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News for 2011 - Show latest items

Past the 9 million dollar milestone!

We have just passed the $9 million mark on New Year's Eve 2011. What a great way to end the year.
We passed the $7 million milestone back in September, $8 million 13 weeks later and $9 million only 9 days after that. We have also been mentioned in a New York Times article by Nicholas Kristof about holiday giving.
Every donation from every person counts as the total of $9,008,000 from nearly 45,000 donations and transactions, in 161 countries, indicates. 100% buys nets.
Our best wishes to all in 2012. 

We are now GiveWell's #1 rated charity globally!

After thousands of hours of investigation, evaluation and review - covering internal documents, interviews and on-site visits - the independent charity evaluator GiveWell has just announced its new top-rated charity: Against Malaria!

Read their announcement and the detailed review of our charity for more details. 

What is it like to distribute nets?

Elise Johnson, a student at North Central High School, and now at Stanford University, talks on national radio in the US about her experience distributing nets in Senegal: http://soundmedicine.iu.edu/segment/3062/Malaria-Nets-for-Africa

The Global Fund cancel all Round 11 grants

The Global Fund (for Aids, TB and Malaria) has cancelled all Round 11 grants, ie for programmes from mid 2012, as they do not have the money to fund them. This is very worrying for the fight against malaria. Good progress in malaria control has been made in the last five years. Higher levels of net coverage have helped achieve a fall in malaria cases and deaths. We must keep up that momentum as it offers the best chance, and the real possibility, of malaria being brought under control with the dramatic reduction in the number of people who fall sick or die from malaria that can bring.

More info: The Guardian

1 million dollar donation for nets

The Souter Charitable Trust today announced a US$1 million donation to the UK charity the Against Malaria Foundation to fund long-lasting insecticide treated nets to protect people at risk from malaria.

This is one of the Trust's single largest donations to date.

Betty and Brian Souter commented:

"Malaria is a devastating killer of children under 5 and pregnant women. Yet a simple bed net can protect those at risk from falling sick and suffering or dying from the disease. These nets will protect half a million people. 

Important progress has been made in the fight against malaria over the last five years but funds for nets are still desperately needed.

The trust's purpose/mission is to support projects for the relief of human suffering and we have chosen the Against Malaria Foundation as the recipient of this donation because they are a highly effective charity in the ongoing efforts to combat malaria. They have a strong focus on transparency, accountability and efficiency in the way they operate. 100% of the funds we have donated will buy nets."

Rob Mather of the Against Malaria Foundation said:

"This is a fantastic donation which will allow us to protect half a million people as they sleep at night.

More specifically, the nets will be distributed from mid December 2011 to mid February 2012 in one of the 28 districts of Malawi to achieve universal coverage – all sleeping spaces covered – of a population of some 550,000 people. We expect this to have a significant impact in reducing malaria rates in a very badly affected area." 

Press Release (pdf 17.58 kb)


Nets instead of Christmas cards this year?

Instead of sending Christmas cards this year why not donate nets for the equivalent money and let your friends and family know?
Of course, you could also choose to donate nets instead of giving or receiving birthday presents, wedding gifts etc.
Simply donate and leave a message! We then send you a link which you can share with others. If you want to send something tangible then you could print out one of our gift cards...
Every net matters.

Malaria vaccine update - Oct 2011

From the Kaiser Daily Global Health Policy Report 

Reasons For Caution About Experimental Malaria Vaccine
"Writing in KPLU's "Humanosphere" blog, Tom Paulson responds to last week's announcement of results from an ongoing clinical trial of an experimental malaria vaccine, saying, "Despite the hype and fanfare, many experts at the Seattle meeting said this experimental vaccine (known as RTS,S) actually so far represents only incremental progress -- a scientific achievement which may still turn out to have little practical utility in the real world." Paulson says "the findings largely repeat earlier 'interim' results"; the cost of the vaccine, which has not yet been confirmed; and difficulty developing a malaria vaccine that offers an acceptable level of protection are reasons why the vaccine may not be successful (10/25)." The Kaiser Daily Global Health Policy Report is published by the Kaiser Family Foundation. 2011 Henry J. Kaiser Family Foundation.

Other commentators also point out the need to continue using proven methods to combat malaria

All those working to defeat malaria hope the vaccine does prove to be a significant weapon in the fight against malaria.

UpdateNew England Journal of Medicine Editorial 

Infant mortality due to malaria falls in Africa

Awa Marie Coll-Seck, Executive Director of the 'Roll Back Malaria' Partnership, has just given an interview stating that malaria has moved from being the largest cause of infant mortality to the third largest in Africa, although this differs in many countries and regions.

Read more here.

Past the 7 million dollar milestone!

Wow! We have passed $7m raised! The James (DJ Sine) Brown Fund in England made the donation that took us past this milestone.

Every donation from every person counts as the total of $7,005,124 from 41,985 different donations and transactions, in 160 countries, and from 468,720 people participating indicates. 100% buys nets.

That's 1,608,757 nets, protecting more than 3.2 million people.

Every net matters.

Thank you for your continued support.

Mosquitoes resistance to one of the insecticides used in LLINs?

Research over the last decade and more shows mosquitoes can develop resistance to drugs used to combat malaria. Well-documented and extensive research conducted ten years ago showed the development of resistance in the malaria parasite to chloroquine. This emphasised the importance of drug-resistance research as this helped avoid funding millions of dollars of chloroquine to an area where there were high-levels of chloroquine resistance. Further, knowledge of this developing resistance made it imperative to find other drugs that could be used to prevent, or treat those with, malaria so the focus was not on a single drug. Indeed, another drug, artemisinin is now one of the main ones used to treat those with malaria. Unsurprisingly perhaps, malaria parasites have now been found that have developed a resistance to Artemisinin so significant work is underway to understand and limit this resistance which is currently confined to a relatively small geographic area.
As with malaria drugs, bednets are no different and there is the potential for mosquitoes to develop a resistance to the insecticide used in long-lasting insecticide treated nets (LLINs). 
A recent research study in Senegal (also covered in this BBC news article) suggests such resistance may be developing. There is debate in the scientific community as to whether the results of this research study indicate the development of widespread resistance. It is likely further research is needed to establish how much of an issue this could be and what steps may be needed, such as the use of different insecticides, to ensure LLINs remain effective. This research is very important as the consequences of us not knowing if resistance has developed could be LLINs becoming much less effective than they are currently.

Giving by Text - 100% reaches us

A new service has been launched in the UK which now means 100% of any donation made by text reaches the donor's chosen charity. 
We think this is an excellent development and because of this 100% element, we have signed up.
This service is thanks to a partnership between Vodafone and JustTextGiving, with particularly thanks to the Vodafone Foundation who are covering costs. 
100% of any text donation comes to us and 100% buys nets.
For a text donation from a UK registered mobile to Against Malaria simply text NETS42 followed by your amount £3 /£5 /£10 to 70070. For example, for a £5 donation, text NETS42 £5 to 70070. Simple!

Where do we buy our nets?

We are often asked some very good questions by interested members of the public. Recently Alan asked us a great question about the source of our nets and whether it was possible to buy them from sources local to the distributions:
I'm interested in your charity, but I'm wondering what companies or countries your nets are purchased from. That info was not immediately evident on your site, only that you pay very low prices for them...
Hi Alan-
The vast majority of the nets, long-lasting insecticide treated nets, LLINs, the only type we buy, that we have bought are from Verstergaard Frandsen (PemaNet nets) and Sumitomo Chemical (Olyset nets).
Any net we buy must be WHOPES Phase II approved (see this page for more details).
The nets we buy are manufactured in Vietnam, Thailand, China and Tanzania. This is where the large net manufactures have their facilities. We have also bought nets in Malawi but these were manufactured in Tanzania.
As nets are a textile, manufacturing economies of scale are significant. There are relatively few, large production facilities and it is not economic, for the cost of the net, to have small or medium sized manufacturing facilities in many different, for example African, countries. Shipping costs at US$0.20-0.40 per net are a relatively small element of the total distribution cost of a net. A net is US$4-5 and an additional $1-2 (including the $0.2-0.4) can be considered the non-net distribution cost total, including pre-distribution and post-distribution follow-up costs. Beyond the Sumitomo technology-sharing that led to the Tanzanian facility (run by AtoZ Textiles), manufacturers have plans for manufacturing facilities in Nigeria and Ethiopia. When we funded 120,000 nets for distribution to some 400 boarding schools in Tanzania and 120,000 nets for Malawi, these were/are being sourced from Tanzania.  
I hope this is of interest and helps.
Kind rgds
Hi Rob,
Thanks very much for your comprehensive answer. My main concern is (as I have read) that floods of foreign-sourced charitable nets have actually had the unfortunate negative effect of putting african mosquito net manufacturers out of business. As you probably know, Africa's health, environmental, social, political and economic woes are largely tied together. This concern is mentioned in Dambisa Moyo's book entitled "Dead Aid". I'm not sure if you're familiar with this argument but I felt compelled to contact you regarding this issue, since it can potentially make a difference for the lives of Africans. I would suggest that as whole it might be of greater benefit to Africans to make sure they manufacture the nets they use - that way the charity $$$ would pay dividends of creating jobs which would help lift them out of the poverty which makes them so vulnerable. What do you think?

Dear Alan-
Yes, I think this is an important issue.
It must be a better situation if long-lasting insecticide treated nets (LLINs) are manufactured in the countries in which they are needed. That would bring two advantages. First, reduced transport costs. Second, local employment. There is a manufacturing facility in Tanzania, a Sumitomo-AtoZ textiles joint venture, so 'local' production, and the employment this brings, is possible.
We are alive to this issue and, where we can, act in a way to support local enterprise. We have bought tens of thousands of nets that way when it has been 'near-economic' to do so.
However, there are challenges to the speed of local capacity development and the number of facilities that could be developed.
First, economies of scale mean only a small number of large factories are required to produce world demand. Micro-factories, located in each net-consuming country would not be economic. The number of countries that could benefit from locally located facilities therefore would be small. Some countries benefiting would be better than none of course.
Second, domestic markets are often not enough to sustain a production facility: nets are required to be exported. This leads to a problem, or inefficiency, in that shipping and transport from some African countries to others can be more difficult and more expensive than shipping from Asia to many African countries given established shipping routes. This raises overall prices for net buyers and reduces the number of nets that can bought for a given level of funds.
Further, technology transfer is an issue with challenges around training a workforce and guarding against technology intellectual property loss, the latter being a reasonable concern of the primary manufacturer. Ensuring raw material, spare parts supply and quality control are also issues to overcome.
The first and second issues are the structural ones and present the greatest challenge. The other issues can be overcome as the Tanzania joint venture has indicated. With major capital investment required and the need to consider the long term viability of a new facility, these developments take year/s not months.
Another method of developing local capacity has been via shipping large rolls of netting from an African based manufacturing facility to another African country where the cutting and stitching of nets then takes place. This has some shipping cost savings and provides local employment. We have bought nets in this way also.
Note, we are only talking about LLINs here as that is the only sensible net to distribute. If part of the background to your comments is concern over local insecticide treated nets (ITNs, but not long-lasting, so an entirely different net), or untreated net production being threatened by the import of LLINs, the higher issue is going to be the need to protect people with LLINs rather than ITNs or untreated nets. This is because LLINs are much more effective than these other nets at protecting people from malaria. For information on different types of nets, see: http://www.againstmalaria.com/FAQ_Bednets.aspx
Our approach, therefore, is with our priority being to buy the most nets possible for the funds available. We keep a close eye on local-sourcing options and where it is 'near-economic' to do so, we do. Economics will drive manufacturers to locally locate and we can do our bit by applying this 'near-economic' approach.
I hope this helps.
Kind regards

41,000th donor!

We have just reached our 41,000th donor! A donation from an Academy in Vermont USA took us over the 41,000 mark and is now immortalised on our milestones page - thank you!

What happens to the plastic bags in which the nets are packaged?

A question from Alex H (Australia)

"You have distributed a little over 1.4million nets. Each net comes in its own plastic bag. Does this mean there are 1.4 million used plastic bags now littering the areas in which the nets have been distributed?"
Our answer is as follows:
Plastic bags? 

No. Plastic bags are either:

a) removed before the nets are handed out. Sometimes but not always. (Estimate: 25% of cases.)

b) not removed at the time of distribution
  • ... but collected during the post-distribution follow-up by the distribution partner and taken away for disposal, typically landfill (Est: 15%)
  • ... and not collected post-distribution and
    • reused as bags/storage etc (Est: 10%)
    • thrown away (Est: 50%)
These are educated guesses based on some data and other anecdotal information.

Where possible, nets are handed out removed from the bags. This is to reduce either possible resale (albeit this doesn’t happen often) or avoid the beneficiary keeping the new net until a net currently being used, but worn out, is even more worn out. In the situation where it is removed, the plastic bag typically goes to landfill. However, bags are now increasingly biodegradable (see an example here).

What about the nets?

Obviously, the nets constitute a larger quantity of plastic. There is a study underway looking at the recycling options for nets as this is becoming a significant issue/opportunity. This is not an easy issue to resolve but there is a strong consensus a solution must be found. For example - pdf 1.5Mb
The obvious benefit of the nets protecting people from malaria leaves us all with the clear choice that, even absent of net recycling/organised disposal/bag disposal, it is worth distributing the nets. However, biodegradability is likely to be the way forward for the bags and recycling the way forward for the nets.


Should nets be recycled?

We are sometimes asked whether nets are, or should be, recycled when new nets are distributed or reach the end of their working life. We asked Jo Lines, at the World Health Organisation, who is leads research this area.

Jo's summary advice is: "Don't do it."

The reasons he cites are, and we quote:

"First, there is no evidence there is a pressing need to do it.

Second, when people stop using a net for sleeping, they normally put the net to a lot of other uses.

Third, and perhaps the most important point: these are not our nets, and there are legal and ethical limits to our right to take them away.

Also, if you try to give new nets only to families where the old ones are gone or in bad condition, and not to the families where the nets are still in good condition, you are creating a strong and perverse incentive for people to hide, damage or destroy nets when the project staff are approaching."

The full email from Jo is reproduced below.

Our view is that recycling of nets is very likely to happen but achieving this is not simple. The obvious benefit of the nets protecting people from malaria leaves us all with the clear choice that, even absent of net recycling, it is worth distributing nets.


Jo's email: 

"We do have a couple of people in our team working on this and we are completing a SAICM and World Bank-supported three-country research project on it, with the help of an excellent team of consultants. There is also a long mailing list with a wide range of interested stakeholders - anyone who wants to join it should email Stephanie [guillaneuxs@who.int] or Aurelie [bottelina@who.int]. Many of the key questions cannot be given definitive answers until this research has been completed, but we do have some tentative and subject-to-revision observations and advice to offer in the meantime. 

Our interim advice is : "don't do it".

First there's no evidence for a pressing need to do it: although the total amount of plastic in all those nets sounds large, it represents about 1% of the total plastic entering the region, according to industry estimates. There are concerns that worn out nets might block the use of new ones, but these remain unsupported by solid evidence. The point is: not all old nets are useless. We do have evidence that when a new net is given to net-owning families, the new one is sometimes stored for later use, but this could be because the old net is still working, and we have no evidence to contradict that hypothesis.

Second, we know that when people stop using a net for sleeping, they normally put the old net to a lot of other uses.... OK fishing is not a good idea, but the other purposes - as padding under the sleeping mat, a room divider, a door curtain, crop protection, fencing for the chicken coop - are probably not at all risky, and probably do have significant benefits. These are extremely poor families, so if we want to take something useful away from them, we should have a very good reason... and that reason has not yet been established.

Third, and perhaps the most important point : these are not our nets, and there are legal and ethical limits to our right to take them away. We gave them away freely, with no contract agreed or implied. We can offer to take them away from householders who voluntarily want to get rid of them, but it would probably not be ethical to put them under any pressure. In particular, it is probably not good practice to make the gift of a new net conditional on the surrender of an old one; this would be legal, but it would penalise people whose net was lost for legitimate accidental reasons, and lead to a gradual decline in overall coverage.

It probably IS a good idea to think of whether it would be possible to set up plastic recycling mechanisms, but such schemes should probably be voluntary (or commercial), not compulsory, and should probably embrace a wide range of plastics, not just old nets.

Finally, a note on the coverage gaps that can be caused when campaign nets wear out more quickly than expected. Some programmes have responded to these gaps by carrying out repeat campaigns after an interval of much less than 3 years since a previous campaign. This may be necessary as an interim response, but there is a long-term solution that is expected to be more effective. First, we must recognise that the lifespan of nets in a cohort has a very wide range, with some disappearing very quickly and some remaining functional for more than 4 or 5 years . For this reason, there are inevitable limitations on the capacity of repeated campaigns to maintain full coverage without waste. If you try to give new nets only to families where the old ones are gone or in bad condition, and not to the families where the nets are still in good condition, you are creating a strong and perverse incentive for people to hide, damage or destroy nets when the project staff are approaching. There are rumours that this is exactly what happened in parts of West Africa. If you give nets to everyone, then timing is never good: repeating the campaign after a short interval minimises the coverage gap but is wasteful; repeating it later is less wasteful but leaves a long period when many people are unprotected. Hence our advice is to deliver nets for free to ALL pregnant women and all infants attending EPI. This rate of continuous input will replace a large proportion of the nets that are lost, and greatly reduce the size of the coverage gap. WHO recommendation is that this kind of distribution through routine services should be equal priority to campaigns. As in immunisation, we must plan that in places where there has so far been no routine LLIN distribution, "the catch-up campaign must be Day One of the routine keep-up service".

Hope this helps


Great malaria awareness video

We are not here to pass a view on the population control message at the end of the video, but the video is very effective at describing the malaria problem.

 Of course the malaria solution is something we also have now, in large part: Bednets


Konami supports Against Malaria

Konami has just announced its continuing support of Against Malaria as part of its Local and Community Assistance program.

Konami has been a supporter of World Swim Against Malaria since it first began in 2005 and has a strong reputation for charitable giving, also supporting the World Food programme and Aid to disaster victims, most recently, of course, those of the Japanese Tsunami.

As part of its recent update Konami has put together a very effective graphic illustrating the path from donations to nets protecting people. 


Decoding the 100% donation

We believe being completely transparent about where your donations go is essential to the fight against malaria. But it might come as a surprise to some we ensure 100% of the money you donate will buy bed nets. After all, every net requires other expenses: administration, distribution, and so on.

So how are these costs covered? First, many companies and individuals help in important ways and do so for free. Our list of supporters gives an idea of how many groups work behind the scenes to ensure donor money goes directly to nets. Second, to cover the few costs we do have, a small group of trustees and private donors contribute. Thirdly, organizations distributing nets cover the distribution costs.

In such a way, every partner in malaria intervention can address malaria the way they know how. Companies fund the services they are familiar with, distributors cover the costs of their work, and donors provide the nets they know will matter. This process ensures every participant knows they are helping meaningfully, which only strengthens our work. Importantly, it means funds donated for nets do just that, buy nets.

If you want to help in a way other than donating (as those listed on the People to Thank page) please contact us.


Catalyzing further action

Whilst the nets we fund are important, as each net protects two people, catalyzing further action is equally important.

For example, a lot of progress has been made in Phalombe District. Concern Universal has just completed a distribution of 20,000 nets in Phalombe District, Malawi and the following information has just been received with exceptionally good news about further nets from a government stock of nets that, by all accounts, had remained undistributed for some months. The initial distribution of Against Malaria nets has catalysed further distributions using the same standards and methodolgy established by our distribution. 

A quote from Concern Universal  (pdf 259.20 kb)

Where are we with a malaria vaccine?

1. Our understanding
It would be great if nets were not needed and a vaccine, similar to that which proved so effective in the fight against polio, could be found.
Those who are most optimistic believe a vaccine may be available as early as 2015. However, many believe an effective vaccine is at least 15-20 years away, and even that may be optimistic. This is based on where we are with the most promising vaccine currently in trials and the number of years an approval process would take before a vaccine would be released for widespread use. 

So what is the most promising prospect at the moment? Progress has recently been announced with the 'experimental vaccine' RTS,S from GSK.[1] The results to date show 46% effectiveness (ie would protect 46 in every 100 people vaccinated) and protection lasts for 15 months[2].

Though the RTS,S vaccine meets the requirements of the Roll Back Malaria initiative's 2015 goal,[3] a vaccine that is only 50% effective cannot single-handedly turn back malaria. The polio vaccine has an effectiveness of 95%, and lasts a lifetime [4]. Until the malaria vaccine can achieve this degree of success, other interventions continue to be crucial.

Another obstacle to overcome is the difficulty storing and transferring a malaria vaccine to the locations where it is needed most. This process requires refrigeration, a problem that also faced polio vaccines so it is not insuperable, but it is costly. 

Our hope: scientists continue to make progress, and quickly.

2. Comments from Ally Olotu (in charge of GSK's RTS,S malaria vaccine programme at the Kemri-Wellcome Trust Research Programme)

"The efficacy we have seen in this study is in line with the targets set by the Malaria Vaccine Technology Roadmap and that it has a potential to save hundred of thousands of lives given the burden of the malaria disease in Africa. However I agree more work to improve on the efficacy of this and other malaria vaccines is required. This is currently ongoing with various groups.

A mechanism has been put in place by collaboration between local ministries of health, regulatory authorities, WHO and MVI at PATH to ensure that countries are able to make an informed decision on implementation of the RTS,S. This should avoid unnecessary delays. It may therefore take around 5 years or less from the outcome of phase III to implementation.

I agree with you that no single measure is enough to fight malaria. Should RTS,S be implemented, it would ideally be used as an addition to the existing measures, rather than as a sole intervention.
I agree vaccines have different sensitivities to heat and cold. However RTS,S  requires similar field cold chain conditions as current EPI vaccines as recommended by WHO (i.e temp 2-8C). Integration into EPI would therefore not be affected by cold chain conditions."

3. Further questions and responses

Rob: Am I correct in my understanding that 'RTS,S  requires similar field cold chain conditions as current EPI vaccines as recommended by WHO (i.e temp 2-8C).' means that the vaccine would need refrigeration?

Ally: Yes. But I wanted to point out that all EPI vaccines require refrigeration at one point in the cold chain and RTS,S would not require a separate system for delivery to the field. These systems are effective despite variation from country to country. The coverage for DPT vaccine for instance using this system is well over 75% in most African countries according to WHO report.

Rob: You comment 'A mechanism has been put in place by collaboration between local ministries of health, regulatory authorities, WHO and MVI at PATH to ensure that countries are able to make an informed decision on implementation of the RTS,S. This should avoid unnecessary delays. It may therefore take around 5 years or less from the outcome of phase III to implementation.' Can you let me know what the normal time period would be compressed to the 5 years and what elements are either shortened or missed out such that the 5 year timeframe can be achieved? Is this 5 years from today?

Ally: The registration of the vaccine will be done under EMEA article 58 (http://www.who.int/immunization_standards/vaccine_regulation/article_58/en/index.html). Under this plan, the file for the RTS,S vaccine candidate would be submitted to regulatory authorities in 2012 based on efficacy in children 5-17 months of age. Additional safety and immunogenicity data from the infant population will be submitted soon thereafter, followed by efficacy data for infants once available.

If all goes well the vaccine may get WHO recommendation in 2015, which is after the EMEA has reviewed the submitted file. Decision frame work for malaria vaccine was put in place in 2006 and is meant to address all the policy and programmatic issues before the countries are ready to make decision on malaria vaccine (http://www.malariavaccine.org/files/MVIfactsheet_DMF_091026.pdf). This process will definitely shorten the time to introduction which would normally take up to 15 years from the time vaccine is registered.

Rob: May I also ask your personal view on the possibility of a malaria vaccine being found that a) would have a 90% plus efficiency and/or b) a lifetime duration?

Ally: This is tough question to answer Rob. My personal view is more work is required to understand the immune correlates of protection against malaria in order to improve our ability to make more efficacious vaccines. It is amazing how much we still don't know about this meaning malaria vaccine development has largely been empirical. There is steady accumulation of knowledge on malaria immunity and hopefully this will inform the malaria Vaccinology research and lead to better vaccines.

I agree with you that 50% is not enough and more work is required to produce better vaccines. However given that hundreds of thousands of children are currently dying from this scourge each year it is very hard to justify throwing away something which could half that mortality and wait for better vaccine which is not yet on site.

Rob: Any view on the cost per dose (just the cost of the drug, not including delivered cost) – or who I can ask?

Ally: There is commitment from GSK and MVI to ensure that vaccine becomes available to those who need it. Efforts are ongoing to discuss on this possibility with malaria endemic countries and international institutions. The partners agree that price will not stand in the way of access, but it is too early to determine the exact price since the vaccine will not be submitted for initial regulatory review until 2012. Multilateral groups such as the GAVI Alliance, UNICEF and others will be involved in this collaboration to ensure vaccine are purchased in large volumes at affordable price once favorable recommendation is obtained from WHO and countries have made decision to introduce the vaccine.

I would direct you to David Poland of MVI for more information on the cost and delivery issues. MVI at PATH have funded the phase II RTS,S vaccine trials.

Targeted Distribution or Universal Coverage?

It is often difficult to decide where nets go when the need for nets far exceeds the quantity we can fund.

Should 20,000 nets go to one country or 10,000 each to two countries? The dilemma is the same whatever the number of nets involved. Some people somewhere will remain unprotected from malaria whatever the decision.

The choice is particularly stark when deciding whether to focus on those most at risk from malaria—children under five years old and pregnant women—or instead to achieve universal coverage, which means every sleeping space is covered in a (smaller) area.

A real example: There are 500 nets in total available for five villages. Each village contains 1,000 people, among whom are 100 pregnant women and children under five. Do you protect all the under fives and pregnant women in all five villages or blanket cover one village, given two people sleep under each net?

Each method has its benefits. 

The logic of protecting the most vulnerable is obvious: those most likely to contract malaria due to a less well-developed immune system (under fives) or weakened immune system (pregnant women) should be protected first. Their need is greatest and so they deserve our attention first.

The argument for universal coverage centres on the 'mass-effect' that occurs when 60% or more of sleeping spaces in a given area are covered. In such a circumstance, malaria rates fall dramatically because the pregnant female malaria-carrying mosquito population is denied its nightly blood meal. If these mosquitoes do not feed for 10-12 days they cannot reproduce. Fewer mosquitoes means fewer ways to get infected, which reduces the spread of malaria among net-users and non-net-users alike (see related links). 

The advantages of universal coverage come not only from preventing the pregnant female mosquito feeding, but also from the involvement and engagement of an entire community in malaria prevention. It can have a dramatic effect with malaria case rates falling precipitously.

There is no one answer.

In recent years, the move has been to universal coverage given the often dramatic effect on an entire community. The intention, using the example above, would then be to come back to the other villages as soon as possible and universally protect them too. While there are not enough funds for nets this is not always possible. In the meantime, difficult choices remain.
Relevant links

More milestones: 40,000th donor

We have just reached our 40,000th donor! A donor from Cardiff in Wales took us over the 40,000 mark and is now immortalised on our milestones page - thank you!

Incidentally, we have also gone past the 450,000th participant, or person involved in fundraising activities. Thanks to the Central Sports Masters Festival which took place in Japan.


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