Initiatives to Combat Malaria and Support Education in Africa

On-The-Record Briefing: On the President’s Initiatives to Combat Malaria and Support Education in Africa

Andrew Natsios , U.S. Agency for International Development Administrator

Washington, DC, June 30, 2005, (1:30 p.m. EDT)

MR. ERELI: Hello, everyone. Thank you for your patience. We are very pleased to have today Andrew Natsios, the Director of the U.S. Agency for International Development, who is here to brief us on a couple of aspects of the President's initiative that was announced today with regard to aid for Africa. The malaria -- funds to support malaria treatment and prevention, and education in Africa. So I will let the AID Administrator talk about those two issues. Thank you for coming, Andrew. We are really happy you can talk about these things and inform our press corps.

ADMINISTRATOR NATSIOS: Thank you very much, Adam.

The President announced today several major initiatives for Africa, and the first of which is the Malaria Initiative. Let met talk about that a little bit. One of the biggest killers in Africa is malaria. Because we have virtually eliminated malaria in the United States over the last century and a half, people here and in Europe don't think about this as a disease much because people don't get it here. They do get HIV/AIDS and so there's a lot more understanding in the United States of that disease.

That does not mean that this is not a major health problem in Africa. In fact, it's a health crisis. A large percentage of the worldwide deaths in malaria are attributable to Sub-Sahara Africa. The President announced today a five-year, $1.2 billion Anti-Malaria Initiative in Africa. The money that's included in that 1.2 billion does not include the money that we contribute to the Global Fund. We're the largest donor. We've given them a third, which is our legal limit of the funding, 1.1 billion so far has been contributed. About 30 percent of the funding to the Global Fund goes to malaria. We're not counting that in that figure.

The President's goal -- and this is a results-based objective he's given us -- is to reduce malaria deaths by 50 percent in each of the target countries by the end of 2010. There are 15 countries in the initiative that the United States will be responsible for. Three of them we will begin work on at the beginning of the next fiscal year: Tanzania, Uganda and Angola. Now, we're already doing a $89 million anti-malaria program in Africa this year. This is on top of that.

The United States Government spends about $235 million total, all branches of government, and the rest of the money that's not being spent by AID is being spent by the CDC and National Institute of Health in doing research on malaria clinical research.

The initiative over that period of time will ultimately affect countries with a total population of 175 million people. What is the strategy? What's the initiative? One, we expect to get 85 percent coverage of high-risk populations. Who are high-risk populations? They're children under five and they're pregnant women. They are the most vulnerable. A pregnant woman who is not treated and has malaria may, in fact, give it to their newborn and the newborn would then be severely at risk.

I know from my own work in famines over the years that acutely malnourished children, in a food emergency, usually have a 50 percent survival rate if they get malaria. Malaria, in fact, measles and pneumonia are the leading killers in most famines and it's because a child's immune system breaks down and malaria is one of the biggest and most dangerous things that we have to deal with in these famines.

There are essentially four proven responses to malaria that we already have clinical evidence of, we've tested this stuff and it does work. And this is a matter of taking this up to much larger scale on a much more massive level.

The first is what is called long-lasting insecticide treated bed nets, and they're simply bed nets that are soaked in insecticide and that people sleep under at night, particularly women and children. Most malaria infection takes place at night because that's where the mosquito feeds. And so a large-scale extension of this program, not just through health clinics, but all through the marketplaces, we're doing a large-scale campaign to educate people in developing countries that insecticide-treated bed nets, in fact, do result in much lower infection rates. And so there's a lot of advertising and public education that goes on to make sure people know that this works.

The second is Artemisinin Combination Therapy. That is an herb from Asia from what's called wormwood. It's a plant. And we've now -- we've spent $13 million through the World Health Organization and other scientific institutions to test this several years ago on a large scale in Africa to see whether or not it works with other therapy. You use this herbal drug with other drugs and it increases dramatically the survival rates of children who get malaria who are treated with this. Artemisinin is -- it can be grown in Africa and we've now funded a American-based NGO working with the World Health Organization, TechnoServe, some of you may have heard of it, to plant with Africans farmers 2,500 acres of this herb. And then we're working with factories in Africa to produce the herb into a pill form that can be used on the commercial markets.

The third strategy is a dosage of a particular drug -- anti-malarial drug -- to pregnant women to reduce the incident of absorption by the newborn child when the child is born.

And the fourth test we've done is in terms of indoor spraying of insecticides on people's huts and their homes to kill the mosquitoes that are in the house at night.

If you combine all these together and carefully target them, we know you can reduce the death rates significantly. We think the President's goal of a 50 percent reduction in malaria deaths in the target countries is a realistic goal, particularly given the high level of funding that he's provided for us that we'll work with.

But all of this is based on results. It's not based on how much money we've put in and it's not based on just therapies and the different strategies we take. Ultimately, the only thing that counts is whether or not the death rates from malaria drop. That's all. That's ultimately, what we care about.

We are concentrating far more resources on a fewer number of countries and we will be doing the direct production of commodities. And most importantly, something that people don't quite get, is that a large portion of health care in Africa, as much as 50 percent, is provided by the private sector, not by NGOs -- I'm sorry, not by ministries of health, but by missionary hospitals and private doctors and health clinics that are private and NGOs. And we have to get our strategies not just in through the ministries of health in the public sector, but through the private sector as well. We need to get these different kinds of therapies into pharmacies in Africa. We need to get them into the marketplace, the insecticide-treated bed nets into the market. So we're working on marketing strategies to make sure this is available to people who have money.

And to people who don't have money, who are poor, we'll either give free bed nets, for example, or, if they have some money, subsidized nets. And for people who have the money, they'll buy them on the commercial markets.

The second big initiative of the President is the Education Initiative in Sub-Sahara Africa. It's $400 million over four years, $100 million a year. It targets 16 countries' basic education in grades 1 through 12. It will provide 300 scholarships for children who are marginalized or vulnerable or very poor to ensure that they can afford to go to school. Because in Africa, in many places, there are school fees, there are books, there are uniforms, there are boarding costs for children to go, and if their family doesn't have money, they can't attend.

We are putting a heavy emphasis on scholarships to girls because our own research over the years has shown that perhaps the most powerful investment in foreign assistance you can make is educating girls through high school. Mortality rates among children drop if you do nothing else but educate mothers up through high school. Family income rises if mothers have a high school education. We know that agricultural production increases -- we've actually done field tests on this -- if women are educated. We know that the size of families declines without any other interventions if women are educated. We know that most importantly, that it reduces the number of very early marriages. In some countries, girls get married at 13 or 14 years old and that's a problem in any country. We also know that the education and achievement levels of children in the next generation are profoundly influenced by whether their parents are educated. If a mother is educated through high school, it's a very high likelihood that she will insist that her children be educated.

And so the President's initiative to increase literacy rates and innumeracy rates in Africa is a powerful development tool that we believe will change the dynamic in many societies and many countries. All of this we will do working with the Ministers of Education in the 16 countries that we are targeting for this initiative. We will be working with faith-based groups. We will be working with the NGO community, with UNICEF and the UN that has a lead for education among children and mothers. We will also be training 500,000 teachers and administrators. We will begin a school rehabilitation and new school construction building program. We will produce 10 million new textbooks and we are going to make an effort to begin a publishing and printing capacity-building effort in Africa so these books are printed, published, written in Africa and distributed in Africa by African companies. Because we think that's the way of making this capacity develop sufficiently to make the program self-sustainable even after the funding stops.

So these are two of the President's initiatives he announced today. If you have any questions, I'd be glad to answer them. Yes.

QUESTION: This may be a little down in the weeds, but you talked about an herbal --

ADMINISTRATOR NATSIOS: Right.

QUESTION: A supplement.

ADMINISTRATOR NATSIOS: Right, right. Artemisinin.

QUESTION: Right. Why is the U.S. not investing in, you know, antibiotic therapies, some of the other proven methods, like mefloquine?

ADMINISTRATOR NATSIOS: We do. The question is: What's most effective? What will actually drive the infection rates down? And what the field tests we did, working with WHO and clinical research facilities in Africa, is that when you combine artemisinin with one of these other drugs, the resistance -- because mosquitoes develop resistance. It's a very simple process. The mosquitoes that are most sensitive don't survive. And this is true, by the way, of insecticides, too. Insects develop resistance to insecticides develop resistance to insecticides in this country or anywhere else in the world. And so you have to constantly do research to keep ahead of the insect population, or the viruses, or the parasites in the case of malaria. So a combination therapy between artemisinin and the mefloquine, for example -- there are other therapies. There are a number of new drugs that have come on the market -- if you combine them, you reduce significantly the resistance rate among the mosquitoes and increase the survival rates. And that now has been clinically proven by scientific field trials on such a degree that there's no debate about this anymore. It's called ACT -- A-C-T, which is Artemisinin Combination Therapy.

QUESTION: Thanks.

ADMINISTRATOR NATSIOS: Yes, sir.

QUESTION: Director Natsios, this coming week is the big Live 8 Concert. It's being -- to various continents, being produced by Bob Geldof. Have you been asked to work with them or, in turn, are you working with some of their particular projects? It's all centered on Africa.

ADMINISTRATOR NATSIOS: We've been working with a number of the groups. I know in terms -- in the entertainment industry in terms of HIV/AIDS, because one of the most effective ways of getting the message out in Africa is the entertainment industry. And I know we've worked with a bunch of pop groups. I don't go to these concerts myself, so I'm not quite an expert on all the names. But Geldof has a long history with AID that goes back into the mid-'80s when the first -- not the first Ethiopian -- the Ethiopian famine that people remember, actually, Ethiopian famines, unfortunately, go back a long way. But he began his work and I think he complimented us two years ago and said the U.S. Government was way ahead of everyone else in responding to the food emergency needs to Africa and he's urging people, once again, to do that now.

I would also add that we can't separate -- we can separate it here, but in the field, you can't separate these things from each other. If you have a food emergency, and large number of children become acutely malnourished, their immune systems break down, they're much more vulnerable to HIV/AIDS, to malaria, to tuberculosis, to measles, to upper respiratory infections, to diarrhea and they die in huge numbers. So we work in integrated programming in the field to do all of these things simultaneously. So this whole malaria initiative actually works very well with our food aid programs, in our child survival programs and our HIV/AIDS programs. Because if a person is HIV/AIDS positive, their immune system is compromised, they're much more vulnerable to malaria. And that's why the Global Fund is not just HIV/AIDS, it's also tuberculosis and malaria because these things work with each other.

We are now facing a food emergency -- a serious food emergency -- which is primarily a function of drought across the Sahel and North Africa. There are emergencies now in Niger, in Chad, severe emergencies that are beyond the catastrophe in Darfur, which the President spoke about in his speech this morning. Even in Northern Kordofan, which is a stable province to the East, there is no food left. And even aid workers who are Sudanese, are having trouble finding food to buy, even though they have money. Ethiopia, Eritrea and Somalia are all facing severe food emergencies, as is Zimbabwe.

Now, Zimbabwe is a little different. There is a problem beyond drought in Zimbabwe in that the government has orchestrated the entire collapse of the national economy. And by the massive displacement of population by uprooting urban populations in the last two months, they have made these populations much more vulnerable to famine in Zimbabwe.

So we're facing multiple emergencies. The President has pledged with Tony Blair a large-scale effort to deal with the food emergency in Africa, both in terms of food aid, but also in terms of what we call "non-food assistance," which includes water and sanitation and immunization programs to make sure that disease doesn't spread and also shelter programs to care for people.

We urge other donor governments to step up to the plate and to join Britain and the United States in this effort because we cannot do this alone. I have written to all my colleagues who are development ministers in the wealthy northern countries to ask them to contribute. We're focusing our attention on the Horn, which is the epicenter of some of the worst catastrophes we're dealing with. But we would urge other European, Canadian, Japanese, Australian, New Zealand donor aid agencies to join us in this effort or we're not going to succeed.

QUESTION: I have a follow-up.

ADMINISTRATOR NATSIOS: Yes.

QUESTION: Unfortunately, apparently, a ship that left Kenya this morning with food aid, a freighter, was hijacked. Is there enough security when a food shipment is being made?

ADMINISTRATOR NATSIOS: This is the first time I heard of this. I'll have to get a report on it this afternoon. I was not aware of that. That has not happened before that I know of.

Yes, sir.

QUESTION: Can you speak slower?

ADMINISTRATOR NATSIOS: Yeah. I'm sorry, I'm speaking so quickly.

QUESTION: What is part of the incentive? Is there going to be anything to help the children who already have it? I mean, what's the President's plan for that because, you know, he has the four-pronged way to prevent them, but what about the people?

ADMINISTRATOR NATSIOS: No, no. The Artemisinin Combination Therapy is for malaria, once you get it.

QUESTION: Right.

ADMINISTRATOR NATSIOS: Okay. There is another effort that's -- actually, I didn't go through, that the Center for Disease Control is working on with us and NIH, we're beginning field trials in Kenya right now, for immunization. In other words, you take a shot and you -- we've been trying to do this for a long time. It will take between now and maybe 2010, 2015 to actually do the field trials, test it and be sure of the effectiveness of the vaccine that's been developed against malaria before we can use it. So in some ways, this is a bridge until we can develop a vaccine that's effective, if the current tests work. They may show that the thing is ineffective. We're testing it now, so there's a whole series of other parts to this strategy, which involve the longer term.

None of this that I mentioned is immunizing; it's preventing by preventing people from getting bitten by killing mosquitoes with bed nets or with insecticides or treating it once they get the illness in the first place. Does that answer your question? Other questions?

Thank you very much. (This briefing was concluded at 1:52 p.m.) 2005/668

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