Co-authored by Alex Burke
We live in a political era dominated by tremendous division, and there is a climate in which intransigence is celebrated as strength and compromise is vilified as a weakness. However, there is at least one initiative, which George W. Bush started and Barack Obama has continued, that will endure as a bipartisan effort that helps define their legacies positively: America's role in drastically reducing malaria-related deaths in sub-Saharan Africa.
Malaria originates from a parasite that often infects the anopheles mosquito, an insect that feeds on human blood. While increased investments in malaria control have seen positive results, it remains a devastating and deadly disease in some of the poorest nations on Earth. In 2012, more than 200 million clinical cases of malaria occurred, resulting in the loss of more than 625,000 lives, many in sub-Saharan Africa. In areas of increased transmission, the most vulnerable individuals are children, who have not yet effectively developed immunity to the disease, and pregnant women, whose resistance lowers during pregnancy. Unfortunately, to date, there is no vaccine against the disease.
However, building upon numerous scientific advancements made in the past 100 years, there are effective prevention measures to reduce mosquito populations as well as treatments for those infected. For example, in 1947, the United States launched the National Malaria Eradication Program, which included the application of mosquito spray to more than 46 million households. By 1951, malaria was considered eradicated in the United States. Today, there are approximately 1,500 malaria cases in the U.S. per year, but these are generally immigrants or travelers returning to the U.S. from infected areas. Unfortunately, prevention, control, and treatment strategies are expensive and have limited availability in the most vulnerable regions. In the poorest tropical and subtropical areas, malaria remains difficult to control. In these locations, efficient mosquitoes thrive in a favorable climate, transmitting the disease to the most vulnerable.
George W. Bush, in 2005, launched two successful initiatives: the President's Malaria Initiative (PMI) and the President's Emergency Plan for AIDS Relief. The PMI began as a five-year program costing $1.2 billion, with $30 million spent during the first year in part to distribute insecticide-laced mosquito nets in Tanzania, Angola, and Uganda. Today more than $600 million is spent per fiscal year to work in 19 African countries and Southeast Asia's Mekong River region.
At a time when America faces historic debt levels, some rightly question any expenditure that does not have an immediate offset or return on investment. It is important to note that despite common misperceptions, only about 1% is expropriated for foreign assistance, and only a small percentage of that goes to global health initiatives. When we reduce diseases abroad, we lessen the risk of infecting Americans traveling abroad as well as those seeking to travel to the United States.
The PMI's original goal was to reduce deaths attributed to malaria by 50% in 15 sub-Saharan African countries. The initiative has focused on four primary treatment measures: indoor residual spraying, insecticide-treated mosquito nets, preventive treatment of pregnant women, and diagnosis and treatment with artemisinin-based combination therapies.
Progress to combat malaria in the 21st century has been dramatic. Estimates are that malaria-control interventions between 2001 and 2013 led to 4.3 million fewer malaria deaths, largely composed of children younger than 5 in sub-Saharan Africa.
Addressing the program's success, Michael Miller, former deputy assistant administrator for global health at the U.S. Agency for International Development (USAID), wrote, "When I began working on malaria at USAID in 2004, the disease killed more than a million people annually--the vast majority of them African children. Since then, deaths have been cut roughly in half, and endemic countries and donors are looking to achieve a state just short of eradication in coming years. One of mankind's deadliest and most persistent killers is in retreat."
The PMI's objectives by 2020 are ambitious. Two key objectives are to decrease malaria mortality by a third of 2015 levels in PMI-supported countries and to reduce malaria morbidity by 40% of 2015 levels in those countries.
President Obama even addressed the issue in this year's State of the Union address when he said, "When we help African countries feed their people and care for the sick, it's the right thing to do, and it prevents the next pandemic from reaching our shores. Right now, we're on track to end the scourge of HIV/AIDS. That's within our grasp. And we have the chance to accomplish the same thing with malaria--something I'll be pushing this Congress to fund this year. That's American strength. That's American leadership. And that kind of leadership depends on the power of our example."
America has taken the lead in addressing a humanitarian crisis, and as a result, millions of lives have been saved, and the moral authority of the United States has been strengthened abroad. This would not be possible without a bipartisan effort. Our role in this fight represents the best of American politics and work of which we should all be proud.
Michael A. (Mike) Moodian chairs the Santa Margarita Catholic High School Consultative School Board in Southern California and is a past chairman of the World Affairs Council of Orange County. Alex Burke, a Santa Margarita Catholic High School junior, is founder and president of the school's International Relations Club. The opinions expressed are their own.