London School of Hygiene & Tropical Medicine

The London School of Hygiene and Tropical Medicine's Professor Chris Curtis has joined the Earth Institute's Professor Jeffrey Sachs to call for the mass distribution of free insecticidal bed nets to replace social marketing as a means of controlling malaria in Africa.

In a joint editorial published early online today by the Lancet, Professors Curtis and Sachs, with the Earth Institute's Malaria Programme Director Awash Teklehaimanot, dismiss social marketing of long-lasting insecticidal nets (LLINs), which limits subsidised sales of bed nets to vulnerable groups such as under fives and pregnant women, or those who can afford to pay, as false economy.

By relying on too narrow a definition of who is vulnerable, they say, these initiatives miss out on an opportunity to reduce the incidence of malaria in older children and adults other than pregnant women, and to achieve full community coverage which causes a major reduction in the infective mosquito population in the area. They call for malaria-endemic countries to abandon social marketing in all malaria-affected areas, and to change to a policy that regards antimalarial commodities as public goods to be available free of charge for mass distribution.

At the moment coverage with long-lasting insecticidal nets (LLINs) remains low, with many places providing nets for 10% or less of the community. But the authors emphasise that combining maximum LLIN coverage with timely treatment for individuals who develop malaria will provide optimum community protection, and that protection could be achieved for as little as $0.60 per person per year.

They conclude: 'Comprehensive malaria control in Africa is achievable by 2010, at the minimal cost of $3bn per year if sound principles of public health and economics are observed. Millions of lives can be saved and Africa will be given vital help in escaping from the vicious circle of poverty and disease that continues to grip the continent'.