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Brendan Smialowski for WORLD

Survivor

Disease | Adm. Tim Ziemer has come through war, tragedy, and political upheaval-to do battle with the mosquito

Issue: "Fighting poverty," March 13, 2010

WASHINGTON-As a child, Tim Ziemer remembers lying in his home in the village of Ban Me Thout in southern Vietnam-then French Indochina-consumed with a burning fever from malaria. The antidote of choice at the time was quinine, which brought him along with his missionary parents and two siblings through the illness alive.

The fever "makes you almost blind-burns your lips," described Connie Fairchild, who was a next-door neighbor and family friend to the Ziemers in Vietnam and is now senior director of development at World Relief. Like everyone else, she had malaria too: "You shake. The shaking is terrible."

Today Admiral Ziemer, 63, heads up the President's Malaria Initiative, an aggressive $1.2 billion program begun in 2006 under President George W. Bush. The eradication program is supposed to reduce malaria deaths by 50 percent by next year, an objective that Ziemer says is on track to be completed. Ten years ago, the U.S. government was investing only $1 million to fight malaria in Africa-and losing.

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Malaria is a fading memory in the United States, but in Africa-where Ziemer has made 16 trips as head of the Malaria Initiative-it kills almost a million people every year, almost all of them children under the age of 5. About 500 million contract the illness worldwide. The U.S. initiative is focused in 15 African countries, where malaria prevalence rates in Zambia, for example, fell by 53 percent in the first three years of the program.

One of Ziemer's chores as a child was to spray the insecticide DDT along the baseboards of his family's home to protect them from malaria-carrying mosquitos. A little bit of DDT mixed with water and sprayed on inside walls is one of the longest-lasting and cheapest protections against malaria. If a mosquito lands on the treated wall, it dies without passing the malaria parasite on to humans, and the repellant lasts for up to a year, months longer than other insecticides.

But few countries use the chemical widely because of environmental concerns that Rachel Carson introduced in her 1962 book Silent Spring. She alleged that DDT thins the eggshells of birds, threatening certain species. While those allegations have largely been disproved in years since, the perception of DDT remains, and a number of Western countries impose trade restrictions on countries that use DDT.

"The compliance is really cumbersome," said Ziemer, sitting in his office at the U.S. Agency for International Development (USAID). On his desk is a sign: "If only Noah had swatted those two mosquitos."

If DDT is used properly, he said, "There's no scientific evidence that would require us to remove it as a public health intervention." As restrictions stand now, only four of the countries the malaria program works in use DDT as their insecticide of choice, while Ziemer argues that laying off insecticides like DDT means, "We'll lose more lives, there's no doubt about it."

The funding for the program comes to an end next year, so Ziemer is working to convince Congress to continue the malaria budget, even as most politicians are thinking about domestic concerns like jobs. But Ziemer said he's confident, and that lawmakers have expressed support for the malaria program "in a very generous and aggressive way."

Ziemer is a rarity in Washington: a Bush appointee reappointed by President Obama, which he said was "unsolicited and unexpected." Mark Dybul, the head of a major health success of the Bush administration, the AIDS program PEPFAR, lost his job a few days after President Obama's inauguration. Dybul made choices on thorny issues like the U.S. government's promotion of abstinence efforts, issues that Ziemer doesn't have to bother with. Malaria prevention is a bit more basic: insecticide and mosquito nets.

Still, Obama has not personally owned PEPFAR or the Malaria Initiative the way President Bush did. To this point, Ziemer has not met the president, though he saw Bush often. "Frankly, in the big scheme of things, malaria is just one of the moving parts. I don't feel shunned or unappreciated," Ziemer said. "[President Obama] has mentioned the significance of malaria, so we're doing all right."

Ziemer has survived more than a change in administrations. Growing up in southern Vietnam, he watched the French leave the country and lived through the build-up to war with the north. In the midst of political upheaval, his parents, Bob and Marie, worked with a mission team translating the Bible into the regional dialect. They opened a school, a church, a clinic, and a leprosarium (leprosy was a scourge on Vietnam at the time, and remains a problem today).

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