[MUSIC]

Another place where we can really make changes in addition

to diarrheal diseases and HIV/AIDS is in regards to malaria.

Malaria is, you know, is kind of the grandparent

disease I guess with tuberculosis, that we're still fighting.

We know how to fight malaria.

We're, we've gotten pretty good at fighting mal-, we've gotten

very good at fighting malaria, but it still occurs in

nearly 100 countries worldwide. And it takes a huge toll on health and

and on the ability to earn a living particularly in sub-sa, saharan Africa.

And in other developing countries in South Asia.

More than 200 million people, more than 200

million people suffered from the disease in 2010 and

about 650 or 600 more than 650,000 people died of malaria just a few years ago.

The vast majority of people who die of malaria are young children.

You can live with malaria.

There are ways of, you know, dealing with the disease and

certainly reducing and eradicating its symptoms,

but the, the hundreds of thousands

of people who die, most of them will be children under five.

Malaria is preventable and it's treatable.

We know it can be eliminated. And we've, we'll hear, we have heard in

this class from developmental economists and others who talk about some of the ways

you can reduce the likelihood of bites from infected mosquitoes

and, and other things we can do to defeat malaria.

But the, the combination of malaria and

extreme poverty is a deadly combination still today.

>> Hello.

I am so delighted to be here.

And you will be delighted to be here after you hear the wonderful

panel that we have for you.

Especially to start off, with Congressman Meeks, who is

just such an inspiration when you're talking about malaria.

It's going to be a real treat to hear from him.

My name is Deb Derrick and I come from the

Friends for the Global fight against AIDS, TB, and malaria.

We represent the Global Fund in Washington, DC.

And for those of you who don't know, the Global Fund is the world's

largest health financier.

Provides more than $3 billion a year to fight malaria, TB, and AIDS.

And again, just delighted to be here and to be at this panel on malaria.

So, there have been tremendous advances in malaria.

For those of you who haven't heard about this yet, there's been

in the last decade or so about a 25% reduction in mortality globally

in malaria, even as the world's population has grown.

And so just without further ado, I'd like to turn

to Congressman Meeks, who is a long-term member of Congress.

He's a ranking person on the House Foreign Affairs Committee.

He's also a co-chair of the House Malaria and Neglected Tropical Diseases Caucus.

And the first thing that I'd like to

say is you are such when, when you get in front of audiences, you really inspire

people with your work on malaria. How did you get excited about it yourself?

>> Well, when you know that you can make a difference, and you can

see that difference, and you know that it just takes some hard work and commitment.

And you can eradicate this horrible disease.

We've done it before and we can do it now if we stay focused.

And so that excites you when you know that you can see the actual results of

your work just by educating people, and getting

people involved, and making sure that people are contributing.

You can make a difference, and if, you know,

I always say the camera of history is rolling, and

you want in your lifetime to be able to

say that you've seen something different when history goes back.

So I want to be able to say that I played a roll in eradicating malaria from

the planet called Earth. >> That's awesome.

>> [LAUGH]

>> And so, how do, how do you inspire members of Congress?

Do you walk around and give that same

speech on the floor when you're in the House?

>> Well me and my co-chair, what we do, we try to make sure that we have meetings.

But it hasn't been difficult because the world is much smaller today than it was

10, 15, even 20 years ago when we started making sure we wiped it out

here in the United States.

And I think that you get a sense of really tapping into a person, you

know them being a human being and saying look, why do we have this disease?

And then you think about the words that you, you know, I think about words

that Dr. King, you know, he says,

injustice anywhere is a threat to justice everywhere.

Well, malaria anywhere is a threat to malaria everywhere.

And so what we say is, it is in our own

self-interest to make sure that we wipe it out across the planet.

Because when you look at, you know, airplanes and other diseases that

can, that can be transported back and forth, why take the chance?

And so, we talk and talk and this is one of the issues, fortunately.

And Lord knows we have our partisan issues

in Washington DC and we can't agree on much.

But one of the areas, I can tell you, that we've come together and

we agree upon, both Democrats and Republicans and House

and the Senate, is eradicating this disease called malaria.

>> Yeah, I would echo that.

It has been astoundingly bipartisan in Washington, D.C.,

which is unusual in Washington, D.C. these days.

Thank you very much. We also have with us Mikkel Vestergaard

Frandsen, and he is the CEO and of, of a company by the

same name.

And Mikkel, you had a very interesting

introduction to the company and to your work.

So, when you were young you, you went to Africa and how did, what, what happened?

>> Well so the company that is today involved in

the fight against malaria and this is purely private sector.

Actually the history started a little bit before that I was

I started my first company when I was 19, moved to

Nigeria and west Africa and started a company.

I was doing truck and truck imports and truck engine imports.

And did that for about a year then there was a military coup and I was,

more or less, sent packing, came home, my

father wanted me to join the family business.

At the time they were doing textiles for the Scandinavian market.

I was unable to see myself growing old selling shirts in Sweden, wanting to

work with Africa, it got under my skin, it gave me a heart beat.

And so

my father who is very, you know large about my, my

career and future, said, okay, but this is a textile company.

So if you want to work with Africa, textiles for Africa.

And so, this starts, to give you some examples of what that is, that is.

A tsetse fly trap where they key is, where the trick is

to dye a fabric in certain color so when the sun shines

in it, it reflects a ray of exactly 600

and, 450 nanometers where it attracts a tsetse fly.

It is a guinea worm filter which is a nylon cloth that is woven

with a specific mesh so that it takes the guinea worm out of river water.

And then, a good example also is

the same technology, the fluorocarbon binder that makes

a shirt wrinkle free, is what we're using

in the long lasting insecticidal bed nets today.

And so with that, taking the old technology from an old

textile company, turning that into a modern company that is, is working at

the nexus of doing business and doing good, has been a very exciting journey.

>> And what excites you about nets, because I know that there

has been, for example, there was a, a clinical trial recently where

there was great excitement around the prospect for a vaccine, but that's

going to be sometime in the distance, and in the meantime, controlling malaria

is really grounded in standard, current treatment, including the distribution

of nets, which has been phenomenally successful and active recent.

What excites you about nets at this point?

>> Well, I very much agree with Congressman Meeks,

that it is the results that are so incredibly exciting.

In the last, just in the last five years we've gone from more

than a million children dying every year due to malaria, to last year close

to 700,000.

That is, of course, 700,000 too many, but it's still a

remarkable achievement and it shows that, it shows two great things.

That investing in public health works and certainly investing in malaria works.

I'm glad that these results have also

been, been a spearhead in, in bipartisan success.

And I'm truly grateful for your leadership.

But it also shows that, that investment in global development

at large is a success. And, and so this success came about.

Yes, there is drugs. There is diagnostics.

But the success so far has largely been due to the

to the large scale distribution of the insecticide treated bed net.

And, and just a little anecdote to that our bed net

got, got endorsed by the World Health Organization in February 2007.

That was the same month that Facebook was launched,

and up until the end of 2010 we still had more

people sleeping on our bed mats than there were users on Facebook.

>> Wow.

That's, that's also quite awesome.

Is there anything new in the technology

that, that is especially again exciting for you?

>> I think we need to understand that the the gains that we've made are fragile.

Of course that means for that means on the technology front that as

mosquitoes evolve and become mutant to the insecticides that

are used today, we need develop nets that are smarter.

We have one that is ready that kills insects mosquitoes that

are resistant to the known insecticides and is still safe for humans.

The data package is ready and we're waiting

for the World Health Organization to evaluate it.

But as we're on the topic of, of fragile success, I think we need to be reminded

also that keeping pressure on the on the funding, on the progress and the gains

we've made is so important, because if we

don't keep the pressure on malaria's going to resurge.

>> Right, and we've seen tremendous success.

I just recently went to a Global Fund board meeting in Sri Lanka, where they had

gone from having 260,000 cases of malaria a year, about a decade

ago, to having zero indigenous cases now. So it is a success and it does

require continued vigilance, too, because it can resurface if you don't control it.

>> And certainly, sorry.

And certainly, when it's a replenishment year for the Global Fund this

year, I know that, that this is near and dear to your heart.

They have a target of raising a lot of money, 15

billion, and we, we want to make sure that they're on track.

>> Right.

So finally, we have

a terrific story from Edson Kodama and his daughter, Naomi.

And they get involved in in malaria, and in

particular, you, Naomi, got involved in a very interesting way.

How old were you when you first started looking at or taking action on malaria?

>> Well actually my involvement with

helping others starting before Nothing But Nets.

It was when I was seven

years old my seventh birthday was December 26th, 2004.

Which was coincidentally also the day of the tsunami in Indonesia, and so we

were celebrating my birthday and actually saw on the news all these children dying.

And I felt in my heart, I did not feel

like celebrating mere seven years of my life, when there

are children out there who are dying and losing everything

that they have that might be my age or younger.

And so I told my father that instead of receiving presents that, although

they might be great, I may not necessarily use them for my benefit.

They might just end up thrown in the corner collecting dust.

But instead of using that money that they would spend anyway

on me getting a present, use this money to save someone's life.

Because there's no ma, no gift that someone can buy for

me that is more valuable, and more significant than someone's life.

>> That's really also awesome, yeah. >> And so, yeah.

>> [SOUND]

And how old are you now? >> I'm 15 now.

>> And you've been doing this every year since, and expanding it?

>> Yes.

Yeah.

I started working with Nothing But Nets when I was

eight, which is a malaria eradication campaign under the UN Foundation.

Cause the following year I told my dad I wanted to continue helping people and he

talked to me about the UN MDGs or Millennium Development Goals.

And Nothing But Nets was a campaign under that helping eradicate malaria.

And it was a very simple concept.

It was $10 to send a net and save a

life, and as an eight year old who didn't really understand

how much $10 was, it was a simple concept for me

to grasp and a simple concept to share to other people.

>> Great.

And Edson you took that,

I mean, you were, you worked with JCI. >> Yes.

>> And so you help youth

do youth organization activities and philanthropic work.

How many how many people do you have in your organization?

>> We have 200,000 active citizens, that we call ourselves,

and members from the age of 18 through 40 years old.

We are in 5,000 communities around the world, in 126 countries.

The active citizenship concept means the members

are involved in the problem solving process.

So we just not talk.

Like the Nothing But Nets campaign is one of the campaigns we embrace.

We try to implement projects in a unique way.

Just two weeks ago we, we run the, the regatta.

It was organized by JCI Netherlands with several countries in Europe.

We run the regatta and

raise funds for Nothing But Nets. We did also in, in Japan.

We did agreements with the companies, the vending machines.

A couple of cents of every drink, the sales

in vending machines in Japan goes to Nothing But Nets.

And we have also the, the Budapest-Bamako

which is the JCI version of Paris-Dakar Rally.

We load the Jeeps and cars with bed nets and run through west Africa to distribute

nets and create awareness in the process. And just last week we

have the JCI booster, JCI USA, create awareness here in the United States.

It's not a problem here in the United States, the malaria.

But we are creating awareness, raising funds,

and sending help to lives in Africa.

>> And how much money, pegging off of your daughters involvement in malaria

and Nothing But Nets, how much money have you raised for Nothing But Nets?

>> Well,

we are close to $2 million as of today and I believe that we can encourage

more people to engage in this process. $10 is so simple.

That resonates a lot in our membership, and similar

to the project that she does it's a birthday party.

You hold a birthday party, they are so simple.

You, you, you don't go to have a, a, a fast

food, and you can save life.

It's something that our members, because of the

age range, they have a lot of children.

So, that $10 issue resonates pretty well among our memberships.

>> And finally I wanted to note about Edson an

interesting story, you were a professional baseball player in Brazil?

>> Yes, I use to play baseball, yeah, a long time ago.

>> And

Nothing But Nets helped you fulfill one of your dreams?

>> Yes, my dream was to play in the

major league and they, a couple months ago in,

in St. Louis before the, the game St. Louis

and Cincinnati Reds, and I throw the first pitch.

It was, it was [SOUND] all donation for Nothing But

Nets and then again, but that was long time ago.

Today if I throw the ball the mosquito might stop on there on top of the ball.

[LAUGH] >> [LAUGH] Very good.

Congressman, is there anything you'd like to add to it?

I mean, in particular, how do you keep people inspired, given that

there's a constant crush of questions and issues that come up in Congress?

How do you keep people inspired in Congress?

>> Well, you know, when you think about it, we all have a responsibility.

You don't get into public life, and just

say that you're going to forget about humankind.

And as I said earlier, by the world being

smaller, you try to demonstrate by leadership.

And, it, $2 million.

If you can raise $2 million, what should

we be able to be doing government by government?

Not just the United States government, but

working collectively together, this is UN week.

What could we do if we're talking to our colleagues,

you know, and what we do on a consistent basis.

Parliamentarians to parliamentarians trying to make sure that

everybody's making a contribution and focused on eradicating malaria.

And so when we try to keep it in the

in the conscious of everyone because it seems to be though

when you talk about what we have in our humanity

collected together that is something that we should all rally around.

If you talk about what's taking place in Syria

what the big deal was the chemical weapons being utilized

and the reason why the president wanted to step up

was because that was a violation of some human dignities.

Well a violation of human dignities is

still young people in the year 2013 losing their life because of malaria.

So we've gotta keep it on the forefront, keep talking, keep raising money.

And letting folks know they can see the benefit of their dollar every day.

And you hear the statistic that's being talked about, you

know, when you go down from a million to 700,000.

But with just a little extra money, we can go from 700,000 down to zero.

And that's the goal and the focus that should keep us driving and motivated.

Because we can do it.

And we don't know whose lives we're going to save but we're saving our

children because that is the most precious resource that we have on this planet.

>> Yeah.

And on that front we've had some great announcements this week.

And one of them was that the United Kingdom is stepping up

to the plate, and it's made a pledge to the Global Fund.

That's coming on the heels of the Nordic countries making a terrific announcement

of the same, an increased pledge, as we head into this replenishment process.

So I just wanted to say thank you for your time, thank you for all that you're

doing, and for anybody in the audience who is interested in learning more.

I would encourage you to go to www.nothing nothingbutnets.net

>> Nothingbutnets.net.

Yes. >> Right.

Or www.theglobalfund.org and you can find our more

and there may be ways that you can help.

Again, the message is go ahead.

>> Sorry, because it's really such an easy way to solve this problem.

Because right now, if we want to eradicate malaria

in Africa, all we need is 400 million nets.

I mean think about how many people there are in the US.

If every American donated just two nets, this is just the United States, we

could solve this problem.

>> There

you go. Thank you very much.

>> Infection diseases is another place where we can really make a difference now.

I mean there are other research programs where we're trying to, you know,

cure certain kinds of cancers and things like that which are, are really important.

But the ones I'm talking to you about now, gastroendocrinologal diseases.

That is, diarrheal

diseases, HIV/AIDS and malaria.

These are things we know how to deal with right now.

And, and there are many infectious diseases that still wreak havoc in

populations around the world but and, and we know how to deal with those diseases.

If we can get the drugs in the hands of people who need them the most.

More than 1 billion people in developing countries suffer from infectious

diseases that attract little donor support.

I mean, there are some diseases that we all

talk about, like malaria, let's say but there are others

that get little attention and little funding and more

than a billion people around the world suffer from them.

And with attention and funding, we know how to combat those diseases.

[BLANK_AUDIO]

So we're here with Professor Jessica Cohen, who

is at the Harvard School of Public Health.

And talking to us through a some

form of advanced technology that I don't understand.

And thank you for making time to talk with, with me today.

Professor Cohen is a Wesleyan graduate, and has

been at Harvard for the last few years?

Is that? >> Four years.

Yep. >> Four years.

And I thought we'd start off by you saying a little bit about your own itinerary.

>> Sure.

So, thank you for having me.

It's a pleasure to see Wesleyan through the

>> [LAUGH]. >> Through the webcam.

So at Wesleyan I was an economics major. I thought

that it was one of the best ways to think sort of systematically and rigorously

about behavior, questions about behavior and society.

And at the time I was interested in sort of very broad big questions.

My thesis at Wesleyan was about, what was it about?

It was about the evolution of the reciprocity norm.

And how people people give gifts to one

another, and how economic institutions influence that type

of giving. Very different from what I do now.

went to the Brookings Institution after Wesleyan, and worked with

a labor economist named Bill Dickens, and also with Joe Stiglitz.

And I got more and more interested in policy approaches to economics.

And then the year after went to MIT as a doctoral student in economics.

Economics at MIT, and in the Cambridge area there's

a, there's a burgeoning interest in development economics.

>> Mm-hm.

>> So using the tools of economics to

think about poverty and health and agriculture and issues

in developing countries that was just starting to

get a lot of momentum in the early 2000s.

And I got very excited about the possibilities of development

economics at the time, and so I went to Kenya

for the summer to work with Michael Kramer and

Esther Duflo who were founding members the Poverty Action Lab.

At the time I worked on a project that was

looking at how to get farmers to adopt fertilizer actually.

>> Uh-huh.

>> So, the starting project, the starting point for the

project was, why hasn't there been a green revolution in Africa?

The way that fertilizer transformed agriculture and

poverty in India.

Fertilizer was available, you know, even in sma, it, it's

divisible, so even in small quantities farmers could afford it.

>> Right. >> But they weren't buying it.

They were sort of leaving dollars on the ground.

And so what was the reason for that?

So I was there for an early phase of this project that went on for years.

And is actually a great example of the type of

work that the Poverty Action Lab and other development economists

like me do these days, which is a form of searching.

>> Mm-hm.

>> So trying to understand why certain poverty traps exist.

>> Right.

>> And health traps exist.

And experimenting with solutions to get out of it.

And so we can come back to, sort of, what was explored in that fertilizer project.

And so I spent the summer shucking corn and learning how to do randomized

trials in developing countries.

And at the time so this was a

part of Kenya that has incredible burden of malaria.

So in this part of Kenya, and much of

many parts of sub-Saharan Africa, malaria is like the ear

infection that, you know, among kids in, in the

US, it, malaria's like that for kids in, in Africa.

It's just a chronic, chronic

burden.

It's a leading cause of death among children under five, and a

major source of morbidity for pregnant

women also because of compromised immunity.

And it's very, very common. So in this part of Kenya people could

expect a few episodes a year at least and at the

time the interventions to help prevent malaria were not very

very widely available. >> Mm-hm.

>> So another economics student, Pasqualine DuPan and

I thought that it would be a great

idea to distribute insecticide treated mosquito nets which

are one of the most powerful weapons against malaria.

They hang over a sleeping space and protect you from mosquitoes that bite you

in the middle of the night which are the type of mosquitoes that transmit the

lethal form of malaria, falciparum malaria.

And targeting these nets to pregnant women seemed like a particularly good

idea, because it's pregnant women and their newborns that are most vulnerable

to to death from this disease and also pregnant women need

to sleep under a net to avoid low birth weight and other birth complications.

So we started a little NGO

called Tamtam, Together Against Malaria, twice.

>> Ah-ha.

>> And where we distributed free mosquito nets through prenatal clinics.

>> Right.

>> And part of the condition from some of

the early donors was we needed to evaluate this strategy.

And so what we did was we set up a very small

evaluation that looked at if you

provide insecticide treated net through prenatal clinics.

>> Mm-hm. >> When women are coming

for prenatal care.

Does that increase attendance at prenatal care?

So, does it, is it successful at getting women to come earlier?

>> I see.

>> More frequently and the idea was that there would be like a nice a

nice what do you call it, synthesis

between increasing prenatal care and also preventing malaria.

So we did that, and it was a small NGO, and it was a

nice little study, and we found that it

did indeed increase prenatal attendance by a lot.

>> Hm.

>> But about a year after that a very large NGO named

Population Services International started working with the government of Kenya

to distribute prenatal insecticide treated nets throughout Kenya.

And since then,

insecticide treated nets have been scaled up throughout Africa.

>> Right.

>> It is the main reason why malaria deaths, one of the main

reasons why malaria deaths have dropped by a third over the last ten years.

They are just hugely effective at controlling this disease, and

so they came in and they we said, you know what?

They have it covered, we'll go work in, somewhere else.

We don't need to duplicate efforts.

The difference though was that this

organization and the government of Kenya was charging something for the nets.

>> So we had been giving them for free.

And this organization represented the views of a

lot of countries and NGOs where the, the

idea was that you have to charge something in order for these nets to be valued.

So nets are about $6 or $7.

Much more than a lot of people in these areas can afford.

So there's an understanding that they need to be cheaper, but the argument

is that if you can give them away for free people will just not use them.

So there were anecdotes abound.

>> Hm.

>> That people use them for fishing, they use them for wedding veils.

And that this was a perfect example of the waste that's inherit in global aid.

>> I see.

>> That aid for health, that if you give them

for free, they'll just end up being used for fishing nets.

If you charge $0.75 for them, right,

people can still afford them, but you sort of eliminate the people

who will take them just because they're free, but they wouldn't use them.

So this was like a great idea.

So there was a, so what we found was that

when they started doing this, that prenatal

attendance went back down to very low levels.

>> Really?

>> To lower levels.

And that got us thinking, wow, could there really be

that big of an effect of charging $0.75 for a net.

I mean, a net that these people really needed, right?

There was tons of malaria, clear benefit. Clear economic benefit, right?

Because you can work if you don't have malaria.

Clear health benefit.

Could it really be that it mattered that much to charge that?

>> Right.

>> So we went back.

This was part of my senior thesis.

My senior thesis, my doctoral dissertation.

>> Right. >> And we did an experiment.

Where we looked at the effect of charging $0.75

for a bed net, relative to giving them for free.

And we looked at a few prices in between.

So the idea was just like the way you would do a clinical trial

for medicine or surgery.

We did a randomized control trial to compare policy A to policy B.

Does it make sense to give them for free or to charge something?

And the starting point was that, while it may be the case that when you charge

something people are more likely to use it and to value it.

You could be sort of cutting your nose to spite your face.

>> Yes >> Because people are poor and.

You know, you're shut.

You know, your, your, your objective is to increase coverage by a lot.

>> Right.

>> And so what we did was we compared a few things, but the

main things were how many pregnant women get a net when you charge something.

>> Right.

>> And how many get it when it's free, and how many then are sleeping

under it and using it a month later that we looked at that through home visits.

And what

we found was a tremendous amount of price sensitivity.

So if 100 women take a free net

>> Right

>> 40 of them will pay 60 cents for it.

And 25 of them will pay the, the the price that the government of Kenya was charging.

So in other words they were losing 75% coverage.

>> Right.

>> In order to get back a 10% of the cost of this net, right?

And on

the other hand, there was no difference in the

chances that a woman was sleeping under the net, if

she bought it, you know, if she took it for

free, or if she paid the highest price for it.

So, the implication was that it makes no sense

at all to charge small user fees for bed nets.

What your, what you're losing you're not making up for at all.

>> Yep.

>> In terms of what, and that was the beginning of a change

in policy that contributed to a change in policy in Kenya toward free distribution

of these nets. And also was part of a mounting evidence

that these small fees for these essential health products are counter-productive.

And Jeffrey Sachs who you're talking to

later will probably tell you something similar.

And so, that's sort of, that was sort of my path, and it's led me to

this work on impact evaluation and this sort of approach to development and

poverty which thinks about sort of searching for the right policy or program.

[BLANK_AUDIO]

Major Health Challenges and Responses (2)

How to Change the World

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