Friday, June 22, 2007

Making magic for Liberia's children

It is little wonder that Liberians suffer from ill health. The country’s hot, rain-soaked climate provides a feasting frenzy for dozens of dreadful diseases: cholera, lymphatic filariasis, yellow fever, and river blindness, to name a few. Above all, just one disease --- malaria --- poses the single greatest health threat. Spread by the bite of an infected mosquito, malaria is so pervasive in Liberia that it is deemed hyperendemic. The disease kills a staggering number of children – one of every two children that dies before the age of five is killed by malaria -- and is one of the primary reasons that Liberia has the fourth highest rates of child mortality in all of Africa.

Yet in the face of these pernicious diseases, the government’s capacity to fund life-saving medicines, clinics, and health programs is woefully inadequate. Liberia has only recently emerged from two decades of civil war, which left the government saddled with more than $3 billion in foreign debt and constrained by a shattered revenue base. Last year, the entire budget of the Government of Liberia was just $129 million and was divided among many additional pressing priorities. Thus while the health needs of the country are mammoth, they dwarf the government’s ability to finance them. Today the Government of Liberia spends less than $5 per person per year for health, a teeny fraction of the average $5,627 per person that the United States spends annually, and hardly enough to keep its citizens healthy.

Worrisome still is the shortage of trained health care workers in Liberia. For a country of more than three million people, there are fewer than 40 Liberian doctors and 50 nurse midwives. To put this into perspective, the building on M Street in Washington, DC that houses my primary care physician has more doctors sitting together under one roof than there are Liberian doctors in the entire country of Liberia. Moreover, years of destruction and looting during the war severely damaged the health infrastructure throughout the country.

Perhaps most damning is the reality that Liberia does not yet have the tools in its arsenal to win the battle against infectious diseases. Without a vaccine to prevent malaria, treatment efforts have been undermined by the increasing resistance of mosquitoes to antimalarial drugs, and prevention efforts with treated bednets have made only modest strides. Yet success is possible. In spite of all of the deficiencies in Liberia’s broken health system, one of the most stunning accomplishments has been the immunization of more than 95% of Liberian children with the measles vaccine and the subsequent slashing of measles deaths. Imagine the sheer number of lives that could be saved if Liberia had a malaria vaccine!

Today the world – and Liberia – still waits for a malaria vaccine to be developed. Unfortunately, the shallow pockets of Liberia’s citizens alone will not induce the private sector to step up to the plate. Three quarters of Liberia’s citizens live on less than a dollar a day and few if any have access to health insurance. This poverty makes Liberians – and their neighbors in Africa, a continent which accounts for 90% of malaria deaths worldwide -- unlikely customers for expensive new health technologies, and provides little financial incentive for costly investments by pharmaceutical companies in the discovery and development of life-saving vaccines. Too often, diseases like malaria are then sidelined from the global research agenda.

Thankfully, there exists a promising new solution to this colossal market failure. This year marked the launch of the first ever "Advance Market Commitment," an innovative financing mechanism that creates commercial incentives for pharmaceutical companies to invest in the development of life-saving medicines that they may otherwise ignore. To do this, the Advance Market Commitment enables international donors to make a binding commitment to finance a specific vaccine (such as a malaria vaccine) if and when it is developed, at a price that is profitable. The brilliance of this scheme is that it allows donors to unleash the powerful ingenuity and innovation of the private sector, aligning technological advances with the greatest social good. In February donors committed $1.5 billion to such a mechanism to spur the development of a vaccine to prevent child pneumonia. Should donors decide to act, a similar mechanism for malaria may not be far behind.

A sobering year of grad school has already drained from me any illusions of holy grails or “silver bullet” solutions for ending poverty. To be sure, a malaria vaccine is not a panacea -- it cannot fix the gaping weaknesses in Liberia’s health system, nor perform miracles with Liberia’s budget – but it sure comes close. Saving the lives of half of Liberia's children who die before they reach their fifth birthday with just one powerful shot? Sounds pretty miraculous to me.


Francesco Ferretti said...

190578molly!!! keep on going, don't stop. you have passion you're incredibly smart, you look gorgeous with African dress, you are becoming tanned under the African sun and you will be my roommate next year!!!

you have all !!!! :-)

beside the jokes, here in India I am getting quite annoyed by many western freaks (and I am falling in love with Indian people instead) I am meeting here, with their old analysis/lullabies about how crap is western society and bla bla bla, how it lacks the "third world purity" and bla bla, and in the meantime they eat in Indian extra luxury restaurants, buy hippy/chic clothes in India without paying the minimum attention to the problems that most of the people (and most of the children) do face here.

After that, reading your sharp analysis about policy alternatives for Liberia problems is a kind of relief for me.

bye Molly...keep on going...


(for whoever might be interested in reading about my summer in India:

Meritxell said...

Hi from French-speaking West Africa. Same reality over here and probably same awful weather, right?
My internship with UNICEF rocks, their education program makes such a difference to many many children and to their mothers. I am not the most positive person about how development aid is being managed...but up to know I am absolutely convinced UNICEF is putting some money in the right places. There is hope.
Big kiss, Mtxll

Anonymous said...

Molly, Your blog is a wonderful way to catch a slice of your life. Thank you so much for sharing it with all of us. I have been hearing about arguments that promote the use of DDT to stop Malaria. The criticism of Rachel Carson and her book Silent Spring,is certainly not politically correct but the millions of deaths, post DDT ban,are certainly a reason to question the science and the politics that criticize the judicious use of DDT. Rather than focusing on the cure, perhaps more emphasis on prevention would be cost effective and productive.

John Connolly

Erin said...

Dearest Molly - your entries and observations have been both sobering and refreshing. Having been engaged in development (often without achieving the desired results in the time frame we had hoped for) for the past decade and a half, I often lose my perspective and become discouraged - until I hear from those (like you!) that are so committed and look at the global issues of poverty and democratic stabilization in the most fragile states with new energy, enthusiasm, and acuity - thank you for reinvigorating my perspective (once again) - keep the faith! Cousin Erin

Karinochka said...

hey Molly! Your blog entries are very educational and inspiring. It seems like you are learning a great deal and its great to learn through you. I am getting a much better understanding of the challenges facing Liberia. I was especially moved by this entry about helping Liberia's children.

Thanks for your lonely planet guide. it is definitely coming in handy!

:) Karina

Brandi said...

I just found your blog through google searching for Malaria stats in Liberia b/c we are raising money for mosquito nets with Orphan Relief and Rescue. I can't wait to read more. We brought home our son from Liberia in December and I ache to go back. I love how eductational your blog will be while also giving me tidbits of life in Liberia and a people who have stolen my heart hook line and sinker!


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