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A historic opportunity

November 13, 2005

OVER THE SHORT TERM, diseases such as the black plague and AIDS have killed more people than malaria. But medieval generations gradually built up resistance to the bubonic plague, and the discovery of antibiotics ended its deadly rampage. AIDS is a relatively young disease, a couple of decades old, and medical advancements are coming fast.

Malaria, by contrast, has stalked humanity since the beginning of history, reaping corpses beyond counting. It is a killer unlike any the world has known, a parasite that may have snuffed out more people since its origin than any other. And it's getting worse.

Malaria kills anywhere from 1 million to 3 million people a year, 90% of them in sub-Saharan Africa, most of them children under age 5. A study last year found that the child-mortality rate from malaria roughly doubled between 1990 and 2002, thanks largely to the parasite's growing resistance to older drugs and a breakdown in Africa's healthcare infrastructure. Every 30 seconds, or about the time it took to read this far, a child's heart is stilled by malaria.

Over the last six years, Africa's misery has become an international issue. Groups such as the United Nations and the World Health Organization have set concrete targets on reducing malaria by 2010 or 2015. Funding of anti-malaria initiatives has risen sharply. The good news culminated in President Bush's commitment in June to spend $1.2 billion over the next five years to fight the disease.

Yet nobody on the front lines is declaring victory. Future funding for Bush's malaria project is uncertain. The Global Fund to Fight AIDS, Tuberculosis and Malaria, the largest source of funding for anti-malaria efforts, raised less money in 2005 than 2004, and the outlook for the next two years isn't promising. The world is spending only about a tenth of what it would take to effectively fight the disease.

At this rate, none of these international goals for reducing malaria will be met. Millions more children will die, and a historic opportunity to crush one of mankind's most potent enemies will have been lost.

America gets serious

Last year, something surprising happened in the Senate: Key lawmakers began demanding answers from the U.S. Agency for International Development about its malaria programs, a topic that had been widely ignored for years. Congressional hearings on the subject proved highly embarrassing for USAID; at one hearing, a former administrator had to admit that she couldn't account for how the agency had spent its $80-million malaria budget in 2004.

Finally, in December, USAID released a report breaking down its malaria allocations. The results pleased no one. Only $4 million, or 5% of the malaria budget, was being spent on proven interventions such as bed nets and anti-malarial drugs in other countries. The rest was going to U.S. consultants. Mostly, these consultants help African countries apply for grants from the Global Fund, though some also work on more concrete projects such as building a sustainable marketplace for bed nets in Africa.

During the 1990s, development assistance fell sharply, and USAID's existence was threatened. Instead of phasing it out, though, Congress transformed it into a contracting organization. Rather than giving money to foreign governments, it began giving money to American contractors. It formed a symbiotic relationship with these organizations: They would lobby Congress for more money on behalf of USAID, and USAID would distribute it to them. How they do it is anybody's guess. It is nearly impossible for outsiders to track whether USAID programs are effective, or even to tell how the money is spent.

USAID's report on its malaria funding didn't placate its Senate opponents, particularly because it was an extremely sloppy document, using only vague descriptions of project activities and numbers that didn't add up. Sen. Sam Brownback (R-Kan.) responded with a bill requiring USAID to spend a majority of its malaria money on concrete interventions such as pesticide spraying, bed nets and drugs, and to improve its transparency.

The bill never came to a vote, and it is languishing in the Senate. But it had an effect. Brownback, a powerful force in the social conservative movement, discussed malaria and USAID's shoddy record with Bush. A week before a Group of 8 meeting in July at which aid to Africa would be at the top of the agenda for the club of industrialized nations, Bush announced his $1.2-billion malaria initiative.

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