We have just reached the $14 million milestone, only a few weeks after passing $13 million!
We have received donations both large and small and every $4 matters as every net matters.
100% of the funds we have received will buy nets and all donors will be able to see exactly where the nets they fund are distributed.
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We have just passed the $13 million mark, thanks to a donor from San Francisco, USA!
Every donation from every person counts as the total of $13,120,514 from over 54,000 donations and transactions, in 168 countries, indicates. 100% buys nets.
That's 3,038,427 nets, protecting more than 5 million people.
Thank you!
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2012 has been a good year for Against Malaria. With your support we have almost reached the $13 million raised mark and we would like to share a few of the highlights with you.
Malaria in Ntcheu, Malawi falls by up to 50%
After a major distribution of 270,000 nets in locations across Ntcheu we have been collecting data on the incidence of malaria in each location and monitoring the continued use and condition of the nets. more
#1 ranked
GiveWell ranked us #1 for the second year running, saying "AMF has outstanding self-evaluation and transparency. It first became our #1 charity in late 2011 and has continued to impress us." more
Updated website
We have revamped our website and added even more information on the workings of the charity, in keeping with our emphasis on transparency with all aspects of our work. We have made improvements to many other pages and added the ability to make a donation as a gift for someone else. more
Best wishes for the holiday season,
Rob and Andrew
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In the coming months we intend to publish status information for each potential distribution being assessed. Information will be presented in a format similar to that shown on our Future distributions page.
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We are delighted to say GiveWell has just announced its updated top charity ranking... and AMF has been ranked #1 for the second year running!
GiveWell has said, "...of all the charitable interventions we know of that have clear room for more funding, this one has the strongest evidence of effectiveness and cost-effectiveness. AMF has outstanding self-evaluation and transparency. It first became our #1 charity in late 2011 and has continued to impress us."
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Recently approved
We have approved a distribution of 250,000 nets in the districts of Balaka and Dedza in Malawi. The distribution would take sleeping space coverage levels from 30-60% (the level is currently unknown) to 90% and above. We are discussing the funding of non-net costs and the timing of the pre-distribution registration survey with our distribution partner. We expect the distribution to place before the end of Q1 2013.
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Recently approved
We have approved a distribution of 250,000 nets in the districts of Balaka and Dedza in Malawi. The distribution would take sleeping space coverage levels from 30-60% (the level is currently unknown) to 90% and above. We are discussing the funding of non-net costs and the timing of the pre-distribution registration survey with our distribution partner. We expect the distribution to place before the end of Q1 2013.
The distribution partner is Concern Universal, Malawi, with whom we distributed 270,000 nets in Ntcheu district from January to April 2012. An NMCP coordinated distribution of nets took place in the districts in the middle of 2012. Further nets are required to achieve universal coverage.
Being assessed
We are assessing nine distributions of between 60,000 and 4 million nets each. The distributions are in Angola, Burkina Faso, Cameroon, Malawi, Mali, Nigeria, Senegal and Sierra Leone. In one country we are lookng at several separate distributions. Assessments are at different stages.
The quantities of nets we are considering, with the country's estimated need in 2013 shown in brackets, are:
Angola - 500,000 to 1 million (3.2 million)
Burkina Faso - 500,000 to 1 million (8.6 million)
Cameroon - 500,000 (2.1 million)
Malawi - 500,000 to 1 million (500,000 to 1 million)
Mali - 500,000 (4 million)
Nigeria - 500,000 to 1.5 million (tens of millions)
Senegal - 60,000 (unclear)
Sierra Leone - 500,000 to 1 million (3.4 million)
This information and future updates can be found in our recently launched Future Distributions section.
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We have not proceeded with three potential distributions being considered during 2012 in Malawi, Togo and Mali.
Malawi, 600,000 LLINs
Through January to June 2012 we offered to contribute 600,000 to 1 million nets to close the gap in nets required to achieve universal coverage. The NMCP would not progress discussions about sharing the extensive pre-distribution registration data they said they had. We considered it important for us to see to this information before contributing nets.
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We have not proceeded with three potential distributions being considered during 2012 in Malawi, Togo and Mali.
Malawi, 600,000 LLINs
Through January to June 2012 we offered to contribute 600,000 to 1 million nets to close the gap in nets required to achieve universal coverage. The NMCP would not progress discussions about sharing the extensive pre-distribution registration data they said they had. We considered it important for us to see to this information before contributing nets.
Togo, 500,000 LLINs
Through January to August 2012, we offered to contribute 500,000 nets when there were no other sources of funding to fill the net gap to complete a universal coverage campaign. The offer was not accepted. The NMCP would not agree to a Pre-Distribution Registration Survey (PDRS) being carried out even though our Distribution Partner had agreed to do so and had agreed to fund it. The NMCP said they had conducted a universal coverage campaign on the basis of one net per two people and they did not want to change the basis of the distribution. We said if the data was good, we could agree to that being the basis of the distribution. We asked to see the data. No data was forthcoming. A PDRS was required in our view as the existing NMCP data was:
- for the number of people per household rather than the number of sleeping spaces (although not the best basis, we could have agreed to using this data if it were recently collected and accurate, with additional accuracy being sacrificed in order to achieve an immediate distribution and people protected); and
- gathered at least six months previously when discussions first began and at least 12 months old when we withdrew from discussions.
Mali, 500,000+ LLINs
Unrest and fighting, including killings, in Mali have led to security fears and safety concerns. Our distribution partner has on several occasions withdrawn staff from the country. This has put our potential contribution of nets on hold. New timing is unknown. The need is for 4 million nets.
We have learned it is important to progress more potential distributions at the same time to avoid a delay in converting funds to nets.
Is the failure to progress with these distributions a concern?
Yes, in that it has meant we have taken longer to convert funds into nets being distributed.
What would we do differently if faced with the same situation?
We would progress more potential distributions at the same time. We are doing that now. See below
Could this be indicative of what we might find when trying to do more large-scale distributions with the degree of accuracy, transparency and accountability we require?
We do not think so. What supports this is there is a significant need for nets and the results we have achieved in Ntcheu have generated interest. More distributions with similar results will help further.
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We have received the third three-months set of post-distribution malaria case data following the February 2012 distribution of 270,000 nets in Ntcheu District, Malawi. The results continue to be good.
We have received the third three-months set of post-distribution malaria case data following the February 2012 distribution of 270,000 nets in Ntcheu District, Malawi. The results continue to be good.
A quick summary:
- The incidence of malaria in July, August and September 2012 were 41%, 47% and 35% lower than in the corresponding months of the prior year.
We will continue to collect and publish monthly malaria data and hope to see this decline in malaria rates continue.
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While recent field trial results for the potential malaria vaccine RTS,S may be disappointing, it is worth noting this is important work and the science may well prove an important contributor to the eventual development of a successful, cost-effective malaria vaccine. From an editorial in The New England Journal Of Medicine by Johanna Daily:
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While recent field trial results for the potential malaria vaccine RTS,S may be disappointing, it is worth noting this is important work and the science may well prove an important contributor to the eventual development of a successful, cost-effective malaria vaccine. From an editorial in The New England Journal Of Medicine by Johanna Daily:
“The results of this trial suggest that this candidate malaria vaccine is not ready to become part of the routine panel of infant immunizations. [AMF added bold] However, this trial did show protection in a subset of children and thus should be used as an opportunity to enlighten researchers regarding the host responses that correlate with vaccine protection. There are many vaccine candidates in the pipeline that use alternative parasite targets and vaccination strategies. Whether leaders in malaria-vaccine development will be able to support the costs needed to integrate sophisticated host-response studies or other value-added studies into these future vaccine trials remains to be seen. The results of this immunization trial suggest that a malaria vaccine is possible, but a more detailed understanding of effective host responses will be necessary to achieve this goal and avert the illnesses and deaths associated with this devastating infection for millions of children."
We hope significant funding will be directed to vaccine research for the five malaria parasites. While it is the case, currently, there has never been an effective vaccine against a parasite, there is reason to believe scientific research will lead to one being developed. The impact of such a vaccine could be hugely significant.
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Everyone involved in malaria control has a fervent wish a malaria vaccine is found.
There is what could be bad news about one potential malaria vaccine.
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Everyone involved in malaria control has a fervent wish a malaria vaccine is found.
There is what could be bad news about one potential malaria vaccine.
"An experimental malaria vaccine once thought promising is turning out to be a disappointment, with a new study showing it is only about 30 percent effective at protecting infants from the killer disease.
'If it turns out to have a clear 30 percent efficacy, it is probably not worth it to implement this in Africa on a large scale', said Genton Blaise, a malaria expert at the Swiss Tropical and Public Health Institute in Basel, who also sits on a WHO advisory board. He said the vaccine might work better under certain conditions but more research was needed.
Scientists have been working for decades to develop a malaria vaccine, a complicated endeavor since the disease is caused by five different species of parasites. There has never been an effective vaccine against a parasite. Worldwide, there are several dozen malaria vaccine candidates being researched.
Eleanor Riley of the London School of Hygiene and Tropical Medicine, said the vaccine might be useful if used together with other strategies, like bed nets. She was involved in an earlier study of the vaccine and had hoped for better results. 'We're all a bit frustrated that it has proven so hard to make a malaria vaccine,' she said. 'The question is how much money are the funders willing to keep throwing at it.'
WHO said it couldn't comment on the incomplete results and would wait until the trial was finished before drawing any conclusions."
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Greece has reported a total of more than 70 cases of malaria since the beginning of the year. This is worrying. However, given the relative economic wealth and levels of sanitation and other health services in Greece compared to many African and other malaria affected countries, it can be expected this outbreak can be contained. Read more
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In Ntcheu, Malawi we conducted the first of the regular 6-monthly Post-Distribution Surveys to assess net use and condition. We found very good results with net hang-up high at 90% across the population of 550,000 people. For 27 of the 37 areas that make up the district the hang-up rate was a very high average of 95% (range: 91-98%). For 10 districts the average was 84% (range 78-88%), 11 percentage points lower. AMF and Concern Universal (CU) both believed it possible to increase the hang-up rate in the 10 areas by 10 percentage points through additional, structured malaria education and hang-up activities with full involvement of the local communities. These activities took place between 23-27 Sep 2012. We expect to receive, and will publish, updated hang-up data for these 10 areas by the end of November 2012. The reason for this additional low-cost intervention was to seek the optimal impact of the nets distributed.
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In Ntcheu, Malawi we conducted the first of the regular 6-monthly Post-Distribution Surveys to assess net use and condition. We found very good results with net hang-up high at 90% across the population of 550,000 people. For 27 of the 37 areas that make up the district the hang-up rate was a very high average of 95% (range: 91-98%). For 10 districts the average was 84% (range 78-88%), 11 percentage points lower. AMF and Concern Universal (CU) both believed it possible to increase the hang-up rate in the 10 areas by 10 percentage points through additional, structured malaria education and hang-up activities with full involvement of the local communities. These activities took place between 23-27 Sep 2012. We expect to receive, and will publish, updated hang-up data for these 10 areas by the end of November 2012. The reason for this additional low-cost intervention was to seek the optimal impact of the nets distributed.
In the 6-months Post Distribution Survey, 7,646 randomly selected households were visited and 15,735 nets surveyed. Survey questions covered net use and net condition for both AMF and non-AMF distributed nets. The survey was carried out by staff from each of the 37 health centres and clinics in Ntcheu, with training and supervision by CU staff. The data was collected on written forms and entered by CU staff into a database to facilitate analysis. The data is available on the AMF website.
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A number of independent charity evaluators review causes and individual charities and make their own giving recommendations.
We have just published a page showing 'What people say about us' and how they rate us in comparison to other charities.
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We continue to make public, information and data behind the workings of AMF.
1. Annual accounts – what we file.
2. Easier-to-understand accounts - our audited annual accounts with additional detail added and laid out in a way we believe is clearer than formal accounts.
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Mosquitoes developing resistance to the insecticide used in long-lasting insecticidal nets (LLINs) and mosquitoes changing their biting (feeding) behaviour and biting not between 10pm and 2am but towards the early morning ie 5am - or rather, in both cases, natural selection occurring favouring those mosquitoes that develop some level of resistance or having a later biting time - is starting to be seen. The extent to which either or both of these factors become a major problem for the effectiveness of LLINs is currently not clear.
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Mosquitoes developing resistance to the insecticide used in long-lasting insecticidal nets (LLINs) and mosquitoes changing their biting (feeding) behaviour and biting not between 10pm and 2am but towards the early morning ie 5am - or rather, in both cases, natural selection occurring favouring those mosquitoes that develop some level of resistance or having a later biting time - is starting to be seen. The extent to which either or both of these factors become a major problem for the effectiveness of LLINs is currently not clear.
Currently both issues - resistance to pyrethroids and changed time of biting - are not widespread. Currently LLINs remain highly effective in reducing the incidence of malaria.
Professor Steve Lindsay of Durham University comments: 'It is more likely we will see an increase of mosquitoes biting outdoors in the early evening, before people go to bed, although we do not have evidence for this occurring in Africa at present. Nonetheless, what is a common finding is that large-scale use of LLINs has resulted in the near extermination of Anopheles gambiae sensu stricto in houses in East Africa, with An. arabiensis remaining as the major vector, biting outdoors. In this case, the view is that there is no increase in An. arabiensis populations.'
On resistance to pyrethroids, Steve Lindsay comments: 'Resistance to pyrethroids is a rapidly growing phenomenon. We do not know whether this is impacting the control of malaria yet, but it is likely to be the case in the future. For the present they are probably effective in most places. New nets with different combinations of insecticides may provide better protection where pyrethroid resistance occurs, but these products are in the early stages of testing. And we shouldn't forget that an intact net is protective against malaria. For the moment, don't stop rolling out the nets.'
It is perfectly possible either or both – resistance to pyrethroids and changed time of biting - will remain a relatively minor problem without widespread impact.
It is also perfectly possible, over time, either or both - resistance to pyrethroids and changed time of biting - will become a material issue. This is the more likely scenario.
Resistance has been seen in other areas so it would not be a great surprise to see resistance developing to an insecticide. For example, the malaria parasite (rather than the mosquito in this case) first showed resistance to chloroquine in the 1950s and more recently, in 2004, evidence of resistance to Artemisinin Combination Therapy (ACT), the primary drug currently used to treat malaria.
This highlights the importance of meta-research studies that look at both these issues - resistance to pyrethroids and changed time of biting - in many more locations to both establish how prevalent the problems are and to monitor developments.
This is a very important time for research so we gain clearer information that can influence decisions.
A solution to mosquitoes developing pyrethroid resistance is the use of non-pyrethroid insecticides. Currently there aren’t any that can be used on nets. Significant research is being carried out by a variety of groups and organisations to develop such insecticides. No-one can give a clear timeframe or the chances of success although some in this research area suggest a three to ten year timeframe is likely before products are able to come to market given the strict testing of such insecticide-including products.
In 2010, a net incorporating a second chemical, referred to as a synergist, was introduced to the market. There is some, but not conclusive, evidence that the combination of the pyrethroid and the synergist is more effective than pyrethroid-only nets at achieving knock-down of mosquitoes developing pyrethroid resistance. Further research studies, including field studies, are currently underway. More are required. The conclusion currently therefore, is there is no clear indication that the synergist treated nets are the nets of choice for areas where resistance is indicated, or indeed for other areas to prevent resistance developing. However, they do show promise and they might prove to be better than non-synergist-including nets. The synergist treated nets are currently 30% more expensive than the pyrethroid-only treated nets.
A solution to mosquitoes changed time of biting is less clear, as is the extent of the problem. There is an interesting article that discusses some of the current factors that may influence how serious, or not, a problem this becomes.
The bottom line:
- Long-lasting insecticide treated nets (LLINs) remain the most effective means of malaria prevention.
- More research needs to be funded to understand the extent of problems such as mosquito resistance to the insecticide used on nets (pyrethroids) and change in time of day of biting of some mosquitoes.
- Research into both non-pyrethroid insecticides and chemical combinations (with pyrethroids) is very important.
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Giving What We Can appeared on the BBC's Daily Politics show and this short video explains their philosophy. There are some interesting numbers in there from the start (and at the end!).
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We have just passed the $12 million mark! Thank you to Simon from Melbourne, Australia who has just taken us past that milestone.
Every donation from every person counts as the total of $12,011,000 from nearly 52,000 donations and transactions, in 168 countries, indicates. 100% buys nets.
That's 2,780,528 nets, protecting more than 5 million people.
Thank you!
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Over the coming months we are going to make public, information and data behind the workings of AMF. Transparency is a central element of our philosophy and we hope the information will both be of interest to supporters and donors and help answer questions about how we operate and make decisions.
Recurring donations
Whilst rapid progress can be made against malaria (see recent results in Ntcheu, Malawi), sustained action and sustained support are key to securing permanent malaria reduction. Recurring donations to AMF are one of a number of indices we follow to assess how we are performing and engaging support. They currently represent a small proportion of the funds AMF receives, approximately 5%, but the number and total value of recurring donations is growing. We are publishing here monthly totals for recurring donations so others can see the numbers and follow progress. 100% of these funds buy nets.
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Their summary is: "Bottom line: We remain confident in the effectiveness of AMF's activities. It remains our #1-ranked organization."
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Normally we allocate a donation to a particular distribution within a few weeks or months of receiving it. The allocation of your donation is taking longer and we wanted to explain why and keep you updated.
We are currently evaluating two large distributions of 500,000 and 600,000 nets respectively in two different countries, albeit in the second country the need is for 4 million nets. We have been accumulating donations so we can fund the nets for these significant distributions. We are far advanced in the assessment of one, and at a key stage with the evaluation of the second. These are the distributions to which we have provisionally allocated all current donations. We hope to make final decisions in the coming weeks with exact timing dependent upon responses from the relevant National Malaria Control Programmes and our distribution partners in-country.
However, it is possible, even late in the process, we decide we cannot support a particular distribution. This would be because we could not obtain various data we feel necessary to (1) fully evaluate the distribution (i.e. malaria case rate information and data that reliably establishes the level of net need) and/or (2) underpin the intended distribution (i.e. pre-distribution beneficiary survey information that forms the basis of exactly where the nets are distributed). This was the case in May 2012 for a 600,000 net distribution we were considering in one country. We will not risk donations.
We are developing a pipeline of potential large scale distributions so the time between receiving donations and allocating them to a distribution is minimised. Our aim is for the majority of donations to be allocated within three months of their receipt and for the maximum to be four months.
The success of a recent large scale distribution in Ntcheu, Malawi, where we achieved universal coverage of a population of some 550,000 people via the distribution of 270,000 nets, has guided our focus on these larger distributions. The Ntcheu distribution has resulted in an immediate fall in the incidence of malaria of an estimated 50%. This is very significant and we aim we see the decline continue in Ntcheu as well as replicate this impact in the two distributions we are considering now and in subsequent distributions.
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Amongst other messages in this short article, there is an interesting example of why it makes economic sense to fight malaria.
Aside improved health, the most fundamental of impacts, malaria control reduces days off work and the malaria drug bill and can have a very quick payback.
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We now have two sets of post-distribution data following the December 2011 to February 2012 distribution of 270,000 nets that achieved universal coverage of a population of 550,000 in Ntcheu District, Malawi and the results are very strong.
A quick summary:
- Malaria rates in March to June 2012 are already 50%, 45%, 40% and 40% lower than in the corresponding months in 2011.
- The six months post-distribution survey of 7,657 households and 15,768 nets showed a hang-up (usage) level of 90% and the percentage of nets in a very good condition is 99% (ninety nine).
We will continue to collect and publish monthly malaria data and hope to see a continued and sustained decline in malaria rates.
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We have just received our 50,000th donation! (In some cases a single donation received by us actually consists of many hundreds of individual donations, collected as part of a fundraising event.) This milestone donor was Yetzenia Leiva who donated $10 in support of a friend's birthday. Thank you Yetzenia!
We are currently looking at two significant distributions of 500,000 nets each and hope to make decisions very shortly. Each distribution would protect approximately 900,000 people.
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In the light of recent reviews of the progress in the fight against malaria we were reminded of this TED talk given by Bill Gates several years ago. It is as relevant today and he puts the malaria issue well and in context.
It is well worth watching the first, inspiring 8 minutes or so. He released live, biting mosquitoes into the auditorium during his talk for added effect.
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Peace Corps Volunteer Ben Gascoigne has a great idea for illustrating the importance of using bed nets in Senegal.
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A new study suggests 58% of the decline in infant mortality in Sub-Saharan Africa is due to insecticide-treated mosquito nets. It also suggests that the decline has accelerated over the last few years.
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Could you help with some important data entry that requires an hour of your time and some attention to detail?
If so please do get in touch as we have a collection of Post-Distribution Survey questionnaires we are adding to the website as part of our reporting to donors. If 10 volunteers respond we can succeed in making the data available to the public in days.
We are always keen for volunteers to help us with activities such as photo selecting/captioning, video editing, data entry and more.
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A study published in Malaria Journal suggests "that funding for malaria prevention in Africa over the past decade has had a substantial impact on decreasing child deaths due to malaria." The study tries to quantify the impact on malaria mortality over the past decade (2001-2010) resulting from the scale-up of malaria prevention intervention. It says that "ITNs accounted for 99% of the lives saved." and recommends that "rapidly achieving and then maintaining universal coverage of these interventions should be an urgent priority for malaria control programmes in the future."
You can view both the abstract and the paper online.
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Someone recently asked us, "Are we winning the fight against malaria?"
Yes, but we are at a critical time now and funds must accelerate so we do not lose the gains made over the last few years.
A picture I can paint for you is to imagine the fight against malaria as walking along a conveyor belt. The good news is the conveyor belt has an end in sight. Compare that to some humanitarian issues, like HIV/Aids and TB, where the end of those conveyor belts cannot be seen or at least they are in the very far distance.
So, there is an end in sight for the fight against malaria, albeit 10+ years away. Now, the conveyor belt is moving against us.
In the last five or so years we have started to make good 'net' (ie positive) progress along the conveyor belt - even though it is moving against us
One measure of this progress is the growth in the number of nets distributed over the last few years. In 2005, globally, 5 million nets were distributed. In 2010, that number was 130 million nets. Good progress. Malaria deaths and the number falling ill both fell. But remember the number of nets needed per year is of the order of 250 million so we are only half way there at best. The issue we now face is malaria funding, while still not enough, is coming under pressure and we already seeing, for example, significant drops in funding to the Global Fund who are one of the organisations through whom governments around the world channel significant funds against malaria.
This is where the analogy with the conveyor belt is a useful one. If the funding is reduced we can start going backwards on the conveyor belt and it is possible we go back to where we were four years or so ago. Think of this on a micro level, ie at the community level, and think about a village that has received. What happens when the nets are at the end of their useful life and new ones are needed? If we don’t have the funds, we cannot replace them and malaria can build again and to the levels we saw pre nets.
That is why funding for nets is so important so we do not lose the gains we have made over the last five or so years: we do not want to go backwards on the conveyor belt. Instead, we want to keep moving forwards so in the next 10 years or so malaria is brought under control - across Africa and elsewhere.
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A recent article in the Lancet, which uses a new way of estimating the number of deaths due to malaria, concludes that 1.24 million people died from the disease in 2010 - much higher than previously recognised.
You can read more about the article on the BBC News site and Against Malaria Founder Rob Mather was interviewed by BBC 5 Live this morning. You can hear the interview via the mp3 link: Malaria interview 5 live.mp3 (7.63 mb). There is also a breakdown of the data on the Guardian website.
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