Lifeblood: New 'business model' in fight to eradicate malaria

Alex Perry's book examines a revolutionary idea to tackle a disease that kills one million people a year in the lowlands of Africa and Asia.

Lifeblood: How to Change the World One Dead Mosquito at a Time Alex Perry C Hurst & Co Dh92

Of all the scourges that have plagued mankind, malaria is the worst. Its path of destruction, via the Plasmodium falciparum parasite and the Anopheles mosquito, dates back millennia, as evidenced by traces of falciparum in Egyptian mummies from as early as 3200BC. Over time, malaria has actually changed global history - by killing the powerful Tutankhamen in 1324BC, Alexander the Great in 326BC, Genghis Khan in 1227 and Oliver Cromwell in 1658, to name a few - and afflicting the influential: eight US presidents, from George Washington to John F Kennedy, were all infected.

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More important is the fact that malaria is still with us, killing an estimated one million people a year in three dozen countries and infecting up to half a billion more, causing sporadic bouts of illness that force school absences, job interruptions, and among the hardest-hit survivors, severe brain damage.

In the swampy lowlands of Africa and Asia, malaria breeds poverty because it halts development. And what makes this toll particularly wrenching is that malaria is preventable: a $10 bed net treated with insecticide, combined with area spraying, cuts child deaths by 70 per cent.

So why does malaria persist? Simple, according to Lifeblood: How to Change the World One Dead Mosquito at a Time - the foreign governments and aid groups traditionally charged with malaria's eradication never came up with the right business plan. "A business that consistently delivers subpar results, or misses deadlines, or cannot account for money spent will eventually go bust or at least stop winning tenders," author and journalist Alex Perry points out. "Not so in aid, where good projects were trumpeted, but bad ones, I learned, [were] merely downplayed." Non-governmental organisations (NGOs) may have worked hard against malaria, Perry says, but they issued few performance evaluations or pink slips. "Efficiency was not the priority."

Enter the Millennium Development Goals (MDGs), eight minimum standards of poverty alleviation and health, which the United Nations vowed to make universal by 2015. One of those MDGs called for halting and starting to reverse malaria; associated goals included halving poverty and cutting child mortality and maternal mortality worldwide.

With their goals, guidelines and deadlines, these MDGs were "in effect, a rudimentary business plan", Perry writes. And that was good because it got rich people thinking about "the paradox of millionaire philanthropy". He continues: "Conscience was dropping a bill in the poor box once a year; self-interest was setting up your own foundation and monitoring how your money was spent."

Names that come to mind here include Bill and Melinda Gates, and certainly Perry writes about the Microsoft founder's astounding contribution to wiping out global childhood disease.

But Lifeblood focuses especially on a lesser-known hero of the malaria campaign: Ray Chambers, self-made millionaire and leveraged buyout king from a poor neighbourhood in Newark, New Jersey.

Chambers was inspired by both the MDGs and mavericks such as Steven Phillips, an occupational medicine specialist with ExxonMobil in Nigeria, who talked his bosses into taking on HIV and malaria in the private sector because, well, it was good business.

Chambers had a similar epiphany. As a now-famous story goes, the millionaire, one day in 2006, was spending time with Jeffrey Sachs, the famed development economist; the two men were co-sponsoring 13 "Millennium Villages" as a showcase of efforts to achieve the eight MDGs.

Picking up a photograph Sachs had taken in Malawi, a charmed Chambers commented on the angelic sleeping children he thought he saw there. But he was swiftly corrected: "Ray, you don't understand," an impassioned Sachs told him. "They're all in malarious comas. They're all dying."

And the children did die. That nailed it for Chambers. "I'd like to come up with some business concepts," he told Sachs, "to see if we can't save a million children a year."

Chambers did exactly that, Perry tells us in his compelling, highly readable book. The millionaire worked alongside the Gates Foundation; the newly formed (2002) Global Fund to Fight Aids, Tuberculosis and Malaria; the World Bank; and George Bush's President's Malaria Initiative. Countries including Britain and Germany jumped in, and Chambers himself founded an NGO, Malaria No More, headed by, you guessed it, another business guy - the ex-News Corp president Peter Chernin. Phase I of Malaria No More promised universal coverage of bed nets by late 2010 for seven African countries: Nigeria, southern Sudan, Tanzania, Kenya, Ethiopia, Uganda, and the Democratic Republic of Congo (DRC). These accounted for two-thirds of the world's malaria cases and 85 to 90 per cent of deaths.

The plan committed to 300 million bed nets, pushed out at the rate of 312,500 a day. Phase II would be the end of malaria deaths by 2015. Phase III was eradication over several decades.

Chambers, appointed UN Envoy for Malaria (on a salary of $1 a year), busied himself getting everyone on board, from Ashton Kutcher, Demi Moore, Bono and David Beckham to business leaders from LinkedIn, Priceline and Time Warner. He talked the makers of the TV programme American Idol into producing a special 2007 telecast featuring everyone who's anyone in Hollywood.

Those were the high points. But the low points outnumbered them: Chambers had to battle the Global Fund over its time-wasting, two-step programme to distribute nets first to pregnant women and young children. He had to deal with Kenya's repeated rejections for grants from the Global Fund over that nation's inefficiency. The DRC's reclusive president wouldn't give Chambers a meeting. And Uganda's health ministers outright stole their first round of funding - running into the millions of dollars.

Such corruption and delays cost lives, not just because the new nets were delayed but because the effectiveness of the existing ones was expiring: their insecticide lasts only three years. That meant that children already protected would be more vulnerable because they had no immunity should the mosquitoes start biting again. What's more, experts warned that eradication would require three to four rounds of nets and spraying - and six or seven in the most malarious places.

Perry, Time magazine's African bureau chief, knows those places well, and his descriptions of them make for the most harrowing parts of the book. At one point he describes a night spent in Apac, Uganda, "the most malarious place on earth". In Apac, the local hospital's packed malaria ward had no bed nets but did have plenty of helpless, emaciated patients defecating diarrhoea in the courtyard.

Out on the streets - ghostly for their lack of people hiding from the deadly bites - men, brain-damaged from malaria, and naked, lumbered zombie-like through the alleyways.

Outside the town, cotton farmers objected to mosquito spraying because their Western buyers - Nike, H&M, Wal-Mart - wouldn't buy insecticide-tainted crops. "The reality is that African babies are dying so that western babies can wear organic," Perry notes.

The author reserves his harshest words for the big NGOs, whose employees live the high life amid some of the worst poverty on earth. "Again and again I saw money spent on fleets of cars and ranks of furnished offices and villas rather than actual assistance," he writes, "until the mere sight of a white Toyota Land Cruiser was enough to spark an instant surge of anger." Perry watches, speechless, as aid groups, in a bid for donations in 2008, warn that the gathering financial crisis will be dire for Africa, when in fact assistance during that period actually rose, and the continent's 29 lowest-income countries grew by 4.5 per cent.

En route, Perry asks the questions that need to be asked, such as: can Africa fight malaria on its own? Possibly, the author answers. In 2006, foreign investment there reached $48 billion, overtaking foreign aid for the first time. "Sub-Saharan Africa today resembles Asia in the 1980s," by offering the world's highest rate of return on investment," Perry writes. China is falling all over itself to invest.

As for Africans themselves, they crave self-sufficiency. In a cringeworthy moment, Perry is told by a coffee company CEO how fed up he is with western celebrities championing aid. "Africa finds itself represented not by Africans, but by Bono and Geldof," the CEO groused, in a 2009 interview. "I mean, how would America react if Amy Winehouse dropped in to advise them on the credit crunch?"

As for Malaria No More's business plan, it worked - almost. Chambers had set the goal of distributing 300 million nets to 600 million people by the end of 2010; and his campaign ended up distributing 298 million nets to 578 million people. Yet he wasn't all that close to his goal after all: estimates of need for the nets had grown to 700 million people. And there remained that nagging issue of expiration.

Still, in September 2010, a report estimated that 175,000 lives were being saved each year because of the nets effort. And that same year Perry returned to Apac, to find happy townspeople sitting outside at night in open-air bars, finally unafraid. That hellish local hospital? It was cleaned up and efficient; mosquito nets graced every bed; and the old incidence of 15 new malaria patients each day had plummeted to 15 a week.

Thanks to Chambers and others, the new mantra in business of "doing well by doing good" had transformed mankind's harshest plague. In October 2010 Apac could finally report that not a single child died of malaria in that month.

Joan Oleck is a freelance writer based in Brooklyn, New York.