TCS Daily


World Health Assembly Coverage: Who Needs WHO?

By Richard Tren - May 18, 2005 12:00 AM

GENEVA -- The World Health Assembly began this week for many people with a long and boring wait in the rain in order to register. The queue that snaked along slowly was made up largely of hundreds of Taiwanese, waiting for the solitary WHO official on duty to grant them access to the meeting. Taiwan's efforts to become a fully recognised member of the WHO seem to have been thwarted by the People's Republic of China as it would conflict with that country's one China policy. One has to ask however, why Taiwan would even want to be part of the WHO as it seems to be doing pretty well without it.

Taiwan supports healthcare programs in many parts of Africa, often sending physicians for long stretches to work in rural clinics. Taiwan also supports malaria control on the continent; it recently announced that it is supporting the eradication of malaria in the West African island state of Sao Tome and Principe. Taiwan is well placed to help out other island states, having eradicated its own malaria problem in 1965 with the insecticide DDT.

The method of mosquito control Taiwan is using on Sao Tome and Principe is indoor residual spraying (IRS). IRS involves spraymen applying tiny quantities of pesticide on the inside walls of houses. Depending upon the pesticide used, this technique repels mosquitoes, stopping them from entering the dwelling, irritates them sufficiently to drive them out of the dwelling, or kills them. This form of malaria control is highly effective, and most southern African governments use it to great effect.

Because Taiwan is supporting an IRS program on Sao Tome and Principe, the prospects for malaria eradication look good. While there are various options available for controlling mosquitoes, ongoing operational research and on-the-ground results show that spraying insecticides inside houses to be the most effective technique in Africa.

The distribution of insecticide treated bednets (ITNs), which is the choice of the aid community, can be an effective adjunct to spraying, but on its own has not reduced the burden of malaria. In fact those countries that rely exclusively on ITNs have increasing numbers of malaria cases and deaths, while those countries that have expanded IRS programs have reduced the burden of malaria.

Taiwan's choice of a tool for malaria control is a good one. However, the WHO only supports IRS theoretically, but not in any practical way; indeed for many years it has been trying to scale back IRS. The WHO officials in Geneva, far removed from the gritty and difficult business of malaria control in Africa, consider IRS to be "unsustainable" and at odds with good environmental practice. This is nonsense. IRS involves spraying tiny amounts of insecticide inside houses and does not constitute a threat to the environment in any way. Moreover, many countries have sustained IRS programs for decades and dropped malaria rates. In contrast, WHO's preferred "sustainable" alternative of ITNs has only managed to sustain increased malaria cases and deaths. The leading medical journal, the Lancet, recently characterised Roll Back Malaria, the WHO's high profile malaria program, as a failure.

Meanwhile the WHO praises the British government for doing the wrong thing. The British donor agency DFID has just donated 400 000 ITNs to the government of Zimbabwe, earning the plaudits of UNICEF, the UN's children's fund, despite the fact that decades of practice and research have shown that an effective IRS program works much better at controlling malaria in Zimbabwe than do ITN distributions.

But the most shocking element of this donation is that the British government is involved at all with the Zimbabwean government. Malaria is now a pressing health problem in Zimbabwe, not because of a lack of bednets, but because the Mugabe regime has starved the once excellent malaria control program of funds, diverting them to other causes. Mugabe's hated and brutal secret police, the Central Intelligence Organisation received a 500% increase in its budget this year, while last year the malaria control programme was unable to spray over 96% of dwellings due to a lack of funds.

The despotic Mugabe regime has presided over the economic ruination of Zimbabwe and has beaten, murdered, raped, starved and tortured its own people, but Mugabe blames the 'imperialist' Blair government for all his country's woes. The Blair government's support of the brutal Mugabe is bizarre. Not only does the money that DFID spends in Zimbabwe give legitimacy to the appalling Mugabe government, but it denies healthcare resources to other, better run countries.

The divisive politics of the UN and its many agencies render its efforts irrelevant if not outright harmful to poor countries, while irresponsible government to government aid transfers corrupt the donors and enrich the political elite in recipient countries. Nonetheless, donor aid for healthcare projects can work to better desperate conditions in developing countries. It can work if the projects run along the same lines of the Taiwan model: remove politics and practice good science and medicine that will benefit the people of those countries, not their governments. Given the damaging politics of various UN bodies and their ongoing failures on health matters, one wonders whether Taiwan isn't better off out of it all.

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