Eradicating Malaria: What Business Can (and Cannot) Do For It
By Fiorenzo Conte
Malaria accounts for one third of child mortality in Sub Saharan Africa. The international community has grappled with this issue for decades: the debate evolved around the result to be pursued. Some argue that given the knowledge we have accumulated over the years eradication is a feasible result, others claim that given how much this disease is entrenched with conditions of poverty the most realistic goal is disease management. The book “Lifeblood” by Time’s Africa bureau chief Alex Perry tells the story of the most impressive attempt which has been put up in recent times to first control and then eradicate malaria once and for all in Africa. Perry does an excellent job at depicting a very grim picture of Africa as a continent devastated by malaria and in-habitated by zombies which is locked into a circle of poverty and high mortality. What Africa need is therefore an external support to overcome this obstacle. However, given the past records of the aid as usual (poor achievement, entrenched interested in perpetuating crisis, little accountability to the beneficiaries) traditional aid won’t do the job to rid the world of malaria. What aid needs is a paradigm shift: aid turned into business.
The pioneer of such approach, celebrated in the book, is the millionaire and philanthropist Ray Chambers appointed as UN special envoy for malaria and deus ex machine of the eradicate malaria campaign. Chambers puts forth the fundamental proposition of bringing the business mindset and techniques into the old way of doing philanthropy. This means that the main driver for helping others is one’s self interest. His model envisages a triangle of leverage and accountability which works roughly like this: firstly, you convince the big players (such as World Bank, Western governments and Global Fund) to finance the Eradicate Malaria campaign, then you get these players to promise the funding in front of the media so that later on they are constraint to live up to their promise, unless they want to be seen as liars. The novelty of the approach lies in the involvement of the celebrities and entertainment industry to make the public opinion in the West more sensitive to the issue of malaria: if you get the public opinion in the West behind the issue, so the argument goes, then you can get the politicians to care and commit resources for malaria. By deploying such approach Chambers was extremely successful in mobilizing a great amount of resources. Chambers was also very successful in introducing benchmark against which evaluate the success of the campaign: if the target is to reach universal bed net coverage by 2010, anything that goes below that target means failure. By introducing measurement and deadlines you introduce a mechanism to hold the implementers accountable. Lastly, and most importantly, Chambers has the merit of conveying the urgency of getting things done in the shortest time possible: eradicating malaria is possible and doable. Too often the aid industry dwells on the negative and turns what is difficult to achieve into impossible: such injection of positive thinking can therefore only be beneficial.
There is room for skepticism however. The first reason comes from history: it is not the first time that the world embarked on an Global Malaria Eradication Programme, it did so in the 1960s. At that time the world had a powerful instrument, DDT, capable to kill the vector for a period of time so that the human host fight off the parasite. Today the world believe to have found a similar effective instrument: insecticide treated bed nets. In both cases a 80% coverage is needed to break the cycle of transmission. In the 1960s there was a man, Fred Soper, who had been successful in eradicating malaria in several countries and for that reason was able to convince donor to fund a global malaria eradicate campaign: the funding mobilized was as big as the one raised by Ray Chambers. At that time Fred Soper had introduced new techniques fromthe military field into aid such as discipline, deadline, zealous: an approach which was considered as innovative as the one advocated by Chambers today. So if the Eradicate Malaria campaign of the 1960s was so similar to the Chambers’ campaign why the latter is expected to succeed? The book is very vague on this point given that distributing nets to 80% of the households in a country will run into the same logistical problem of spraying 80% of the houses. Secondly, the 1960s campaign showed that the main problem is long term sustainability, given that as funding drops malaria is likely to bounce back up. Chambers does not have a very specific plan on this. There is however something that both Soper and Chambers had which is key to success: the sense of urgency to save as many lives as possible in the shortest time possible. Reducing malaria deaths is not a task for future generations, it is something to be achieved now.
Another problem concerning this business-of-caring approach has to do with its ethics. One of the enterprises presented in the book as success story of this new approach is ExxonMobil and its work in the Niger Delta. ExxonMobil around 2008 departed from a the traditional exploitative model of resource extraction “we go in, do business, pay taxes, no further services offered” and started a campaign against malaria. It did so not because they were moved by the plight of the local population but because it was its self interest: fighting malaria meant for ExxonMobil saving money for the reduction of day lost of its workforce. Philosopher Slavoj Zizeck puts the finger on the main pitfall of this new type of capitalism: it exploits with one hand and buys its own redemption with the other. If one looks at the situation of the Niger Delta is difficult to disagree with this thesis: the very arrival of oil companies and the start of the oil drilling the standard of living have deteriorated over time. If it is true that the big culprits are corrupt government officials (the government is making enormous profit, yet very little trickled down to the community) yet oil companies bears the blame as well. This extract from a National Geographic reportage “Nigerian Oil” frames the responsibility of the oil companies:
On land, there are oil spills, polluting groundwater and ruining cropland. The government documented 6,817 spills between 1976 and 2001—practically one a day for 25 years—but analysts suspect that the real number may be ten times higher. Old, improperly maintained equipment causes many of the leaks, but oil operators blame sabotage and theft, speculating that disaffected community members deliberately cause oil spills to collect compensation money.
The devastation on the environment has knocked down the local fishing industry thus compromising the livelihood of the local population. To accuse the oil spill to the local population sounds a bit like blaming the victim: in 2010 ExxonMobil imported a 30 years old platform from Angola into Nigeria (it had to be removed from Angola because the government rejected it); the platform broke down, leaked at least five thousand of barrels of crude a day, while ExxonMobil and the Nigerian government swept the story under the carpet. The fundamental problem with this business-like charity is that it perpetuates the fundamental conditions which triggered the marginalization and deprivation of the people now receiving the charity. It lends a new positive image to the company without making a change in its irresponsible behavior necessary. This should warn us from considering this new business-of-caring approach as a panacea.