PoPulationand Public HealtH etHics

policy
Case description
For nearly a century now, experts have believed that it is technically possible
to eradicate malaria. Effective intervention methods have emerged over the
past 30 years or so. They include use of mosquito nets treated with pyrethroid
insecticides, spraying of insecticide inside homes, diagnostic testing,
and preventive treatment of pregnant women. Artemisinin-based combination
therapies are now recommended, because resistance to monotherapies
is a growing problem. In light of the technical resources now available, and
out of concern for the welfare of the affected populations and their right to
health, it has now become imperative to intervene.
The burden of malaria is borne chiefly by countries that have few resources
to deal with it on their own. The only way to overcome this double injustice
is for other countries to act in solidarity with them. World health agencies
have the expertise and legitimacy needed to assume leadership in an effective,
concerted campaign. But anti-malaria interventions that are initiated
and managed from outside these countries may compromise their sovereignty
and hence the acceptability and legitimacy of the interventions themselves.
Consequently, anti-malaria interventions must be locally based, and the methods
of funding them must be equitable.
In 2002, the leading world health agencies established a fund to fight malaria
(www.theglobalfund.org). Their goal is to put an end to deaths due to malaria
by 2015. This fund finances research and interventions in the countries targeted
by local scientists and establishes guidelines to address the problems
associated with corruption. First, a local applicant must commit to co-fund
the proposed research or intervention, and must find an external co-donor.
Because the process is initiated locally, the sovereignty of the countries involved
is preserved, development of local expertise is encouraged, and the
proposed intervention plan is more likely to meet the needs of the population
and to employ implementation methods that are respectful of local practices
and conditions. Next, the fund’s managers evaluate the external donors and
the local applicant. Applications for funding are vetted to determine their
eligibility. These reviews are required to provide an outside expert opinion
and minimize the risks that any funding granted will be misused. These
precautions are similar to peer reviews, ethics reviews, and managementpractices
reviews. In addition, assistance in managing health resources is
offered to limit the losses associated with the risks of bad management. The
PoPulation anD Public HealtH etHics
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