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Margaret Heffernan: A must see for all MW subscribers!

August 7, 2012 - 09:14 -- Bart G.J. Knols

I am not sure if at all you are familiar with TED, which stands for Technology, Entertainment, and Design, with its motto 'Ideas worth spreading'. I love to watch these talks, they inspire me, provide energy, and are often fun to watch.

Yesterday I watched the talk by Margaret Heffernan with the title 'Dare to disagree'. This is a very interesting talk and it made me think of the world of malaria. First, have a look at what she has to say...

After you watched this talk, please consider the following points, where I dare to disagree with the way we are moving forward in the battle against malaria:

1) Unless we tackle the issue of counterfeit drugs, we are bound to lose one after the other anti-malarial drug. Anyone who read Roger Bate's book 'Phaked' will have to acknowledge that until we get serious about this matter, we are up against a wall. But it is a complicated matter, and so we shy away from it. Can we afford to continue this way?

2) Artemisinin resistance is bound to get in our way, and we will even be faced with ACT resistance in Africa. But we continue with the use of ACTs as if they are the panacea for curing malaria. We've had the pleasure of a decade of using ACTs, but it will be coming to an end. Can we shy away from this very serious matter?

3) Bednets have saved countless lives - there is no doubt about it. But also this technology is showing cracks. Resistance to the only class of insecticides approved for impregnation is spreading like wildfire. Yet we continue distributing nets, even to areas where we know resistance is rampant. Moreover, donor fatigue will kick in, sooner rather than later, so who will replace the millions of nets that were dished out for free when they are torn and no longer effective?

4) Searching for new chemical insecticides is like doing the same thing over again. By now we should have learnt that whenever we throw a chemical at an insect it will become resistant in due course. So why do we spend millions and millions of dollars on finding new insecticides when we know up front that they will help for a few years only? Why can't we face this dilemma and really search for viable and sustainable approaches to control malaria vectors?

5) ...this one is for you to fill.

Numerous issues affect the way in which we move forward in the battle against malaria. Like Margaret says, openness isn't the end, it is the beginning. And as she says 'But when we dare to brake that silence, and when we dare to see, and we create conflict, we enable ourselves and the people around us to do our very best thinking. Open information is fantastic, open networks are essential, but the truth won't set us free until we develop the skills and the habit, and the talent and the moral courage to use it.'

Wouldn't you agree? What is your issue regarding malaria that deserves to be discussed yet is hidden away?


Submitted by Anton Alexander on

I found this article very relevant to many of the blogs in MalariaWorld – it is indeed ‘a must see’ and I am surprised that more people haven’t.
I have been reading MalariaWorld for about six months. Once in a while, there are doomsday articles about eg the resistance to insecticides and the return of malaria, or donor fatigue, or lack of an effective organisation to take control of malaria elimination. Many of these articles I think were written in the hope that they would shake the readership into doing something about it, or that people would see the errors of their ways and cease activities that a particular article had criticised.
But this Margaret Heffernan article serves to explain why these activities are like a super-tanker, and that a change of direction, or a cessation of an activity will only take place very very slowly.
Meanwhile malaria continues to leave its ugly mark, and the sense of frustration or impotence at the lack of progress in malaria elimination is evident.
Therefore, instead of first attempting to start anew, to sweep away the old discredited methods, and to rebuild a bright new world from scratch, would it not be more realistic to accept the current anti-malaria activities as they are, and at the same time, but in parallel, begin to organise rigorous malaria-elimination campaigns with its hard work in the heat of the tropical sun advocated by Bart Knols and other MalariaWorld subscribers.
I have the impression there is at present a fallacy that such new campaigns can only be commenced if and when existing criticised methods are brought to an end. Margaret Heffernan has explained why existing doubtful or suspect methods will be with us for a long time yet. So rather than doing nothing, why not dust off and apply the tried and tested methods/principles utilised by Dr I Kligler and Fred Soper of the 1920s and 1930s (both incidentally having previously worked for the Rockefeller Foundation).
Bart Knols has made a study of Fred Soper’s methods, and wrote about him in MalariaWorld on 30th May 2010. Dr Kligler dealt with eradication of malaria in Palestine, which until his arrival there in 1920 was uninhabitable in many areas, and without which eradication, there would have been the possibility Israel could not have come into existence. I have written about Dr Kligler’s work in MalariaWorld on 1st June 2012.

Submitted by Guest (not verified) on

This is really insightful and particularly pointing to tomorrow's failure of today's malaria management efforts...thus,calling up the image of pesticide treadmill effects.

Indeed, we must not continue to feign ignorance of the fact that we are spending billions of dollars every other year on a war we have not yet agreed on the best weapon to execute.

We have well over 3000 species of mosquitoes and with all our 'progrossive' engineering and re-engineering of synthetic chemical pesticides and yet we have not succeeded in effectively and safely controlling one of them.

We shall continue to run in cycles and never making any substantial headway if donor funds continue to stream in without a clear-cut, long-term scalable management efforts, which have been demonstrated by some experts.

In the light of the present ugly outplays of events, let there be a halt of all donor funds and investigation of all donor fund recepients and managers. It is not illogical to say that a few persons in the chain are illegally benefitting from the donor funds and have kept working against every idea that will lead to a sustainable and permanent solutions to the issue. A Nigerian university don connected to a donor fund was quoted as asking "If we do source control of mosquitoes how will the donor fund continue to come?". There's much more to the issue that meets the eyes and unless this is tackled those billions of dollars can only benefit a few immoral persons.

It's my humble appeal to Bart Knols and other malarial experts to do an objective expository analysis of the funds voted so far in the last two decades for malarial control/eradication efforts in Africa. We shall be shocked the extent to which corruption and misappropriation have undermined genuine intentions and efforts to fight malarial wars.

Sent in by Francis C Bosah, a non-toxic pest management expert.

Submitted by Guest (not verified) on

Dear Bart,

Many thanks for the link.

Indeed, a severe shortfall persists between what is needed and what is provided and it’s particularly upsetting to know that the existing insufficient international donor funds which constitute the greater part of the available insufficient resources may diminish over time...which will certainly work against the gains appropriated so far.

It is very saddening that even when funds are inadequate, as they are often in the developing world, fraud and graft often are a problem as people within administrative structures covetously fight over a small amount of available funds to the detriment of human lives.

Even the blind will find it less difficult to see that fraud and graft have limited the usefulness of available inadequate funds; the immediate consequence being that the ugly situation may negatively affect the confidence of international donors, who are already experiencing financial burn-out due to global recession.

According to experts, “…as the ongoing climate of financial uncertainty places strains on investment in global health, there is an increasing need to audit the origin, recipients and geographical distribution of funding for malaria control relative to populations at risk of the disease”.

In this time when international donor support is at a critical moment, it is to be hoped that these influences of fraud and graft will be weakened and that the overriding importance of saving lives and advancing development and better standards of living will become perceptible to administrators in developing as well as developed countries.

It has become morally essential for malarial experts to bring to the forefront the role of fraud and graft in relation to the impending further diminish of international malaria abatement/eradication donor funds.