A foreign policy win for Obama: embrace, and invest in, the President's Malaria Initiative
The efforts, begun by Bush, have saved thousands of lives in Africa

USAID Africa

Local activists explain to a mother in Mbanza Congo, the capital of Angola’s Zaíre Province, the importance of using a bednet to prevent malaria.

Article Highlights

  • President Obama would be wise to talk up our effective aid programs and the soft power they provide with allies.

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  • Under-five mortality rates have declined by 16-50% in 11 PMI target countries.

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  • PMI stands among a handful of donors that conduct quality control tests to weed out substandard drugs.

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The Obama administration is taking it on the chin on foreign policy. The Arab Spring has given way to a violent winter, and with the situation in the Middle East likely to worsen, Gov. Mitt Romney will have plenty of ammunition for the debates, especially the foreign policy showdown on Oct. 22.
In response, President Obama would be wise to talk up our effective aid programs and the soft power they provide with regional allies.
One such program stands out: the U.S. President’s Malaria Initiative (PMI). Pointing to the enormous success of this program — and announcing a budget increase — would score valuable points with swing voters and potentially even help Democrats pull some of them off the fence.
The United States’ malaria control program was not always a shining example of American leadership. From 2004 to 2006, we were part of a team of malaria advocates that exposed the U.S. Agency for International Development’s failing efforts. USAID was buying outdated and ineffective malaria drugs, and it refused to fund insecticide spraying — the method by which most of the developed world eradicated malaria.
When Sen. Tom Coburn, an M.D. who was then chair of the Senate Subcommittee on Federal Financial Management, demanded reforms, President George W. Bush saw a political opportunity. He launched the PMI with a $1.2 billion budget and a renewed focus on sub-Saharan Africa, where malaria was killing about 3,000 children each day.
Seven years later, the PMI stands among the most effective government programs in recent history — and a rare, genuinely bipartisan foreign policy achievement. According to U.S. government data, under-five mortality rates have declined by 16-50% in 11 PMI target countries in which surveys have been conducted; this is attributable in large measure to anti-malaria efforts spearheaded by PMI. "According to U.S. government data, under-five mortality rates have declined by 16-50% in 11 PMI target countries in which surveys have been conducted; this is attributable in large measure to anti-malaria efforts spearheaded by PMI." -Roger Bate In Zanzibar, malaria was almost entirely eliminated by 2007, after only two years of PMI support.
What accounts for this impact? Unlike the old malaria program — and most malaria aid programs worldwide — PMI uses every weapon available to fight the disease: gold-standard drugs, protective bed nets and insecticide-spraying programs, including those that use DDT.
America’s commitment to insecticide spraying has reinvigorated donor support for this method, and led to big advances against malaria. In July, The American Journal of Tropical Medicine and Hygiene published a comprehensive review showing that over the past decade, spraying with insecticides reduced malaria by 62% on average in the worst-hit communities. The same study found that over the same period DDT was the most effective insecticide available.

Furthermore, PMI only purchases top-of-the-line malaria drugs. In so doing, it has come to the rescue of other donor agencies, such as the Global Fund to Fight AIDS, TB and Malaria, that failed to procure these drugs for African countries as promised. And it stands among a handful of donors globally that conduct quality control tests to weed out counterfeits and substandard drugs (real drugs that are poorly made) before they reach the shelves.
This is another critical point, as drug supply chains in Africa are weak and corruption is rampant. For example, last year, about $100 million worth of HIV and malaria drugs purchased by the Global Fund went missing. And poor quality drugs — both counterfeits and good drugs that are poorly made — routinely reach patients in poor countries. In our recent peer-reviewed research, more than 15% of the drugs purchased in low- and middle-income countries were either substandard or outright fakes that failed quality control tests.
The PMI’s success demonstrates that America remains a global leader not only because of its military might, but also due to its technical prowess, its commitment to democratic principles, and the compassion of its people.
The fact that PMI was one of President George W. Bush’s most celebrated achievements would not be lost on compassionate conservatives, nor on moderates who believe in the power of aid. And since America has felt the sting of counterfeit drugs — most recently when 19 U.S. medical practices discovered that they had purchased fakes of the cancer drug Avastin — the extra measures to ensure drug quality for American aid recipients would also resonate.
By making these points during the debates, President Obama could show voters that he makes policy based on what works, not what is politically expedient. He could cement their support by announcing increased funding for the PMI.
Despite its success, pressure to trim government budgets has put PMI on the chopping block. It is scheduled for cuts, while the Global Fund and other less effective agencies are slated to gain. Putting more money into the PMI wouldn’t just be a political boon — it would actually help us save lives in Africa.
Hess is a researcher for Africa Fighting Malaria and Bate is a resident scholar with the American Enterprise Institute.

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