TCS Daily


A Martha Is a Terrible Thing to Waste

By Jennifer Zambone - August 3, 2004 12:00 AM

Commentators can debate whether Martha Stewart deserves her sentence, but in this reuse/recycle age, surely we can agree that her sentence is a terrible waste of resources. Martha made people feel obscurely guilty for failing to tat a matching bedspread/tablecloth ensemble as a wedding present for the postman. Think what she could do on issues about which we really should feel guilty, like malaria.

Malaria remains an intractable problem in the developing world. It infects 300-500 million people per year and kills 1-2 million of them, mostly pregnant women and children under the age of 5. In Africa, its death toll may even exceed that of AIDS. Malaria also exerts a considerable drag upon the economy. Over the past 35 years, malaria alone has reduced the gross domestic product of the countries in Africa where it is endemic by 32%.

Malaria appears intractable, but it's not. As a Cato Institute paper by Richard Tren and Roger Bate delineates, South Africa curbed a malaria epidemic in three years through an integrated mosquito control program, that uses insecticide treated bednets and indoor residual spraying (the spraying of a small amount of pesticide on the interior walls of a house), combined with the use of effective antimalarial drugs, such as artemisinin.

If South Africa has had such success controlling malaria, why aren't other countries following its example? We won't let them.

As part of its indoor residual spraying (IRS) program, South Africa uses the most effective, and cheapest, pesticide available, DDT. Western aid agencies however won't fund IRS programs, especially if they use DDT, even though studies have shown that DDT used in IRS does not harm the environment, but does save people's lives. South Africa, being relatively wealthy, funds its own malaria control program, but as most other countries in Africa are dependant upon Western aid for malaria control, they're stuck with the only measure Western agencies will fund, Insecticide Treated bednets (ITNs).

A bednet is a lovely thing when it's used, but not when it's not. When used properly ITNs can be valuable help in controlling malaria, but often they aren't used properly. If a family can wangle a bednet, they often use it to protect the men in the family rather than the children or the pregnant women who are the most at risk from malaria, or they use it inconsistently. Families can also have a hard time obtaining a bednet because many countries have slapped high tariffs on them, which has made purchasing them prohibitively expensive. Furthermore, it's as foolish to depend in ITN use alone for the control of malaria, as it would be to depend upon IRS alone.

The picture is equally bleak on drugs. An article in The Lancet accused the Global Fund for AIDS, Tuberculosis, and Malaria of spending twice as much on ineffective anti malaria drugs than it does on an effective one. But at least the Global Fund will buy some artemisinin-based drugs, USAID won't purchase them at all. Aid organizations also claim that their hands are tied when giving aid. They can't, they plaintively wail, actually advise countries as to which drug to use or which method of control to use. They can only fund or not fund the proposals the countries set before them.

Unlike aid agencies, Martha has never had any problem issuing advice. What a pity that Judge Cedarbaum didn't embrace the concept of creative sentencing. Instead of sending Ms. Stewart to a minimum security prison for five months, she could have sent her to Uganda or Nigeria or any other malaria infested country in Africa (There's a wide selection from which you can choose.) and told her she can leave that country only when the malarial infection rate has dropped to half of its current rate.

With this sort of incentive, Ms. Stewart would doubtless have made the novel decision of basing malaria control on which methods would be the most effective, not on which methods would be the most palatable to people living in the malaria free world. By the time she left, not only would Ms. Stewart have dropped the malaria rate, but also she surely would be marketing a successful line of affordable and attractive bednets as well as instruction booklets on how to make your own pump sprayers for pesticide applications. Now that would have been gracious living. Martha fighting malaria, it could have been a good thing.

Jennifer Zambone works for the health advocacy group Africa Fighting Malaria.


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