Carter's Life After the White House

There is an apparent anomaly in the current statistics from the World Health Organization on annual deaths from diseases in the developing world, which seem to underestimate the ravages of malaria. In order of deadliness, (1) respiratory diseases come first at 4 million deaths per year, followed by (2) HIV/AIDS, 3 million, (3) malaria, 1 to 5 million, (4) diarrhea, 2.2. million, and (5) tuberculosis, 2 million. But the organization also states, "Malaria kills more than three thousand children each day in sub-Saharan Africa," which amounts to 1.1 million annually just for this age group and geographic area. In Ethiopia, we know that annual deaths from HIV/AIDS are 130,000, while 270,000 die from malaria. This devastating disease causes a lifetime of suffering from chills, diarrhea, pain, and high fevers, with its fatalities concentrated among pregnant women and children in their first five years of life.

Malaria was prevalent in southwestern Georgia when I was growing up during the Great Depression, and it was not until 1946 that the Communicable Disease Center (CDC) was established, primarily to eliminate this disease. A year later, a vast effort was begun to screen houses and to spray outdoor wet places with DDT, and by 1950 only two thousand cases were reported. Malaria was considered eradicated from the United States by 1951. (The CDC subsequently became known as Centers for Disease Control and Prevention.) Meanwhile, the insecticide DDT has been banned from outdoor use in most nations since its devastating effect on wildlife became known.

Along with HIV/AIDS and tuberculosis, malaria qualifies as one of the "big three" disease for which nations can qualify for financial grants from the Global Fund, a public-private partnership based in Switzerland. Nations that receive grants must quickly demonstrate that the money is being used wisely and effectively. In 2006, Ethiopian Prime Minister Meles Zenawi decided to make an all-out effort to reduce the threat of malaria throughout his nation, and we accepted his challenge to join in a partnership with the government ministries.

The plan was to utilize one of the most remarkable technological innovations of recent years?bed nets made of fibers that are impregnated before weaving with a pesticide whose lethal effect on mosquitoes would last for about seven years. Instead of merely being repelled by the nets, the insects would be killed on contact. There were 50 million people living in the endemic areas of Ethiopia, which meant that 20 million nets would be needed to provide an average of 2 per household. It would be a massive project to identify the communities to be included, acquire the nets, distribut4e them, and then ensure their proper installation, use, and care. The government would acquire 17 million nets using a portion of its Global Fund grant, its own resources, and support from other donors. We agreed to provide the remaining 3 million, be responsible for distributing bed nets in the areas where we already were controlling onchocerciasis and trachoma, and monitor the results from the seven-year period. As an added measure in certain areas, DDT would be used to spray interior walls of homes while being strictly prohibited from outdoor applications.

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