MOMBASA, Kenya—In 2007, the Bill & Melinda Gates Foundation said it was committed to eradicating malaria across the globe. By then, it was late to the game.
That year, Chinese scientists working with a Chinese philanthropist and his company, New South, had already begun eradicating malaria from the small African nation of Comoros. Now they’re setting their sights on a more ambitious location: Kenya, the East African nation of nearly 50 million people.
As Western donors garner headlines for funding expensive, experimental malaria interventions, Chinese researchers are undertaking a far more tested approach. Called mass drug administration, or MDA, it involves giving antimalarial pills to every man, woman, and child in a given area all at once. Rather than kill off the world’s mosquitoes, which spread the disease by drawing blood from infected people, the thinking goes, why not simply wipe out malaria among humans?
If successful, the effort would ease the disease’s burden on Kenya’s health system and economy. But it would also showcase Chinese philanthropy in Africa, and may even help change the perception here that Chinese-made goods and medicine are of poor quality. Having recently surpassed the United States to become Africa’s leading trade partner, and with Chinese investment in Africa rising sixtyfold from $500 million to $32 billion in the last 15 years, Chinese cooperation in the continent’s science and public-health sectors may show the world that the country has far more to offer Africa than just roads, railways, and things.
China has employed MDA, along with other methods to fight malaria, at home since at least 1981; last year, for the first time in what is likely millennia, it saw no new native cases of the disease. But MDA is controversial for reasons of both science and ethics. There are concerns that it could lead to increased drug resistance, which could see malaria rise to levels not seen in decades. Others believe it’s unethical to give antimalarials to people who may not even have the disease—or who don’t wish to take them—though such qualms are dismissed in Kenya and elsewhere. Similar dilemmas are challenging U.S. policy makers as they debate how to respond to the rising anti-vax movement.
Chinese officials, researchers, and philanthropists seem unworried by these concerns—as are some Kenyan officials.
Dr. Bernhards Ogutu, who has spent decades studying malaria for the Kenya Medical Research Institute, welcomes the Chinese. For too long, he told me, the world has been “basically firefighting”: waiting until people become sick with the disease, then treating them. He predicted that by using MDA and similar methods, in some parts of Kenya, “we can totally eradicate malaria in the next five years.”
Malaria is a debilitating sickness that can make strong, healthy adults bedridden for weeks and is one of the three leading causes of death for children in sub-Saharan Africa. Symptoms include fever, chills, shaking, muscle aches, and severe fatigue.
According to the World Health Organization, almost half the global population is at risk for malaria. Each year the disease afflicts 212 million people and kills 430,000 of them—nearly 1,200 deaths each day. Ninety percent of malaria cases and 92 percent of deaths occur in Africa.
Song Jianping, deputy director of the Institute of Tropical Medicine at Guangzhou University, which receives funding for its MDA research from the Chinese government, says those numbers could be drastically lowered. “It is not like we don’t have the medicine. It’s not like we don’t have the methods. The hurdle is the wrong perception,” he says. Fighting malaria through prevention is not enough, Song adds. “If the whole [of] Africa can run MDA, in 10 years, there will be no malaria.”
Eradicating the disease won’t be easy: Humans have only succeeded in wiping two diseases—smallpox and rinderpest—from the face of the Earth. “Mass drug administration—that’s a very controversial intervention,” says Desmond Chavasse, who for two decades has worked on malaria initiatives for the NGO Population Services International (PSI). But the appeal “is that the result is there for generations.”
China isn’t new to the global fight against malaria. Chinese scientist Tu Youyou discovered the antimalarial compound artemisinin, in 1972, and figured out how to extract it from the Asian sweet wormwood plant, eventually earning her the Nobel Prize in 2015. For at least 2,000 years, wormwood was used to treat fevers and other symptoms consistent with what we now know to be malaria.
Today, artemisinin is the most effective and widely used antimalarial compound in the world, with millions of doses of artemisinin combination therapies (ACTs) given out each year. Some of the Chinese scientists who helped develop ACTs are now shifting their attention to using MDA in Africa. New South, the Chinese company whose CEO, Zhu Layi, says he has personally spent $300 million on MDA research and experiments in Africa, and his company is in talks with Kenyan health officials to do an MDA test run among 10,000 people on the country’s Indian Ocean coast, near the port city of Mombasa, where malaria is endemic.
But unlike those living in Comoros, many on the Kenyan mainland regularly travel or commute around the region, which poses a problem: People who are out of town when the drugs are administered might return carrying the parasite in their blood, reintroducing malaria to the area. There is also concern that the MDA approach could result in the malarial parasite building up resistance to the drugs used in the treatment. But, says Song: “If we can manage to give the correct dose, and do it fast, then we can kill the parasites before they develop resistance.”
Already, resistance is threatening to undermine the gains made by the last great antimalarial technology: bed nets. In the 1990s, the advent of the insecticide-treated mosquito net led to a breakthrough that resulted in a steady decline of malaria around the world. The problem is that “we’ve already harvested most of the benefits you can expect to harvest” from nets, Chavasse says. Without new insecticides, drugs, and treatment methods, scientists say we’ll soon see an increase in malaria worldwide. Many donors and investors are hesitant to invest in approaches like MDA when older methods have worked in the past. “But the current way of doing this is just going to keep us sick,” Ogutu said.
In Kenya, where 70 percent of the population is at risk for malaria, according to government data, the devastation of the disease goes beyond the sickness itself. “People who get malaria are not able to go to work. Your productivity goes down. If you’re a child, you will not be able to go to school,” says Rebecca Kiptui, of Kenya’s National Malaria Control Program. “If everybody falls sick, then the Kenyan economy would suffer.” Five years ago, 37 percent of all outpatient treatments given in Kenya were for malaria. Taken together, lost work hours and the cost of treating patients for malaria amount to $109 million a year, according to researchers who studied the economic effects of the disease in the region.
Some worry New South, the Chinese company, may be trying to get a piece of the pie—that its MDA campaign may in fact be a ploy to increase sales of its own medicine. Among New South’s vast holdings is a pharmaceutical wing whose Chinese scientists in 2006 invented Artequick, an ACT that China's Ministry of Health approved as the "drug of choice" for treating malaria in the country in 2009. The next year, Beijing listed Artequick as the preferred malaria drug for export to Africa. But Chavasse says “there is a fundamental conflict of interest for why a Chinese ACT manufacturer would be carrying out a research project on mass drug administration.The thought needs to be driven by malaria academics—not by drug companies.”
But Ogutu dismissed the idea that Chinese endeavors must have some ulterior motive. “We live in a conspiracy—that there’s some hidden agenda,” he said. In New South’s case, those fears seem misplaced: Unlike antibiotics and more specialized drugs, there is little money to be made from malaria treatment, with artemisinin-based malaria meds selling for just pennies per pill.
Rather, the company’s campaign to eradicate malaria forces us to reckon with the possibility that Chinese billionaires such as Zhu might be driven by the same altruistic intentions that drive their Western counterparts—philanthropists such as Bill and Melinda Gates, who have spent more than $2 billion fighting malaria. If anything, New South’s secondary motivation isn’t only profit, but also pride. “We want to promote Chinese medicine to the globe,” Ethan Peng, who worked on New South’s MDA efforts in Nigeria, told me last month from his office in Nairobi, Kenya’s capital city.
Many in the West and in Africa are not enthused. Amid popular narratives about Chinese engagement in Africa is the assumption that Chinese-made products are faulty, cheap, subpar, or fake. Similar accusations have been directed at New South’s malaria-eradication campaign. A 2014 report by CBS News questioned the use of New South’s new drug, Artequick, even though it’s a combination of three drugs that are well studied, widely used to fight malaria globally, and deemed by researchers to be an effective treatment for malaria.
The real debate may have less to do with science than it does with ideology: Is malaria elimination—or for that matter, health care in general—a societal affair, or an individual one?
Several of my Chinese and Kenyan friends alike are astounded that some American parents refuse to vaccinate their children against measles out of a disproven fear of autism, and question why people even have that choice. The notion that individual liberties should be respected even when they refute science—to the point of creating a public-health emergency—seems ludicrous in societies where health is treated not as an individual right, but as a common good.
Moreover, such criticism ignores the reality that, in many parts of Africa, solving problems through science has already become a collaborative affair. In November, the Chinese Academy of Sciences opened its first-ever research center in Africa, near Nairobi. Chinese and Kenyan scientists work together to create drought-resistant crops, increase rice yields, and develop new methods for trapping water in the ground to better grow maize.
Chinese medicine has been a boon to Kenya: Pharmacies here carry Chinese-manufactured artemisinin alongside more globally recognized products from the Swiss pharma corporation Novartis, and since 2003 China has donated malaria and HIV drugs to Kenya’s government. Kiptui says she welcomes “any partner in malaria as long as they line up with our needs,” be they from “America or China or Thailand, or wherever.”
“In public health,” Kiptui says, “you do the greatest amount of good for the greatest amount of people.”
“It takes some time for people to understand,” Peng told me. But “in Africa, more and more people are getting to recognize that Chinese medicine is very good.”
This article was developed with the support of the Money Trail Project from Journalismfund.eu. Qian Sun, Anthony Langat, and Felix Franz contributed from China, Kenya, and Germany, respectively.
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