Malaria has killed more people than all the wars of the world — ever, according to a Bloomington-Normal man who has spent more than three decades trying to stamp out the mosquito-borne disease.
Drake Zimmerman said a Rotary International program to distribute insecticide-treated mosquito nets succeeded wildly in Ghana, then in Zambia and Togo, and has become the global standard.
“We got immediate effect," Zimmerman said. "We did it for the lowest cost. The cost was so low that all the scientists and everybody else doubted that we could do that distribution for 36 cents a net."
Zimmerman said statisticians estimate nets and medicine have saved over 12 million lives so far.
“The number of malaria cases is down by the hundreds of millions,” he said. “We got malaria from over a million deaths a year down to about 600,000 a year.”
The Trump administration has threatened that progress with its funding freeze on foreign assistance programs, Zimmerman said, and created a stumbling block in the global march to eradicate the parasite that causes the illness.
“This is devastating," he said. "We know that the death toll is going to rise due to these actions. We have tracked many countries [18] where you take away the interventions and malaria goes straight back up. The [global] death toll will conservatively go from 600,000 a year to 750,000. It might go as high as 900,000."
For instance, he noted that military conflict in Sri Lanka stunted malaria interventions.
On the other hand, rapid intervention has an effect. He said war-torn Timor-Leste had zero infrastructure and 35% of the population had malaria. In a dozen years, it was down to 0%.
“We're on the cusp of taking it completely out of India and Pakistan," Zimmerman said. "They have very organized programs they probably can continue to fund. We can knock malaria out of Asia in the next five years, and that will lower the population subject to malaria in those countries. The U.S. is less of a player in Asia. It's Africa that's going to be hurt the worst on all of this."
These are some of the widely reported cuts affecting the anti-malaria effort.
- A $90 million contract for bed nets, tests, and treatments.
- A contract to manage and distribute $34 million in medical supplies in Kenya for HIV, malaria treatment, tests, and 315,000 nets.
- The REACH Malaria program offers malaria drugs to children in 10 countries.
- The President’s Malaria Initiative program, Evolve, operated in 21 countries. It applies pesticides in homes and water sources that breed mosquitos.
- Demographic and health survey data collection in 90 countries helped nations plan and budget for HIV, maternal and child health, mortality, and nutrition programs, and other health factors.
A lot of malaria eradication work is funded by the Centers for Disease Control [CDC] and the U.S. Agency for International Development, about $800 million.
“Most of that goes to buy goods, buy the mosquito nets, buy the test kits, buy the medicines, and then distribute them. What has been stopped is the delivery of all those essential goods,” Zimmerman said. “Often the nets have been bought. They're there, but they don't have the cost of delivery.”
KFF Health News reports the U.S. government is the No. 2 donor of the prevention and treatment goods going to countries. More than half the total spent comes from the Global Fund for AIDS, TB and Malaria, from the countries, and from private donors, he said.
Even though the cuts were not much of a surprise, he said they were still "jaw-dropping." And while a natural reaction is to be outraged and angry, Zimmerman said that may not be productive.
Over his decades of work on the issue through Rotary, he has seen many roadblocks and snafus.
“It's sort of Murphy's Law on steroids. Over the years, what malaria has taught me is how to think around a particularly difficult situation,” Zimmerman said. “We've already taken it down by half or more. We know how to take it the rest of the way. It's a totally preventable disease. So how do we (Rotary) organize the world? How do we work with partners … the World Health Organization [WHO] and others.”
The research, data collection, and coordination loss from the cuts to the President’s Malaria Initiative is significant as well, Zimmerman said. One of the casualties is a set of dashboards that had country-by-country maps of how much malaria there is, who is working there, what they are doing and how much they are putting in. He said the Roll Back Malaria initiative from the WHO, World Bank, UNICEF and the United Nations Development Program is trying to re-create the network.
“They're reconstructing those data and updating it while they're at it. It has been a spreadsheet. I'm a financial analyst. This spreadsheet is bigger than most of the spreadsheets I have ever seen,” Zimmerman said. “It's recoverable, not easily, not cheaply. It has made for long weeks of work in the past two months.
Who will take up the slack left by U.S. abandonment of the effort to finance malaria abatement?
“It might be private industry and private donors that do that. The Bill and Melinda Gates Foundation is looking at it,” Zimmerman said. “You get stopped and then you start looking for other ways to accomplish the ends. We’re talking to the major donors of the world, the very wealthy people, to show the effectiveness of malaria control. Because we knock out malaria, we build the infrastructure to knock out a lot of other diseases.”
World Health Organization
Trump has said he also intends to terminate the U.S. membership in WHO. The WHO allows the world to work to prevent the spread of disease by stopping outbreaks where they happen.
“The federal government has become difficult to rely on, for the workers, for the information and for the absolute top-level surveillance and work that the Center for Disease Control is known for,” Zimmerman said.
When there's an outbreak of a disease, say in western Congo, some of the people in there testing for the disease, looking for vaccines, and how to prevent the spread are typically from the CDC.
“If you strip them out of the country, we're going to have particular diseases that will spread much more rapidly, kill a lot more people, and may spread far beyond their individual areas,” Zimmerman said.
He said it is in the interest of America to prevent diseases from coming here, whether the next pandemic is in Mombasa, Miami, or Minneapolis. Zimmerman praised CDC workers as "spectacular people."
“Many of whom I've come to know personally," he said. "These guys are brilliant. They're very hard-working. They don't waste money. They're usually fun to work with as well because they're really smart and very, very efficient. They're the people who built an incomparable system to deliver all the tools and the aid needed to stop the disease."
He noted malaria was once a serious health threat in the U.S.
“The Erie Canal was a worker travesty. They knew most of the workers would get malaria and many of them would die just signing up for it,” Zimmerman said. “The war of 1812 was delayed because both sides had malaria so bad.”
There are accounts from the Civil War of large numbers of McLean County soldiers rendered unavailable for combat because they were sick with malaria in Missouri. It's less likely to be an immediate problem in Missouri and Central Illinois because there is no current human reservoir of malaria parasites. It's a slow burn, he said. That is not true everywhere in the U.S.
“We've already had local transmission of malaria in Florida and in Texas," he said. "It's highly likely we're going to have a bunch more cases this year, because the systems are getting weakened."
