Malaria: One NGO worker's fight

GENEVA — Awa Marie Coll-Seck’s first epiphany about malaria occurred when she was 4 years old, at home in Senegal. Her father, a doctor, forced each of his children to swallow a spoonful of the anti-malarial drug chloroquine daily. “The kids would run in all directions when we saw it coming,” she recalled.

Her brother, who was just under 3 years old at the time, mastered the art of holding the bitter–tasting medicine in his mouth, then spitting it out when no one was looking. That all stopped when he developed cerebral malaria. Coll-Seck watched in horror as his body went into convulsions. He survived, but the experience turned everyone in her family into a chloroquine believer.

Not everyone has been so lucky. In sub-Saharan Africa, malaria kills thousands of children (estimates vary). “You can think of the two twin towers of the New York World Trade Center, filled with 5-year-olds, going down every day,” said Prudence Smith, an advocacy specialist at the Roll Back Malaria Partnership. “That is basically what we are talking about.”

Coll-Seck, the partnership’s executive director, compares the casualty figure to the equivalent of four Indian Ocean tsunamis every year. “It is a million children dying each year, without anyone being shocked or feeling that they need to do anything concrete,” she said.

Between 80 and 90 percent of the children who die from the disease are in Africa. It is a vicious circle. The poor are worst affected, and malaria itself is largely responsible for keeping them in poverty. The geographic spread has influenced the attention focused on malaria: It has been virtually nonexistent in Europe and the U.S. since the early 1950s. Unlike for HIV/AIDS, there is hardly anyone who has had direct experience with malaria who is pushing for immediate action.

Even for Coll-Seck, it took a while for the full impact of the disease to sink in.

After finishing medical school, she went to work in one of Senegal’s district hospitals. She realized that on a daily basis nearly half the cases she dealt with involved malaria. A desperate parent would rush up holding an infant in her arms, not realizing the baby was already dead. The stress on the doctors was enormous.

But Coll-Seck realized that the problem was also greater than the parasite responsible for the disease. “It was the weaknesses in our health system,” she said. Patients had to be sent to a referral center for medicine, but often there was no ambulance, or if one was available there was no gasoline. Sixty percent of the medicine had to be bought in the private sector, but by the time parents had raised the money, the child was already dead.

When Coll-Seck became a professor specializing in infectious diseases at Senegal’s university teaching hospital, she began to see the full impact. For six months during the rainy season, the hospital took in upwards of 100 new patients a day. “You put them where ever you could,” she recalled. Then HIV/AIDS struck. “The adults all had AIDS,” she said, "but the children were still dying from malaria.”

Coll-Seck took a brief hiatus from malaria to become the director of policy and strategy for UNAIDS in Geneva. Then she was called back to Senegal to become minister of health. She soon realized that malaria was by far the country’s biggest health problem. It was so prevalent, so much a part of everyday life, that it was constantly being overlooked. People had adapted to its presence. She also realized that effectively fighting malaria required more than medical knowledge.

Pharmacists in Senegal were still selling chloroquine, even though the parasite had developed immunity to it. “To change policy, you needed to make everyone own the change,” Coll-Seck said. “If the pharmacists didn’t care, they would continue selling a drug that no longer worked.” The next problem was money. “We had everyone convinced,” she explained, “but most people couldn’t afford to buy the new drugs that were 20 times more expensive than the old ones.”

Instead of pleading with international donors, Coll-Seck opted for a fund-raising drive in Senegal. She enlisted celebrities and anyone else she could rope in. The campaign raised $1 million — enough to pay for the treatment of every child who needed it during the next rainy season.

Not long after, Coll-Seck was named executive director of the Roll Back Malaria Partnership. The partnership, which grew out of the Global Health Fund’s decision to expand its mandate beyond HIV/AIDS to include tuberculosis and malaria, is a novel concept that may provide a model for other major international problems.

Launched in 1998 by the World Health Organization, UNICEF, the World Bank and the U.N. Development Program, the partnership works out of the World Health Organization’s headquarters in Geneva, under the same rules as any other U.N. organization. The difference is that it also includes a loose coalition of countries most affected by malaria, as well as NGOs, pharmaceutical companies and just about anyone else involved in the struggle. “We needed everyone to work together on this,” Coll-Seck said.

A major theme is to make sure that everyone involved in fighting malaria is headed in the same direction, so no one goes off on a tangent or starts to implement policies that might worsen the situation.

The decision to expand the Global Fund’s mandate to include malaria and tuberculosis as well as HIV/AIDS, however, has given a boost to what had seemed like a forgotten struggle. Where previously only about $60 million was dedicated to fighting malaria, the figure is now about $1.2 billion. Coll-Seck feels that $5 billion a year is needed to get the job done.

The results are already impressive. With increased resources, Ethiopia launched a campaign to distribute 20 million mosquito nets in 18 months and saw a 60 percent decrease in deaths from malaria. In some countries the deaths have dropped off by 90 percent. And the investment in malaria is strengthening many health systems, making them better able to handle other diseases.

Given the amount it is already costing the international community to cope with the economic fallout from malaria, the money seems like a good investment. In contrast to diseases such as HIV/AIDS, where the cure is less certain, malaria appears a relatively easy win.

Coll-Seck’s biggest concern now is that the financial crisis could cut funding just as victory is in sight. Coll-Seck warns against a false economizing. “Just think how much it costs,” she said,” to have half one’s population sick.”

Read more about malaria:

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The situation in India

The situation in Indonesia

The situation in Mozambique

The situation in South Africa

The science of prevention

The science of vaccines

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