“This is now four or five years in which we’re simply stuck. I think what we’re seeing now is the limits of what can be achieved with those tools and those financial resources… What worked for the last 15 years is not necessarily what is going to work and help us move forward in the coming 10 years.”
-Dr. Pedro Alonso, Director of the Global Malaria Programme at the World Health Organization
On December 6, 2021, the World Health Organization (WHO) released its annual report on malaria. The report notes that in 2020, there were more than 241 million cases and approximately 627,000 deaths due to malaria. 95% of malaria cases and 96% of deaths happened in Africa. This represents a six percent increase in cases and 12% increase in deaths from 2019.
We are losing the war on malaria. According to Dr. Pedro Alonso, “we are badly off track and time is running out.”
The problem with the war on malaria is that most malaria fighting strategies focus on symptoms of malaria, and not the root cause. The root cause of malaria cases and deaths is poverty.
Existing strategies to treat malaria, such as providing insecticide treated nets, indoor residual spraying, and preventive chemotherapies have all been shown to reduce the malaria burden on communities, but they are largely unsustainable resource transfers from rich donors to poor communities.
In our research, we call this a push strategy of development.
Push strategies are often driven by the priorities of their originators, typically experts or donors in a particular field of development. They generate solutions that are recommended to low-income communities based on their research and expertise on a particular problem. Although the solutions proffered by push strategists are often “free,” they’re rarely sustainable, beyond the control of local communities, and can be stopped at any time.
For example the US President’s Malaria Initiative provides significant resources to help solve malaria in low-income communities. As helpful as the program is, beneath the surface, it–and programs like it–is a resource transfer from rich countries to poor. In many cases, poor countries don’t have the financial, technical, and managerial resources necessary to maintain the solutions offered by these programs. On average, the total budget (not just health) of African governments amounts to less than $500 per person per year.
As a result, funding is never enough and whenever there is a crisis, like COVID-19, these initiatives suffer. An extra 47,000 people died from malaria because of disruptions caused by the COVID-19 pandemic.
How should we fight malaria?
By not fighting it. At least not directly.
When I was younger, my siblings and I contracted malaria regularly enough that it wasn’t a cause for emergency. We were never at risk of death or severe setbacks. When malaria struck, we struck back with therapies such as Chloroquine and Coartem. In fact, it wasn’t until I got much older that I learned of people dying of the disease.
My family was able to win the war on malaria within our household because we were not living in poverty. Although we weren’t wealthy, we were wealthy enough to afford medications, doctor visits (when necessary), and take time off work or school.
So, what if, instead of fighting malaria, we fought poverty by focusing on creating prosperity in poor countries? This will require a paradigm shift in our thinking and will cause us to consider an entirely different approach called pull strategies.
Pull strategies are different from push strategies in almost every way and are far more effective at triggering sustainable prosperity. These strategies are originated by innovators on the ground who are responding to the struggles of everyday consumers or specific market demands. They also have a more investigative or inquisitorial approach to problem-solving as opposed to a more advocacy or assertive approach.
In essence, pull strategists are there to learn and then solve problems in a sustainable manner. On the contrary, push strategies provide well intentioned, temporary solutions to particular development puzzles.
For example, the mobile telecommunications sector in Africa is now a multibillion dollar industry. In turn, this sector pulls in millions of jobs and hundreds of millions of dollars in tax revenues annually. These resources can be used to fight malaria more sustainably.
Most recently, WHO declared China malaria free. China, like many other countries that are malaria free, has been on a steady march to prosperity for decades. Unfortunately, if the fate of people in poor communities continues to be left in the hands of people in wealthy countries, progress will continue to be slow and unsustainable.