Roger Bate does not care who gets credit for taming the beast, but in truth he did much of the work. For the last two years, he and a dedicated band of experts have been skewering the U.S. Agency for International Development over its ineffective international malaria programs (see "Kill or be killed," Oct. 29). Now, finally, the agency has heard and is changing its ways.
The agency spends about $200 million annually fighting the mosquito-borne disease that afflicts 500 million a year, mostly in Africa, and kills 1 million, mostly children under 5. But instead of focusing on simple, life-saving commodities, such as drugs and insecticides, the agency marshaled almost all its funding toward "technical" assistance, or advice to countries on fighting the disease. So Mr. Bate, a resident fellow at the American Enterprise Institute in Washington, unleashed a steady onslaught of research and criticism on USAID's methods last year.
In mid-December, the agency announced it would realign its malaria funding for 2006, devoting almost half to nuts-and-bolts interventions such as drugs, bed nets, and indoor spraying. The figures are a study in contrasts: In 2004, for example, USAID spent $1 million on indoor spraying; in 2006, that number will be $15 million.
These are encouraging signs for Mr. Bate. Just last summer a research paper he co-authored on USAID's malaria policies invited a blistering rebuke from the agency's administrator, Andrew Natsios. Having battled long, Mr. Bate's attitude now is "trust, but verify." "I believe that they want to change," he told WORLD, "but I don't know that they definitely will."
Last July U.S. anti-malaria efforts received a boost from President Bush when he pledged $1.2 billion over five years to fight the disease. The new money, with White House pressure, was going to follow the commodities-heavy approach experts have been advocating. But USAID's December announcement changes older malaria programs-a more comprehensive reversal. "Once you get a sense there's a better way of doing it, you really need to get going and get it done," said Kent Hill, USAID's deputy administrator for Global Health. He says there was "more good being done than our critics thought. Having said that, we can still do better with the money."
Mr. Bate will now follow the money to see that it goes where it is most needed. One thing he wants to track is how the agency runs its indoor insecticide spraying programs. Spraying with DDT, a chemical banned in the West but most effective at killing mosquitoes, is essential. He suspects allocations for DDT and other insecticides are still low, but that USAID is off to the right start. The change is welcome, he said, "whatever rhetorical spin they put on it."