The following post comes from Randa Kuziez, a former Tony Blair Faiths Act Fellow with the Malaria Policy Center, on her thoughts about this year’s Ramadan and a look back at her time in Africa. 

During the Muslim month of Ramadan, Muslims fast from food, drink, and marital relations during the daylight hours. Ramadan is a time for transformation and spiritual cleansing, to reprioritize where one is in his or her life, where her or she wants to be, and how that is being reflected in his or her actions.

The past 22 Ramadans I’ve spent with my family fasting with an understanding from the Quran that says, “Fasting has been prescribed to you, as it has been to others before you.” I knew that, in theory, I was fasting in solidarity with those who don’t have enough food to break their fast with, and I also knew this was a month of sacrifice and humility.  Despite efforts to make this a reality by extra service and charity during the month, the concept of solidarity didn’t come to fruition until last year.

Exactly one year ago today, I was in spending Ramadan in field training for the Faiths Act Fellowship in Mali with Project Muso Ladamunen. There, I felt this solidarity; to be in a place where I knew the hunger pangs of those fasting for the majority was a common practice, and not a voluntary one, as mine were.  In addition, our visit to Mali occurred during the rainy season, a time when malaria infections and deaths rise significantly. On many occasions, especially the story I share below, is where I found my Ramadan call to action.

I recall a visit to Bamako’s Gabriel Toure Hospital which really put a face to those suffering from Malaria and demonstrated the sense of urgency we need in fighting this disease.  While walking through the crowded rooms, the doctor told us he was seeing as many as 150 cases during the day, and 60 at night. Each room, which normally housed 4 patients in four single beds, currently had 2 to a bed, and 3 on the floor between the beds, thus 14 people shared a 4 person room.  Another room, with the cases of grave malaria had over 20 patients in a coma like state, with their parents patiently waiting and praying for them, unsure of their children’s fate. As we stepped out of this room, the doctor shared with us a very painful and real statistic- around 5 or more patients passed each day in the room that we just stepped out of; the room with the praying mothers; the ones who quietly greeted us in. We felt like intruders, and they considered us guests fulfilling the Malian tradition of visiting the sick, whether we knew them or not.

I saw, right in front of me, how this preventable disease was affecting these children, their families, the entire family dynamic, and the entire country infrastructure. The doctor then reminded us that these are the families that had the means to reach or afford the treatment. A feeling of immense responsibility overtook me, and in a rush of tears I attempted to hide from the doctor, I expressed what our entire group was feeling, and the doctor gave me an answer reflecting those on the ground involved in malaria eradication. “No, Don’t lose hope, this is why we are working.” In that, he gave us a message of hope, but also a deep and urgent call to action. This is urgent, this is NOW, and it shouldn’t be happening. To us, that mosquito may have just been a nuisance, an eventual bite scar I can point to and reflect on how uncomfortable it was to constantly be bitten, but to them, it really is a potential situation of life and death. The world can’t stand by and continue to let this happen. Although that hospital visit is the one I shared, we saw a similar situation in another health clinic, and it was replicated all over the country.

I realized they were the reason why we were on this fellowship, the reason the Malaria Policy Center exists. The Faiths Act Fellowship brought together young leaders inspired by their faith to be ambassadors for the Millennium Development Goals and inspire other young people to do the same, specifically aiding in efforts to eliminate deaths attributed to malaria by 2015. Achieving this goal, Millennium Development Goal 6, would hit the targets for many of the other MDG’s.

Last year, I understood my Ramadan call to action. Now, reflecting on this experience, I invite you to take action. The goals in eliminating deaths from malaria are clearly defined, and our work will help turn that into a reality.

Technology Review recently had a conversation with Bill Gates about a myriad of topics, including his passion for global health. 

One of the most fascinating points that Mr. Gates touches on is the fact that there used to be no market and no incentive for investment in malaria.  In response, The Gates Foundation simply created one by investing massive amounts of capital in malaria and the results have been astounding. 

The interview is excerpted below. 

The Gates Foundation has invested in solutions to big problems like infectious diseases in poor countries. Providing clean energy for the nine billion people the planet will hold in 2050 is a problem that’s equally civilizational in scale. What can philanthropy contribute to energy research?

Well, basically not much. The energy market is an absolutely gigantic market, and the price of energy is a key determinant in improving lifestyles, whether for the rich, the middle-income, or the poorest. It seems slightly more intense for the poor: things like fertilizer and transport, or health care, are very expensive for them. You know, things like basic lighting are very expensive. But it’s a big enough market that if you come up with cheap ways of making electricity, then that should be done with typical big-firm risk taking, small-firm risk taking. On the other hand, the way capitalism works is that it systematically underfunds innovation, because the innovators can’t reap the full benefits. But there’s actually a net benefit to society being more R&D-oriented. And that’s why in health research, governments do fund R&D.

You are a member of the American Energy Innovation Council, the AEIC, which calls for a national energy policy that would increase U.S. investment in energy research every year from $5 billion to $16 billion.

Right.

I was stunned that the U.S. government invests so little.

Yeah, particularly when you look at the DOE budget, and it looks so big–but the biggest part of that by far is dealing with the legacy of nuclear weapons production at various sites around the country. I was stunned myself. You know, the National Institutes of Health invest a bit more than $30 billion.

The Gates Foundation is in that health area, and when we pick a disease to work on, we pick a disease where for some reason the market is not working. Like malaria: rich people don’t need a malaria vaccine. They are rarely in malarial areas, and when they are, they can take prophylactic drugs and not worry about it. And yet for the people who live there, over a million a year, mostly kids in Africa, die. When we did our first $50 million grant for malaria, about a decade ago, we more than doubled the amount of money going into malaria research at the time. It’s a horrific disease, but there’s not a market reward for coming up with a malaria vaccine.

So you made a market.

Yes, you can create a market where there’s no natural market. The biggest project, the one that’s furthest along, is where GlaxoSmithKline is doing a vaccine called R2SS, which is now in phase 3 [trials]. It’s not a perfect vaccine. It reduces mortality a bit more than 50 percent. And then we’re funding a lot of other things that aren’t as far along that–either by themselves or in combination–would get us a perfect vaccine. There are some very novel ideas in the early stages.

But to go back to your question, the reason we’re involved is because there’s not a market. And so our investment is mind-blowing compared to anything else. And you do have that in diseases of the poor world. You know, in the rich world, the percentage of people with AIDS is fairly small, and so the cost of treating people with drugs for a lifetime is affordable. It’s not perfect for those people, it’s not perfect financially, but the difficulties of coming up with a vaccine are such that there’s not a market incentive for it. So an AIDS vaccine is another one that is being funded by a combination of government budgets and philanthropy. The two biggest funders by far are our foundation and the U.S., the part of the NIH involved.

The following blog appeared on Malarianomore.org. 

Imagine if we could predict malaria outbreaks just like we predict the weather. Well, we just might be able to!

The Kenya Medical Research Institute (KEMRI) has developed a model that predicts malaria outbreaks with 86 to 100% accuracy. The model uses weather predictions, information about mosquito reproductive patterns, and geographical data to predict the probability of an outbreak. Over the past nine years, the model has been tested and proven accurate in several countries including Kenya, Uganda and Tanzania.

Dr. Andrew Githeko, the malaria expert in charge of the project, says, “Rainfall and temperatures can be used to explain up to 80% of statistical variation in malaria incidences. This is because the temperature variations are extremely important in breeding of mosquitoes.”

So what does the current malaria forecast look like? According to the technology, an outbreak is unlikely to occur this season because the current temperature in most areas is not high enough for a mass breeding of mosquitoes.  

In this case, we’ll take all the rain checks we can get if it means protecting the millions of people at risk of malaria.

Although he will surely be seeing limited playing time in the upcoming season due to the 76ers’ acquisition of No. 2 NBA pick Evan Turner, nothing will humble veteran guard Willie Green more than his recent trip to Senegal. As part of Basketball without Borders Africa, Green traveled to Dakar, Senegal to instruct the top 60 young basketball players from the continent, on and off the court.

NBA coaches and players from Africa, including DeSagana Diop (Senegal), Luc Mbah a Moute (Cameroon) and Hasheem Thabeet (Tanzania), along with Dwight Howard and former Sixers Sam Dalembert and Dikembe Mutombo (Democratic Republic of Congo), participated in community outreach events through NBA Cares, the league’s social responsibility program. Partnering with the nonprofit organization Hoops 4 Hope the players and coaches led activities that focused on leadership, character development, and health, with particular emphasis on HIV/AIDS and malaria prevention.

The group also participated in the malaria bed-net distribution program in partnership with United Nations Foundation, USAID, and the Senegal Ministry of Health. Green described his experience delivering mosquito bed nets to homes in the community, a simple task that he could do to help the situation. He discussed how sad it is that most  Americans know little about malaria, while it remains a serious killer of young children and mothers in Senegal, and kills nearly one million people every year worldwide. The trip was Green’s first visit to to Africa, and it struck him to his core.

“Seeing the kids here, their faces and eyes light up when they see players from the NBA… they are so happy to see us up close, to give us a handshake, to give us a hug. For the kids, it’s a great experience for them, something they will always remember. But it’s the same for us, maybe even more so.” Witnessing real despair, Green explains how he sees loosing a few minutes on the court with a new perspective.

“It is of particular significance that Basketball without Borders Africa is being held here in Dakar for the first time,” said Amadou Gallo Fall, vice president of development for the NBA in Africa and a Senegal native. “With the help of the current and former NBA and FIBA players, coaches and partners, Basketball without Borders is a perfect vehicle to draw attention to important social issues, while allowing us to coach and mentor the top youth basketball talent from across the African continent.”

Scientists and farmers face challenges as they attempt to supply enough artemisinin, the key ingredient of first-line antimalarial drugs, to meet the increasing demand of the compound  triggered by a $343 million initiative that is battling malaria with hugely subsidized medicines.

The Nature News article describes the two-year trial run by Affordable Medicines Facility-Malaria initiative, a program within the Global Fund to Fight AIDS, Tuberculosis and Malaria, that is increasing the demand for artemisinin.

The AMFm initiative, operating in seven African countries and Cambodia, is hoping to ensure the sale of ACTs in the private sector at $0.20-0.50 per dose. They are already available at governmental public-health clinics for just $1 per dose, but patients more often than not opt for convenience and buy the medicines at local market stalls and private pharmacies at significantly higher prices.

This expense encourages people to buy cheap but ineffective chloroquine or the single artemisinin therapies which lead to drug resistance. Lowering the cost of ACTs in the private sector would be a major breakthrough in the fight against malaria and improve access to affordable and effective medicines that do not promote drug resistance.

However, artemisinin suppliers have experienced this bubble of high demand before. In 2005 the World Health Organization’s call to ramp up production lead to an oversupply of ACTs that dramatically reduced the price of the drugs, putting processing companies and farmers out of business while millions of people in sub-Saharan Africa still were not getting access to the ACTs.

While driving down the price of drugs is undeniably important, it doesn’t yield the intended results unless access to the medicines is also improved, hence the idea for the AMFm, and its attention to local businesses that sell treatments for malaria, hopefully at dramatically reduced prices in the near future.

A new evidence-based mapping study calculates that 2.85 billion people lived at risk of infection of the malaria parasite Plasmodium vivax in 2009, mostly in central and southeast Asia, reported BMJ News.

P vivax is the most widely distributed malaria parasite in the world, and mapping the parasite is critical so that strategies can be put in place to control it. The Malaria Atlas Project conducted the study, a multinational research collaboration that received the majority of its funding from Wellcome Trust. Cutting edge methods were used by the researchers, including “developing global maps of Duffy negativity, which confers partial protection against P vivax. People who are Duffy negative lack an antigen on the surface of red blood cells that codes for a protection receptor for P vivax.”

P vivax potentially represents a greater burden on human health in some areas of the world than P falciparum, which “is undeniably the main killer of the two,” said Dr. Guerra. “Even though more people are exposed to the risk of P vivax infection than P falciparum, most deaths from malaria are reported in Africa,” where people are less vulnerable from becoming infected with P vivax due to high prevalence of Duffy negativity on the continent.

In order to significantly reduce the malaria burden from both parasites it is imperative that a better understanding of the aspects of the mosquito life cycle that directly mediate malaria transmission are investigated.

The Baltimore manufacturer Ellicott Dredges is buying $100,000 in malaria drugs and insecticide treated nets to protect women and children in Nigeria. The company, which built the dredges in the original construction of the Panama Canal, is partnering with Baltimore non-profit Jhpiego to deliver the commodities to women and children in the Akwa Ibom state in the Niger Delta region.

Ellicot Dredges became interested in participating in the fight against malaria in Nigeria during their sand-dredging projects in the country. Malaria accounts for 11 percent of maternal deaths in Nigeria and contributes to poverty, school absenteeism, and low productivity in the country. “Women are the foundation of families throughout the world,” said Peter Bowe, President of Ellicot Dredges. “Their health is directly related to the nations health.”

Robert Black, Chair of Johns Hopkins Bloomberg School of Public Health’s Department of International Health, and his team of researchers recently determined that pneumonia, diarrhea, and malaria are the top three causes of death of 6 million children around the globe. “We now have the latest country-specific estimates of the major causes of child deaths.”

An expert on child mortality, Black implored the leaders of donor and developing host countries to take action to confront this avoidably high death toll. Take malaria for example, an extremely preventable and treatable disease that is still killing over 800,000 people every year, the majority of whom are children younger than five.

“Achieving the global goal of reducing child mortality by two-thirds is only possible if the high numbers of deaths are addressed by health interventions, including vaccines,” he said at a briefing in Baltimore to evaluate the impact of potential of new vaccines, sponsored by the GAVI Alliance and the Johns Hopkins Bloomberg School of Public Health.

In today’s Wall Street Journal, President Jakaya Kikwete and President Yoweri Museveni of Uganda authored an opinion piece on ending taxes and tariffs on approved malaria interventions.  The entire text is below.

This month Uganda has the honor of hosting the annual meeting of the African Union, which brings together more than 40 heads of state to discuss issues of critical importance to our continent. More than ever before, Africa needs strategic leadership, vision and courage to address the challenges we face. We must harness Africa’s enormous potential, opportunities, and resources for the development, prosperity and well-being of its people.

One of the greatest challenges we face is malaria. And in this area, strategic leadership in part means getting government obstructions out of the way.

Malaria causes illness and productivity loss for close to 200 million people in Africa annually. The scourge claims the lives of more than 800,000 Africans each year, most of whom are babies and mothers.

Over the past decade, an unprecedented effort has been launched to defeat malaria, supported by funding from the Global Fund to Fight AIDS, Tuberculosis, and Malaria; the World Bank; key bilateral partners, and other private sources around the world. Thanks to this funding, a huge volume of rapid diagnostic tests, life-saving medicines, and nearly 350 million mosquito nets will be delivered to Africa by the end of 2010. Other efforts, such as spraying households with insecticides, are being scaled up as part of a comprehensive attack on the disease.

 African governments are also stepping up the fight against malaria. The African Leaders Malaria Alliance (ALMA), representing 28 heads of state, recently established a regional effort to facilitate cost-effective bulk procurement of mosquito nets, working together and with UNICEF. This approach will allow the accelerated delivery of nets to the countries that need them most.

We must now commit to overcoming barriers to malaria control and treatment, and a key area here is tax and tariff removal. Most anti-malaria commodities are currently produced outside of Africa, and when the ships that transport nets, medicines, and other essential health products arrive in African ports, their cargoes are often subjected to taxes and tariffs that absorb precious funds, reducing the volume of health goods that can be purchased, and creating inordinate delays in distribution.

The problem with imposing taxes and tariffs on essential anti-malaria commodities is that they hurt our poorest citizens, who cannot afford to purchase nets and medicines in the private sector, and must rely on public distribution. Essentially, imposing taxes and tariffs on malaria drugs and commodities taxes Africa’ s already fragile health system and makes malaria prevention and treatment less available to the poor. Evidence from our countries—Uganda and Tanzania—strongly suggests that removing taxes and tariffs strengthens the fight against malaria and benefits the poor the most. Several years ago, when we removed taxes and tariffs on all anti-malaria commodities, the cost of mosquito nets sold in local markets decreased, local demand for nets increased, and more small businesses entered the market to produce and supply these essential commodities. Since then, our countries have increased access to anti-malaria commodities and have become significant manufacturers of insecticide-treated nets that are exported to other African countries. Tax and tariff removal can, therefore, be good for Africa’s people and good for African entrepreneurs.

Careful attention must be given to the way in which taxes and tariffs are removed, however. Some countries have opted to grant waivers or exemptions for donated goods, but the reality is that obtaining these waivers can be time-consuming and expensive. In some countries, legislation requires that exemptions be renewed every year, and this process can cause months of delay. Removing taxes and tariffs altogether is by far the most equitable and effective solution.

Along with tax and tariff removal, malaria-endemic countries must pay attention to improving customs procedures so that public-health commodities are correctly identified when they arrive at ports. This is important not only to ease the flow of goods into countries, but also to maintain important quality standards as we battle the global problem of counterfeiting and sub-standard products that can lead to drug resistance. If African countries are to achieve universal access to critical health-care commodities and meet the goal of reducing malaria-related deaths to near zero by 2015, we need to take definitive steps now. Tax and tariff removal is one of the steps that we should take, and doing so will help African leaders demonstrate the depth of their commitment to ending malaria.

The global fight against malaria over the past few years has redefined the standards and expectations that we apply to development assistance. We have set measurable targets that we are working hard to achieve, and we are seeing great reductions in malaria thanks to more strategic applications of funding and greater accountability for donor spending. Just as international donors have increased their commitments, it is time for African leaders to intensify theirs by removing costly and counterproductive obstacles to effective malaria control. Through effective partnership, we can give Africa’s children a malaria-free future.

Mr. Kikwete is the president of the United Republic of Tanzania and the current convener of ALMA; Mr. Museveni is the president of the Republic of Uganda and a member of ALMA.

The technology culture that drives the West has developed on a smaller scale in Africa, but with a potentially matching impact. Due to widespread poverty that blankets the continent, personal computers have not acquired the popularity that they have in developed nations, but affordable mobile phones are now mainstream and have become the normal form of communication.

About one and three Africans have a mobile plan, and between 2003 and 2008, Africa had the fastest growing mobile phone market in the world. In Africa, mobile phones are not only mechanisms used for simple conversation but are being utilized to deliver health and educational services to those encumbered by unequal access to information and resources.

Although the procurement of resources to battle diseases such as HIV/AIDS and malaria that plague Africa has experienced enormous progress in recent years, the multimillion dollar investments in drugs are futile if they are not supplemented with monitoring and training. Many non-profit organizations have seized the opportunity that mobile phones provide to augment patient monitoring in areas that lack skilled medical personnel, management staff, and financial resources, which usually coincide with the areas that have the highest disease prevalence. Cell-Life Aftercare “can remotely monitor 15-20 patients per health care worker, provide supplemental medical information and relay information back to a central database all via mobile technology.”

The implications of programs like these are enormous when considering the potential efficacy of drugs and products, such as ARVs and insecticide-treated bed nets. Previously, the provision of these products did not guarantee proper usage, but the advent of mobile phone health technology could eliminate this barrier to health.

Expanding beyond informational messages in the health arena, mobile phone technology can be tapped to provide educational information on every formal school subject. MXit, a mobile messaging and social networking device that reaches 40% of South Africa’s population, has partnered with the government and school systems to administer personal tutoring and curricula.

The agriculture sector can also benefit from mobile phones. They provide access to weather forecasts and global markets, saving farmers and consumers from expensive and time consuming trips and providing knowledge of where and when to sell products for the highest price. A study that examined the fishing industry in sub-Saharan Africa determined that “mobile phone penetration reduced waste, increased profits by 8%, and decreased consumer prices by 4%.”

Affordable mobile phones are making positive impacts on the lives of those who would otherwise be excluded from information and resources that drastically improve the quality of life. Health, education, and agriculture have a long way to go in Africa but utilizing the benefits that mobile phone technology offers is a promising step in the right direction.