EMBARGO UNTIL 25 APRIL 13.00 GMT

MALARIA MAJOR KILLER IN AFRICA – BUT BEDNETS CAN SAVE LIVES

AFRICA’S PROGRESS IN TACKLING MALARIA MAPPED IN NEW REPORT COMMISSIONED BY ROLL BACK MALARIA PARTNERSHIP

Geneva 25 April 2001 – In their efforts to make malaria prevention more affordable to their populations five African countries have reduced or abolished taxes and tariffs on insecticide-treated bed-nets (ITNs), according to a new report issued to mark the first ever Africa Malaria Day, on 25 April. ITNs are considered one of the most effective prevention measures for malaria and, properly used can reduce the risk of transmission by as much as 63%. Malaria is one of the major obstacles to development in Africa south of the Sahara and is responsible for about 1 million deaths a year, most of them in children under five.

Cote d’Ivoire, Nigeria, Tanzania, Uganda and Zambia have changed their policies to help lower the price of ITNs, but more needs to be done to make ITNs affordable to the poorest sectors of all African societies, says the report "Reducing Taxes and Tariffs on Insecticide-Treated Bednets", prepared by Boston University and commissioned by Roll Back Malaria.

"In some countries, the price of a treated bed-net is as much as 8 or 9% of per capita GNP," said Dr Gro Harlem Brundtland, Director General of the World Health Organisation (WHO). "Making these effective prevention tools available to all who need them is one of the big challenges African governments face in their war against malaria."

ITNs are considered one of the most effective tools for reducing malaria transmission and mortality. Clinical trials in Africa have revealed that use of properly maintained ITNs reduces malaria incidence among children by anywhere from 14-63%. Surveys carried out in Gambia, Ghana and Kenya showed that sleeping under an insecticide impregnated bednet reduced mortality by 25%, 17% and 33% respectively in these countries. Sleeping under a bed-net also reduces prevalence of anemia in children.

However, there are several barriers to the use of bednets : lack of information about their benefits, poor access to markets and unaffordable prices for large portions of the African population. The Abuja Declaration of April 25, 2000, signed by representatives of 38 African states, committed governments to implement reductions in the tariffs and taxes imposed on ITNs, netting materials, and insecticides, so as to help lower the retail price of ITNs and broaden household access.

Several countries have indicated an intention to take action on the issue, according to the report. Many of these countries, however, continue to charge large import duties and domestic taxes on finished bednets, netting material, and insecticides. In some cases, import tariffs and domestic taxes comprise 30 or 40% of the retail price of ITNs. In addition, indicates the Boston University report, simply getting the prices down may not suffice to cover all the people at risk. Ensuring private sector investment in importing and manufacturing nets is also a requirement; and further government action in the form of subsidies is needed to make ITNs affordable to the poorest families.

During the 1990s, only one country in sub-Saharan Africa, Tanzania, made significant progress in reducing tariffs and taxes on ITNs. Cote d’Ivoire, Nigeria, Uganda and Zambia took action as a result of the Abuja Declaration. The report authors expect that several other countries will finalize the policy reform process shortly; possibly prior to World Malaria Day on 25 April. Five countries - Cameroon, Ghana, Kenya, Mozambique, and Namibia - are reported to be nearing decisions on tariff and tax reductions. Other countries, where current information was not available, says the report, may be proceeding along similar paths.

Throughout Africa south of the Sahara, infectious diseases are major barriers to economic and social development. Malaria re-emerged in the 1990s as a public health crisis as the rate of death increased by almost 50% between 1970 and the end of the 20th century.

Malaria kills over one million people world-wide every year and most of these preventable deaths are among African children. Despite efforts to combat it, malaria continues to account for 20% of under-five mortality in Africa and constitutes 10% of the continent’s overall disease burden. Malaria causes 30-50% of inpatient admissions, incurs 40% of total public health expenditures, and up to 50% of outpatient visits in malarious areas.

Malaria has severe negative effects on maternal health and birth outcomes. It causes anemia, is associated with increased risks of miscarriage, and is responsible for one-third of the preventable low birth weight; the latter being one of the main causes of mortality in an infant’s first month of life and a major cause of low child development. However, in most malaria endemic regions, fewer than 10% of children or pregnant women regularly sleep under ITNs, says the report.

The rapidly expanding emergence of resistance to what were once effective, low-cost anti-malarial drugs has added to the difficulty in addressing this curable disease. For this reason, prevention of malaria and large scale action to provide better medicines and prompt treatment have become all the more urgent.

The economic impacts of malaria are also profound. Annual economic growth rates in countries with high malaria transmission over a period of 25 years were 1.3% lower than in non-malarious countries, according to the report. Compounded over the fifteen year period 1980-1995 this annual drop in growth leads to a 20% reduction of GNP per capita.

Roll Back Malaria (RBM) has set a goal to halve malaria mortality by 2010. RBM goals for 2005 are : to ensure that 60% of people with malaria have prompt access to affordable and appropriate treatment; that 60% of pregnant women have access to preventive treatment; and that 60% of the population at risk use bednets or other preventive measures.

The last global goal will require 32 million nets and 320 million insecticide retreatments each year. "The political will to reach that goal is there," said David Alnwick, manager of the Roll Back Malaria project. "What we now need is for African governments, the international community and the private sector to strengthen partnerships and expand the resource base so that we can scale up action."