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The Seattle Times Malaria


Tuesday, September 25, 2007 - Page updated at 09:31 AM


Raising the profile | Salesmanship joins science in struggle against disease

Seattle Times business reporter

At the World Bank headquarters in Washington, D.C., a malaria-prevention group funded by the Bill & Melinda Gates Foundation hosted lunch recently for 35 African ambassadors and a special guest, South African pop singer Yvonne Chaka Chaka.

On the menu was an unusual pitch: Urging diplomats to make a disease killing people in their countries a higher priority for resources and public attention. A first step in that strategy is convincing Africans that getting malaria isn't inevitable.

"Nearly all the ambassadors have had malaria. All of their relatives commonly have malaria. It's a normal part of life," said Matthew Lynch, program director of Voices for a Malaria-Free Future, which sponsored the event.

The lunch was part of an ambitious and unorthodox campaign by the Gates Foundation to mobilize the world against a disease that has remained endemic in Africa and much of the developing world for centuries.

The foundation is hoping to transform malaria from a major killer to a rare occurrence within the next two decades, investing heavily in the search for a vaccine and other disease-control programs.

But reaching that goal also requires something else — good buzz. Salesmanship along with the science.

The foundation has helped recruit supporters to that cause, from African diplomats to Bush administration officials to the Methodist church. It has joined with the likes of Bono, the National Basketball Association and the hit television show "American Idol" to put the disease in the public eye and raise millions of dollars.

Raising the profile of some of the globe's worst diseases has become central to the Gates Foundation's mission. Since 1995, it has spent more than $530 million on global-health advocacy campaigns, including malaria. A staff of 34 — a quarter of the foundation's entire global-health staff — is dedicated to public education, policy strategy and communications.

"The power they have is really the power of the purse," said Roble Olhaye, Djibouti's ambassador to the U.S. and dean of the African Diplomatic Corps in Washington, D.C. "There is a renewed focus on malaria, which had not been there before, and we really do welcome it."

The complexity of ending malaria is daunting: It takes money and political will from donor countries, cooperation from drug companies, policy decisions by African countries and efforts to persuade people to use bed nets and seek prompt treatment if they're sick. It also means changing the way global health systems operate, cutting the time it takes to get a new vaccine to Africa from two decades to a few years.

"The painful reality is that no one entity can do it alone," said Joe Cerrell, the Gates Foundation's director of global-health advocacy.

Global-health institutions such as the World Health Organization never focused much on selling their message before, said Sally Stansfield, who spent seven years at the Gates Foundation and now runs a nonprofit health network in Geneva.


"The unspoken rule ... was that it's kind of unseemly to use your facts to raise money or attention," she said.

The foundation broke new ground, she said, because it saw its role as "moving the dial on public attention."

Voices for a Malaria-Free Future, a nonprofit group based at Johns Hopkins University in Baltimore, received about $9 million from the Gates Foundation last year, much of it to get malaria on the agenda of key decision makers.

In the U.S., the group is trying to persuade African diplomats to more vigorously lobby their own governments and Washington, D.C. The goal is to get policymakers "to change the way they allocate resources like money, people and attention."

African governments need to develop a malaria plan and commit resources to it, Lynch said. Malaria vaccines and other new treatments the Gates Foundation hopes to deliver ultimately won't reach people who need them, at least not in a sustainable way, unless African governments and citizens decide to buy them.

Yet an intense focus on specific diseases is no silver bullet for African countries with a host of fundamental problems, some experts say.

"The best long-term solution to malaria is for a country to become wealthy," said Tyler Cowen, economics professor at George Mason University.

Malaria kills more than a million people a year, about 90 percent of them African children, and it sickens many more. Caused by a mosquito-borne parasite, the disease is so common in Africa that many people who survive it as children get it several times throughout their lives, causing repeated misery and economic hardship.

In Mali, Voices for a Malaria-Free Future produced TV spots with local musicians advocating use of insecticide-treated bed nets. Musicians and singers in Mali play an especially powerful social role and can influence political leaders.

The message is simple: Malaria exacts a huge toll, but it can be avoided with the right tools.

The Voices group has also brought African entertainers and grassroots activists to Washington, D.C., to address key congressional leaders, selected because of their interest in malaria.

When it came time to approach the Bush administration, the Gates Foundation took a cue from Bono, the rock-star-tuned-activist. Bill Gates first met Bono at the World Economic Forum in New York in 2002.

Bono successfully made the case to leaders in the White House and Congress — some of whom likely never heard of his band, U2 — that fighting AIDS should be a foreign-policy priority.

What the foundation learned from Bono and his organization, Debt AIDS Trade Africa (DATA), was the need to cultivate unlikely allies and unite them around a common cause, Cerrell said.

Richard Klausner, who headed the National Cancer Institute before becoming director of the Gates Foundation's global-health program in 2002, said the work of activists such as Bono on AIDS and poverty in Africa opened the door to increased administration support.

"It was really this evolution of AIDS opening people's eyes," he said. "Then malaria was just staring us in the face."

Klausner found a sympathetic ear in speechwriter and presidential adviser Michael Gerson, who has deep roots with conservative evangelicals.

"We met and very much hit it off," Klausner said.

At the time, the Gates Foundation was setting up a program to use bed nets and other low-tech methods to protect families from mosquitoes in Zambia. Its practical, measurable approach clicked with Gerson and other administration leaders, Klausner said.

Gerson kept in regular contact, calling Cerrell and Klausner to ask how the programs were working.

In 2005, the Bush administration launched a program of its own: the President's Malaria Initiative, a $1.2 billion, five-year plan to fight malaria in 15 of the hardest-hit countries in Africa. And when the administration held its first White House Summit on Malaria a year later, Laura Bush invited a special guest to help kick it off: Melinda Gates.

The Gates Foundation has helped put the issue of malaria in front of some unlikely audiences — perhaps none more unlikely than "American Idol" fans.

That connection began in London in 2005 when Cerrell visited British screenwriter Richard Curtis, best known for writing "Four Weddings and a Funeral." Curtis' Comic Relief charity raises money for needy people in the United Kingdom and in Africa through entertainment events.

The two brainstormed ways to help sell global-health issues in the U.S.

"It's extremely difficult," Cerrell said. "We're always looking for creative ways."

A few months later, Curtis suggested tapping into the outsized popularity of the "American Idol" talent show. He created a two-day "Idol Gives Back" show, with scenes of Idol judge Simon Cowell and host Ryan Seacrest visiting school kids in Africa. Corporate sponsors and viewers donated to charities in the U.S. and Africa.

The foundation advised Curtis on how to highlight programs from Africa, choose beneficiaries and set up a donation structure.

The 2007 event raised $75 million, more than double what its producers expected, with $18 million going toward anti-malaria programs.

"It was a great test of Americans' appetite to sit and watch a show about global poverty for two hours," Cerrell said.

The "Idol" campaign hit the airwaves as malaria was already becoming a trendy cause.

The nonprofit Malaria No More, for example, features ads with soccer star David Beckham and limited-edition T-shirts created by Glamour magazine.

"The fact you have celebrities talking about bed nets is amazing," said Columbia University economist Jeffrey Sachs, who has long argued that rich countries need to spend more to fight malaria. "Here's the number-one pop-culture television show in the land and they devoted two days on this topic."

More traditional organizations, such as the United Methodist Church, also joined the malaria fight.

The Gates Foundation approached the 13-million-member church last year after an introduction through the United Nations Foundation.

The UN Foundation had launched Nothing But Nets, a grassroots campaign inspired by Sports Illustrated columnist Rick Reilly to raise money for mosquito bed nets. The campaign has a variety of supporters, including the NBA and Major League Soccer.

As part of the partnership, the church holds fundraising drives at congregations throughout the country. And the Gates Foundation matches donations dollar-for-dollar up to $3 million.

At a national youth convention in July, Bishop Thomas Bickerton stood on stage with professional soccer player Diego Gutierrez and held up a $10 bill, challenging the audience to buy a net and save a life.

"This means you have to give up one meal at McDonald's or one pizza at Domino's," Bickerton says he told the crowd.

"All of the sudden at my feet appeared this wad of paper. Thirty seconds later, there was $16,000 on stage."

One of the reasons global-health causes have become more fashionable is the world's fascination with Bill and Melinda Gates themselves.

It's not only Gates' money but his decision to dedicate himself full time to philanthropy that resonates in Africa, said Olhaye, the African diplomatic leader.

"He and his wife are seen in Africa very frequently," he said. "People are very conscious of that and sensitive to what he is doing."

Harder to gauge is whether Gates' efforts can filter down to rural populations that have grown wary of promises from outsiders and often distrust their own governments, said Cowen, the George Mason University professor.

At home, the Gates Foundation is looking at ways to inject the issue of global health into the presidential campaigns. The foundation gave $22 million to Bono's One Campaign for its One Vote '08, which organizes community leaders in four states to press visiting candidates for commitments to ending global poverty.

In the end, rich governments will also have to step up their funding, Sachs argues. He estimates that a comprehensive malaria-control program for Africa would cost about $3 billion a year, a commitment he calls "saving up to 2 million lives at a cost of two days of Pentagon spending."

Some worry that when the glitzy campaigns surrounding malaria prevention fade away, many donors and the public will lose interest as well.

Sachs thinks the new interest drummed up in malaria will have a long-term pay off.

"Here we are on the brink of something big, and I hope they push us over the edge," he said.

Kristi Heim: 206-464-2718 or

Copyright © 2007 The Seattle Times Company

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