Author: Dr. Michel ODIKA - January 15, 2015.
The only relevant test of the validity of a hypothesis is comparison of prediction with experience (Milton FRIEDMAN, economist).
The theory that can absorb the greatest number of facts, and persist in doing so, generation after generation, through all changes of opinion, is the one that must rule all observation (Adam SMITH, economist).
Why do I disagree with the project to develop a malaria vaccine?
Malaria Vaccine: Myth that Conceals Reality… Worldwide, numerous malaria vaccine candidates are in different stages of development. To date, however, progress on malaria vaccine has been poor in terms of efficacy and, possibly also, in terms of cost-efficiency. In many regards, this mismatch suggests that the magnitude of malaria stems not from the deficiencies of available strategies, but from the world’s failure to use the highly effective tools at its disposal to control the disease (5,6,7). For example, most people at high risk of malaria have yet to be reached by prevention, as many malaria-affected countries refrain from implementing approaches - e.g. relevant hygiene and appropriate sanitation - that have been shown to work.
Malaria Vaccine: Single-approach Control Initiative in Response to a Multi-approach Question… In many countries, most of them in sub-Saharan Africa, malaria is not only a public-health challenge of the highest priority - it is basically an environmental issue - i.e., poor hygiene, inappropriate sanitation (1) - that requires coordinated policies, integrated strategies and far-reaching (innovative) partnerships.
In the face of all this, the project to develop a malaria vaccine is likely to be inadequate and naïve.
Inadequate, insofar as malaria basically proceeds from a system's failure - e.g. poor governance and weak leadership…
Naïve, insofar as a system's failure always requires a system's solution, not a single-approach control initiative…
NOW MORE THAN EVER… The response to malaria requires innovative approaches, coordinated efforts, context-sensitive policies, evidence-based strategies and, not least, reliable accountability for tracking progress against the disease.
From Crisis Management to Strategic Response: Let’s Not Miss the Point… Today, a complex web of interrelated facts strongly suggests that HOW and FOR WHAT money is spent matter considerably. Particularly in malaria-affected countries (most of them classified as low-income) where the envelope for health is very small, every dollar that is allocated sub-optimally seems to make a disproportionate difference. That, in itself, is one of the main reasons for increasing support for institutional reforms (2) that would bring the malaria response more in line, not only with current challenges - i.e., social cohesion (3,4), sustainable and equitable development, cost-effectiveness -, but also with people’s expectations - e.g. efficiency, environmental safety…
In summary… From product development to field implementation, the project to elaborate a malaria vaccine is at best "the wrong solution in response to the right question" (8), at worst "the wrong solution in response to the wrong question (9,10).
Dr Michel ODIKA (Congo-Brazzaville)
1. Paludisme : enjeu d’assainissement et d’aménagement du territoire (Michel ODIKA, Nouvel Observateur, Paris, 2011).
2. Observatoire du Paludisme: réformes institutionnelles à l’ordre du jour (Michel ODIKA, Nouvel Observateur, Paris, 2011).
3. Due to high mortality ratios, malaria is putting the social cohesion of many countries under stress, and health systems, as key components of the architecture of contemporary societies, are clearly not performing as well as they could and as they should. In this context, people are increasingly impatient with the inability of health services to deliver levels of national coverage that meet stated demands and urgent needs, and with their failure to provide services in ways that correspond to their expectations…
4. Ending Malaria Deaths in Africa (Jeffrey SACHS, Scientific America, 2007).
5. Questions and answers on malaria vaccines (World Health Organization, Geneva, 2013).
6. Bill GATES - Speech at the United Nations General Assembly (New York, 2008).
7. Military Malaria Research Program (Walter Reed Army Institute of Research, 2015).
8. Paludisme: enjeu géopolitique et géostratégique (Michel ODIKA, Nouvel Observateur, Paris, 2013).
9. Paludisme: enjeu d'assainissement et d'aménagement du territoire (Michel ODIKA, Nouvel Observateur, Paris, 2011).
10. Malaria: Human Impact, Challenges and Control Strategies (Harvard Health Policy Review, 2001).