Bill Gates unleashed mosquitoes on the trendy techies gathered at the TED conference last week to highlight the dangers of malaria. But is he also unleashing dangerously misleading data about the deadly disease?
Yes, according to an interesting post from aid sceptic Bill Easterly (author of White Man’s Burden) on his new blog, Aid Watch. (Thanks to Owen Barder for flagging this up on his own provocative and intelligent blog on development.)
Easterly criticises Gates for claiming that there have been big falls in malaria incidence in some African countries. Gates is “repeating numbers that have already been discredited,” he says, since they were first cited by the World Health Organisation’s former head of malaria control Dr Arata Kochi (who made headlines in 2008 as a critic of the Gates Foundation).
Felix Salmon quickly jumped to Gates’ defence, citing “pretty solid peer-reviewed research” from the Malaria Matters blog that anti-malaria programmes are working in places like Rwanda and Ethiopia, although some of this is evidence from specific projects rather than data on aggregate infection rates for whole countries. The Zambian health ministry, however, is claiming a 50% reduction in parasite prevalence in children since 2006 as result of malaria control programmes and a recent study using sample data in the Malaria Journal has similarly promising results from Ethiopia and Rwanda.
Easterly is right that we should rely on hard evidence to judge whether development programmes are working. He is also highlighting the enormous problems in measuring progress in development because the data is often so poor.
Easterly says that “the Gates Foundation should be funding more rigorous data collection”. Impact measurement in global health has been a focus of a number of Gates investments in recent years, including a $100 million grant to the University of Washington, as well as the WHO’s own Health Metrics Network and the Institute for Health Metrics and Evaluation.
One public health expert commented to us that calculating the effectiveness of anti-malaria programmes is complicated by mis-diagnosis of malaria (when malaria is epidemic, any classic fever is likely to be malaria and so is counted as and treated as malaria; if control programmes work and malaria is less common, fevers are still being diagnosed and treated as malaria, even if they are now more likely to be a respiratory infection). Our expert’s recommendation? Gates should be leading an effort to subsidise a rapid diagnostic test for malaria.