When elephants fight

dscn3097sm.JPGAs the saying goes, when elephants fight, the grass suffers. The New York Times has reported on just such a fight between elephants – titans in the malaria world, The WHO Global Malaria Program (GMP) and the Bill and Melinda Gates Foundation. According to the article GMP has voiced concern that, “the foundation’s money, while crucial, could have ‘far-reaching, largely unintended consequences,'”  and that Gates funded research might subvert the agenda and role of WHO. The Gates Foundation countered by saying that, “the foundation did not second-guess or ‘hold captive’ scientists or research partnerships that it backed,” and values external review.

A key point of contention is the issue of Intermittent Preventive Treatment for Infants (IPTi). GMP’s current position is that sulfadoxine-pyrimethamine (SP) used in IPT may be dangerous given to children in regular doses and that anyway there is increasing resistance to the drug by malaria parasites.  In contrast, research managed by the IPTi Consortium has produced promising results in many countries. The Times quotes scientists on both sides of the debate.

To make the situation more challenging, UNICEF, another key malaria partner, has invested in IPTi and found its effects to be positive: “Research shows that intermittent preventive treatment for infants (IPTi) may be effective in reducing anaemia and clinical malaria in young children, and may soon be provided as part of their routine immunization visits. UNICEF is a member of the IPTi Consortium, which is currently conducting research into the feasibility of introducing this additional intervention in Africa.” UNICEF is stuck in the unenviable middle of the storm.

In the meantime while the elephants fight, infants and small children are the grass that suffers.  While we do have ACTs and LLINs and IRS, we do not have the yet crucial mix of interventions that can permanently rid children from the threat of malaria. We need dialog and partnership in the malaria community, not fighting at the expense of children.
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ps – The baby elephants pictured above are not fighting anyone. While they don’t need IPTi, they do need help. They are residents of the Baby Elephant Orphanage near Nairobi.

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