Malaria's Toll

Malaria's Toll
By JASON L. RILEY
August 21, 2006; Page A11

Each year, malaria afflicts a half-billion people (roughly the population of North America) and kills a million of them (roughly the population of San Jose). And the latter is a low-end estimate. The actual number of fatalities is hard to pin down, since a body initially weakened by malaria becomes predisposed to other maladies.

But we do know that malarial mosquitoes are attracted to the tropical climes of sub-Saharan Africa, where they prey on impoverished populations that lack the sprays, screens and bed nets necessary to keep the insects at bay. Hence, some 75% of malaria victims are African pregnant women and children under five.

The economist William Easterly calculates that medicine that would prevent half of all malaria deaths costs only $0.12 a dose, and bed nets that would severely limit new cases cost a mere $4 apiece. "Preventing five million child deaths over the next ten years would cost just three dollars for each new mother," he writes in his book "The White Man's Burden."

Mr. Easterly argues that the tragic incompetence of the Western foreign aid industry -- $2.3 trillion spent, over five decades, but little forward advance -- stems from its overly bureaucratic approach to problem-solving. Agencies like the World Health Organization, the Global Fund and the World Bank traditionally have been staffed by well-meaning "planners," to use his term, who see "poverty as a technical engineering problem that [their] answers will solve."

What these organizations really need, says Mr. Easterly, are more of what he calls "searchers," or people who understand that "poverty is a complicated tangle of political, social, historical, institutional and technological factors." Where planners raise high expectations but take no responsibility for meeting them, searchers prefer to work case-by-case, using trial and error to tailor solutions to individual problems, fully aware that most remedies must be homegrown.
[Lance Laifer]

Lance Laifer, a hedge-fund manager in Connecticut, is a searcher. The horrors of malaria came to his attention in May 2005 via a Charlie Rose interview with Columbia University's Jeffrey Sachs, the development expert (and quintessential planner). "I didn't know anything about malaria," Mr. Laifer said in a recent interview. "I didn't know it still existed. I didn't know it was still killing people. I thought it was eradicated a long time ago. I was just flabbergasted."

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Mr. Laifer turned his outrage into something of an obsession. He began researching malaria intensely; and he also ran some numbers. Bed nets, medications, insecticide, swamp drainage, etc., came to less than $10,000 for a typical African village of 1,000 people. "That's a doable number," Mr. Laifer concluded.

And then he picked up the phone, turning to friends and associates who help him organize an annual fundraiser to fight cancer. "I basically had a group of people that I know have very big hearts in this area, specifically in dealing with children," he says. "So I called them and said, 'What do you know about malaria and how many people are dying from it?'"

That was the starting point. Where it will end is anyone's guess. Inside of a year, and working with George Ayittey of the Free Africa Foundation, Mr. Laifer's efforts have spawned five "malaria-free zones" in Ghana, Nigeria and Kenya. Expansion to Ivory Coast and Benin is in the works. He adds that he has the financing to roll out additional zones this year but -- ever the searcher -- first wants to assess what's working and what isn't. If all is going well, "next year I see us doing something like 100 villages."

Mr. Laifer says a future focus will also be DDT, the pesticide used by Americans and Europeans in the 1940s to win domestic fights against malarial mosquitoes. Indoor spraying of DDT is by far the cheapest and most effective way to control the disease. One South Africa province employing DDT saw malaria infections and deaths drop 96% over a three-year span.
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African nations, fearful that lucrative European and U.S. markets might ban their agricultural exports, make do with less-effective DDT substitutes. Though DDT, like any chemical, can be harmful in high doses, there's no evidence that using it in the amounts needed to combat malaria has any ill-effect whatsoever on humans.
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But Mr. Bate says the reality is that economic development is the only sure-fire anti-malaria strategy. "We eradicated malaria in Malaysia in the '50s and '60s, and in Singapore at the same time. It came back in Malaysia in the '70s but not in Singapore, and the reason it came back is that there wasn't enough wealth for people to have screens on the windows. Singapore's economy, however, grew rapidly, and there isn't a problem there anymore."

Which is why sub-Saharan Africa's poverty and poor infrastructure make it such a difficult case. And why widespread health problems will persist in the region until people are no longer living under exposed conditions and able to get proper treatment. Not that Mr. Laifer is bowed by these challenges. "All I'm trying to do is give these kids their lives back," he says. "Somebody needs to do this."