs. David Nabarro, project manager for Roll-Back Malaria, said: “Negotiating with industry is now possible.” But non-governmental agencies believe that the industry's stronghold over drug patents prevents poor countries from affording essential medicines (22 January, p 207). Malarial control requires annual donations of$1bn (£0.6bn) from industrialised countries (29 April, p 1161). But Jeffrey Sachs, director of the Centre for International Development in Harvard, told the summit that donations alone will be insufficient unless there is immediate debt cancellation.

“It is a shame,” Professor Sachs said, “that the [International Monetary Fund] has asked Nigeria this year for $1.6bn in debt service[repayment]. This is five times more than Nigeria's health budget. These are funds needed to save lives.” Only the Canadian government made a firm promise in Abuja to cancel debt, although Britain's Department for International Development stated the need to “speed up” debt cancellation. The World Bank claims that it donates$150m a year to African malarial projects, and it has pledged a further $300-500m annually. Professor Sachs was sceptical about their claims: “The$150m is not in programmes I have seen, and there are no standalone [malaria] programmes in Africa. The $300-500m is promising, and we will now have to monitor them.” Responding to these criticisms, Ok Pannenborg of the World Bank said: “There are 100 World Bank operations around Africa. The$150m is money they can use, but whether they do is another matter.”

Details of the WHO's Roll-Back Malaria campaign are at www.rbm.who.int

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