Creating Chemistry For a sustainable future Issue one 2012

Malaria: Also in this issue: 6 How Gary White and Matt Damon are A winnable war? realizing their vision of clean water for all. advisor Jeffrey 28 Scientific advance or aberration? Two experts Sachs explains why make the case for and against plant biotechnology. control is a battle worth fighting. Interview page 14 36 Mission impossible? Mitigating the impact of the global freight boom. 50 Driving into the future: What’s next for our love affair with cars? 58 Conductor Gustavo Dudamel explains what he wishes he had known when he was younger. Malaria: The issue

Fighting the war on malaria Malaria kills 780,000 people every year – most of them in Africa. Its effects have trapped millions in an endless cycle of poverty, but thanks to a massive international push to control the disease, it may finally be losing its grip. Could this be the beginning of the end for malaria?

8 | Creating Chemistry Creating Chemistry | 9

11 | Creating ChemistryCreating The last decade has also seen the the seen also has decade last The technologies these of distribution The resurgenceA cases in has been ever-looming the also is There be cannot challenges These with 73 million people in Africa protected protected Africa in people million 73 with up programs, IRS with malaria from 2005. in million 13 from generation new larvicides, a of arrival Rapid and drugs, anti-malarial of earlier enable which Tests, Diagnostic treatment. accurate more and diagnosis management case better with together positive delivered has education and have countries African Eleven results. in 50% least at of decrease a reported 2009. and 2000 between cases malaria By 2009, the annual number of malaria comparison in 20% by fallen had deaths In millennium. the of beginning with the were Turkmenistan and Morocco 2010, of Director-General the by certified malaria. eliminated having as WHO future challenging A malaria reduce to push the words, other In still are there but – working cases is particular Of ahead. challenges of plenty Roll nets. of distribution the is concern million 100 that estimates Malaria Back distributed and financed be must LLINs coverage sustain to every year, globally with But nets. worn-out replace and in issue an still bottlenecks distribution difficult to proving is this countries, some achieve – as is the organization of IRS. African three least at of parts in observed and Tome Sao Rwanda, countries: reasons The Zambia. and Principe, possible one but uncertain, are this for efforts; control of relaxation a is cause the Principe, and Tome Sao in which in year a followed resurgences example. for deployed, wasn’t IRS commonly-used to resistance of threat In resistance. drug and , drugs -based Cambodia, most the be to hoped currently – – treatment malaria of form effective effect. take to longer taking now are the in was it but why, to as unclear It’s developed resistance that region same drugs antimalarial older the to mefloquine. and chloroquine community global the unless addressed the in interest and investment its sustains concern growing now is There goal. 2015 its to victim fall may campaign the that disease of burden the As success: own weaken could resolve political away, falls diminish. commitments financial and there recession global current the Given control malaria that fear genuine a is development of list the down move could Only hope: is there yet And priorities. announced government U.K. the recently investment its increasing be would it example. for campaign, malaria the in to community manages global the If of eradication the momentum, sustain possibility. distinct a be could malaria

Mali 85%

Niger 76%

Zambia 64%

Malawi 60% The distribution distribution The of -treated nets nets insecticide-treated of is central to malaria control strategy: These nets have reduce to shown been malaria transmission 90%. by Left Percentage of at owning households insecticide- one least 2010 net, treated global UNICEF (Source: databases 2011) malaria Burundi 52% (IRS) – (IRS) spraying residual Indoor (LLIN). Lasting at least three years, three least Lasting at (LLIN). these nets have been shown lower to incidence malaria 90%, by transmission by 50%, and child mortality by 15%. Over the last years, few there has to push international massive a been reportedhas WHO nets: these deliver delivered were nets 289 million that 2008 between Africa sub-Saharan to Thatand is enough 2010. cover to risk. at population the of 76% insecticide with sprayed are walls where reduce to shown been also has – recommends WHO and transmission, Here LLINs. with tandem in used be it impressive, been has distribution again,

Critics are quick to question why, why, question to quick are Critics of the malaria burden: Around 90% of Africa. in occur cases malaria all 1950s, the in work didn’t eradication if it will work But now. much has changed: knowledge, health public in Advances allowed have technology and treatment and coherent of development the strategies, control malaria effective as set out by WHO and in the Global Plan. Action Malaria results Getting The last decade has also seen a series of the of fulfillment make that innovations these of first The achievable. goal 2015 net insecticide-treated long-lasting the is Innovations in medicine and technology are allowing earlier diagnosis and more accurate treatment. Above Above Pregnant women and Pregnant women This isn’t the first time the world has world the time first the isn’t This Climate apparently made the endemic poverty in many countries. countries. many poverty in endemic World the 1955, In malaria. stop to tried submitted (WHO) Organization Health eradication the for proposal ambitious an countries Some worldwide. malaria of successful, less were others it; managed sharp by followed reductions initial with efforts ceased. once increases failure: and success between difference is malaria where countries temperate In was eradication disease, seasonal a where countries for so Not possible. climate The round. year all rife is malaria is it why partly explains least at factor brunt the bears that Africa sub-Saharan It is estimated that 4.2 million lives would be saved by full control malaria of coverage measures – i.e. use of nets, spraying, diagnosis, – drugs at-risk most the in 20 2015 by countries. African Below 85% 85% of all malaria deaths occur five. of the age under children in 40% Malaria accounts approximately for 40% of spending in sub-Saharan Africa, 20% to 50% of inpatient admissions and 50% of outpatient admissions. million 4.2 20% Malaria causes 20% of all childhood deaths in Africa. children are the most the vulnerable are children the to contributes It malaria. to 10,000 estimated an of deaths to up and women pregnant 200,000 infants each year alone. Africa in

he statistics may appear may he statistics seconds 45 Every bleak: malaria of dies child a people 780,000 over and the from die total in Yet year. every disease The issue The

Creating ChemistryCreating Predictably, its greatest impact is on is impact greatest its Predictably, The collective effort is focused on The truth is, cases of malaria are falling

| malaria and you go a long tackling way to with high transmission rates. Tackle Tackle rates. transmission high with of annual economic growth in countries countries in growth economic annual of malaria causes an average loss of 1.3% 1.3% of loss average an causes malaria limited access to healthcare. Overall, Overall, healthcare. to access limited cannot afford treatment or who have have who or treatment afford cannot the world’s poorest – those who simply who those – poorest world’s the poverty and keeps them there. adults from work; it pulls families into into families pulls it work; from adults keeps children away from school and and school from away children keeps of malaria are devastating. Malaria devastating. are malaria of that the economic and social effects effects social and economic the that Research has also demonstrated demonstrated also has Research is both curable and preventable. preventable. and curable both is Unlike other deadly diseases, malaria malaria diseases, deadly other Unlike The poverty connection malaria altogether. malaria – with the ultimate aim of eradicating near-zero deaths from malaria by 2015 2015 by malaria from deaths near-zero has taken this still further with a goal of 2015. The Roll Back Malaria partnership Malaria Back Roll The 2015. malaria and other major diseases by by diseases major other and malaria and begin reverse to the incidence of Goals (MDGs) – one of which is to halt to is which of one – (MDGs) Goals achieving U.N. Millennium Development Development Millennium U.N. achieving United States, and Roll Back Malaria. Back Roll and States, United as the President’s Malaria Initiative in the the in Initiative Malaria President’s the as AIDS, Tuberculosis and Malaria, as well that include the Global Fund to Fight to Fund Global the include that inter-agency partnerships and initiatives initiatives partnerships and inter-agency This is organized through a set of new of set a through organized is This enterprises combining their resources. resources. their combining enterprises aid agencies, governments and private private and governments agencies, aid pace, with public health organizations, organizations, health public with pace, the malaria burden have been gathering gathering been have burden malaria the Since the late 1990s, efforts reduce to offer some hope. hope. some offer the disease the world has ever seen. total fatalities worldwide – those figures those – worldwide fatalities total against campaign collective organized every 30 seconds, with nearly one million one nearly with 30 seconds, every most the arguably is what to thanks – was estimated that a child died of malaria of died child a that estimated was compared with two years ago – when it when – ago years two with compared 10

Malaria: Malaria:

So why malaria – and why now? T Malaria: The issue byIllustration

The Peter Grundy malaria cycle

How malaria spreads – the cycle of infection Malaria is a disease caused by a parasite called . It is transmitted exclusively through 1 Infected 2 Parasite reaches liver 5 Infected red blood cells burst, the bites of female mosquitoes. When bites human. in just 30 minutes. releasing parasites which an infected mosquito bites a human, the parasites then infect other blood cells. enter the blood. Within 30 minutes they infect the liver. Between six and nine days later, the parasites leave the liver and enter the bloodstream where they invade red blood cells. As the parasites multiply, the red blood cells burst, releasing thousands more parasites into the bloodstream where they infect other blood cells. It is at this point that the person 4 Parasite enters blood will suffer from high fever, chills, nausea and anemia. stream, attaches to When another mosquito bites the infected human, and invades red the parasite is transferred to that mosquito. While blood cells. Further in the second mosquito, the malaria parasite goes reproduction occurs. through several stages of growth, which takes between 10 and 21 days, depending on the parasite species and the temperature. When the second mosquito bites someone else, the cycle begins again.

Why species and climate matter Populations at risk from malaria – the perfect storm About 20 different Anopheles species are locally important around the world. Some prefer to bite animals, while others prefer to bite humans. Some have longer life spans, which gives the malaria parasite the time it needs within the mosquito to develop. If the mosquito dies, the parasite dies 6 This repeating with it. The hotter the climate, the less time it takes cycle depletes for the parasite to develop. the body of In sub-Saharan Africa, the oxygen, causing mosquito both prefers to bite humans and has a longer malarial fever life span. The climate also allows the mosquito to and chills. survive year-round – and the heat helps the parasite to develop quickly. As if this weren’t sufficient, Africa is also home to the deadliest form of the malaria parasite: . It is for all these reasons that an overwhelming 90% of malaria deaths occur in Africa.

Active Malaria distribution High risk Limited risk Dormant No risk 7 After release, a Source: World Malaria Report 2010 3 Parasite starts reproducing dormant version of in liver. Some parasites the parasite travels lie dormant and become through the host’s activated years after infection. blood stream, waiting to be ingested by another mosquito and carried to a new host.

12 | Creating Chemistry Creating Chemistry | 13 Malaria: The expert

Professor is the Director of The Earth Institute, Quetelet Professor of Sustainable Development, and Professor of Health Policy and Management at Columbia University in New York. He is also Special Advisor to United Nations Secretary-General Ban Ki-moon. From 2002 to 2006, he was Director of the United Nations Millennium Project, and Special Advisor to United Nations Secretary-General Kofi Annan on the Millennium Development Goals, the internationally agreed goals to reduce extreme poverty, disease, and hunger by the year 2015.

The great campaigner

An interview with Jeffrey Sachs

Can a disease as infectious as malaria ever really be controlled – and is it worth the cost of trying? The answer, according to Professor Jeffrey Sachs, is an unequivocal “yes.”

14 | Creating Chemistry Creating Chemistry | 15 Malaria: The expert

Right Jeffrey Sachs, Special ioneering economist of medicines based on artemisinin; the will to keep up this fight is limited Advisor to the Secretary- General, takes part at the Jeffrey Sachs has new Rapid Diagnostic Tests which and fragile. So we’ve had great U.N. Global Compact Leaders campaigned long and have removed the need for microscopy; success, but I don’t think we can Summit 2010 Closing Press hard to engage the much better vector control capability guarantee against backsliding. Briefing, New York. On the global community in because of long-lasting insecticide- left of the photograph is Chad Holliday, Chairman the fight to end poverty – treated nets (LLINs); and better systems So how do you maintain of Bank of America, and on ofP which controlling malaria is a key part. for community-based treatment. When momentum and keep donors the right of the shot is Georg Indeed, he was among the first to bring the you put all that together you have the engaged and committed? Kell, Executive Director of importance – and feasibility – of malaria potential for very significant control. Well, it requires a tremendous amount the U.N. Global Compact. control to the world’s attention. Today, the The other two things that have of legwork. In the early years I was malaria community is galvanized around changed over the last 10 years are heavily involved in campaigning: the U.N.’s Millennium Development Goals increased financing to implement these Helping to set up the Global Fund, (MDG) to halt and begin to reverse the measures, and improved systems from the President’s Malaria Initiative in the incidence of malaria and other major the global to the local level. This has United States, campaigning for the diseases by 2015. As Special Advisor been a very, very major effort – and a mass distribution of bed nets and many to the U.N. Secretary-General on the fight also, to gain attention, to mobilize other components. And I can tell you – Millennium Development Goals, Sachs resources and build systems – but it’s you face a lot of blank stares from understands more than most what bearing fruit. senior officials for many, many years. needs to happen to make the deadline. So it requires people who are ready So do you think working towards to spend a tremendous amount of Creating Chemistry: The developing that goal is a matter of simply time trying to educate, control, shame, world is beset with problems, reinforcing what’s in place now? pressure and advise people. We need from disease to conflict, weak There’s always a need for continuing as many champions of that sort who governance and extreme poverty... innovation, especially since malaria can speak loudly, clearly, boldly and why is malaria so important? medicines and vector control ethically about this – I think this is Jeffrey Sachs: Malaria is a major killer technologies can lose their efficacy key. Success requires a tremendous and barrier to economic development through resistance – either of the sustained effort by lots of stakeholders. because not only does it cause illness mosquito to insecticides, or the and death, it impedes investment and parasites to medicine. What we know What role does private has pervasive effects that delay or right now is that this very powerful enterprise have to play? block economic growth. But it’s also combination of action requires a Companies have a major role to play an absolutely controllable disease, and whole system of delivery. That means in providing quality products and Funding the fight one can make tremendous progress resources: natural resources, human improving technologies. And I would in fighting it at very low cost. So the resources, organizational capacity, say [their role is also] critically – and Percentage of total malaria How the funding support combination of it being a major scourge political will. And keeping such systems unusually in some ways – working financing by organization, is used in Africa and yet controllable makes it a very in motion is not simple. with public sector organizations, 2003–2009 high priority for action. This is not a market-driven process or multilateral organizations like the 7% Over the last decade, external funding commitments by and large. It’s a public policy-driven Global Fund, or working with the U.N. 20% towards malaria control have increased over fifteenfold. One of the U.N.’s Millennium process – which makes it harder than Secretary-General, to ensure that the 8% 42% Most of the funding is supplied via three organizations: Development Goals is to halt and if this were a matter of selling products public-private partnerships needed the Global Fund, the U.S. President’s Malaria Initiative begin to reverse the incidence on an open market. for success are operating effectively. (PMI) and World Health Organisation (WHO), with the of malaria by 2015. Do you think A tremendous amount of energy, So I think companies have multiple rest provided by around 18 countries and several this goal is still achievable? leadership and intellectual effort needs roles – both as developers and 15% 70% agencies as bilateral funding. According to the Roll The goal is being met right now. to go into sustaining a high-intensity providers of technology, as capable Back Malaria (RBM) partnership, there is a direct There’s a tremendous reversal in control effort. So far there has been scale managers, and as partners in correlation between funding and intervention coverage almost all parts of the world – most a lot of progress – and it has required public-private partnerships. And 38% – in other words, the funding works. Yet while funding notably in sub-Saharan Africa, which breaking through a lot of barriers of CEOs need to appreciate that they levels appear to have peaked at $1.6 billion a year, this is the epicenter of the global malaria ignorance and indifference. In many are among society’s most important is still just 25% of the estimated $5 billion to $6 billion a The Global Fund Prevention burden. This progress could be even parts of the world high income political actors, because politicians year needed to achieve the Millennium Development U.S. President’s Malaria Initiative Treatment more dramatic between now and 2015 countries are needed to support much listen to them. They have to explain Goals for malaria. World Bank Program management and if the steps that are currently underway of this, and that has happened. Now we to politicians who are overwhelmed, Source: RBM’s report Malaria Funding and Resource Utilization: Other strengthening systems are strengthened and implemented as face another challenge: Rich countries overstretched, and not necessarily The First Decade of Roll Back Malaria. planned. Malaria stands out as one are all in economic and political crisis aware of the great progress that has of the great success stories of the right now. Whether they are able to been made, that this fight against malaria Malaria stands out Annual funding commitments of the Global Fund, World Bank, U.S. President’s Malaria Initiative (PMI), Millennium Development Goals. sustain this effort is probably the most needs to be sustained and scaled up. as one of the great countries and multilateral donors participating in the Development Assistance Community (DAC) important question. 2003 99 Millionen $ Why has it been so successful? For years you’ve argued the success stories Malaria is subject to rigorous control Do you think political will case for an integrated approach 2004 175 Millionen $ through a set of known and established is waning? to tackling poverty – through of the Millennium protocols. Malaria control has two Certainly in Europe, the United States fighting disease, increasing Development Goals. 2005 388 Millionen $ major dimensions: One is vector and Japan, aid budgets are under agricultural productivity and so on. Jeffrey Sachs control* to block transmission, and attack – even though the total cost The Millennium Villages project 2006 518 Millionen $ the other is case management to of malaria control that is needed put the theory into practice in treat cases of the disease. These are at $3 billion to $4 billion a year is tiny. 33 villages – with positive results. 2007 745 Millionen $ interacting because better treatment Mobilizing that level of funding is very Could you tell us a bit about that? is also a kind of transmission control. difficult because malaria gets swept up This project is now in about 2008 1.307 Millionen $ There’s been a suite of very in the general frenzy to cut development 15 countries. Leading scientists work * A vector is an organism that carries pathogens that important technologies not only aid that is occurring in U.S. Congress together with local communities to are transferable to humans – such as the malaria 2009 1.629 Millionen $ pathogen Plasmodium falciparum, developed but implemented in the and elsewhere. So this is a very difficult apply best practice technology to achieve which can be transferred to people via last 15 or so years: a new class period. And I would say that in Europe, the Millennium Development Goals. >> mosquitoes of the genus Anopheles. Source: RBM’s report Malaria Funding and Resource Utilization: The First Decade of Roll Back Malaria.

16 | Creating Chemistry Creating Chemistry | 17 Malaria: The expert

Left United Nations Children Malaria control is one of the priorities. something for which I campaigned A vaccine against malaria? Education Fund’s former We use a community-based malaria for over a decade. But I’ve also executive director Ann Veneman control methodology: mass distribution stressed that vector control needs Developing an anti- has proved and leading U.S. economist Jeffrey Sachs dance with Kenyan of LLINs, community health workers to to be combined with effective case challenging – but after decades of research, two students in Sauri village, Siaya help households use the nets properly, management. And in the African recent breakthroughs are inspiring new hope. District, 450 kilometers west and a community health workers’ context, effective case management First, a vaccine called RTS,S from pharmaceutical of the Kenyan capital Nairobi. system which covers all households can’t be done as a clinic-based company GlaxoSmithKline. According to a study Veneman and Sachs visited Sauri to look at development projects to observe cases of malaria in the service – [clinics] are often too far published in the New England Journal of Medicine targeting children. community and then apply treatment away, transport is weak, there are too around 15,000 infants and young children were within the community – saving the time few higher-level health workers such vaccinated with RTS,S with promising results. This required to travel to clinics and thereby as registered nurses or clinical is the first time a vaccine has reached this stage saving many lives. operatives – so we need community- of clinical development. A long-term analysis is not Community health workers carry based treatment. But this requires yet available, but initial findings indicate that in one mobile phones with an expert, text a system: training of health workers, group of children, the risk of contracting malaria message-based system to enter the logistics, staffing, supervision, was reduced by as much as 56%. The number results of Rapid Diagnostic Tests for monitoring, data management. So of severe cases of malaria also fell by 47%. individual patients, and then receive you can’t do these things haphazardly The vaccine’s effectiveness is still too low for instructions by text on dosage and or with the magic bullet of something widespread use – a vaccine is not usually considered follow-up advice for the households. So as wonderful as the LLINs. for production until it is effective in 70% to 80% of this is the holistic system of community- A lot of the public discourse is those vaccinated. based malaria control including vector about the magic of the single tool, The second recent breakthrough holds even control and case management. It is and of course it’s good for the public more promise: Scientists at the Wellcome Trust cutting edge, and the results are striking: to understand some of the key inputs. Sanger Institute in Cambridge, U.K., have discovered a very significant reduction of malaria But it worries me a lot because [while] a single receptor the parasite needs to be able to incidence, mortality rates in children the big success of the last couple of invade human blood cells and complete its life cycle under five, and overall disease burden years has been the mass distribution of in the human body. It is hoped that this discovery from malaria across sites. The project bed nets – and there is more availability of the parasite’s ‘Achilles’ heel’ can be exploited to has built systems for highly successful, of artemisinin-based combination develop an effective vaccine that could contribute on-the-ground malaria control. therapies – there hasn’t yet been a to the eradication of malaria worldwide. proper scaling up of primary health However, experts say it’s too early to celebrate What would you say to the systems. This is what the Global Fund just yet: It is still unclear how a vaccine could be criticism that the results of should invest in, but it is under financial distributed to everyone, especially in the poorer Left For many people, health the Millennium Villages can’t attack by donor governments in the areas of Africa. Vaccines like RTS,S must be clinics are simply too far away, be replicated everywhere? West, basically because of the spillover refrigerated until they are administered and can making integrated community- It’s the opposite. In Nigeria, the of the budget crisis. And I think this only be given by trained professionals, so local based treatment essential. Millennium Village project is being is the weakest point of the malaria infrastructure and healthcare systems are often taken from two main sites to 113 local campaign right now. The 2015 not adequately equipped. The affected countries government areas; so from a coverage campaign will not work unless we would have to rely on financial support from of about 50,000 people to about massively scale up the training and developed countries, and this has tailed off in 20 million people. We just signed an supervising of health workers. recent years. As Dr. Oliver Moldenhauer of aid agreement with the government of organization Médecins Sans Frontières remarked Rwanda to scale up the lessons of the Isn’t government corruption in an interview with the German online magazine Rwandan villages to a national scale. still also a major challenge? Der Spiegel: “Admittedly, significant progress has Similarly, we’ll proceed in Senegal I regard this to a very large extent been made, but that should not result in cuts to with the same type of scale-up. as an information challenge as much malaria prevention and treatment. We need more So the use of systems – especially as a morality challenge, in that the mosquito nets and drugs.” information and communications mismanagement and misuse of money technology (ICT) systems that are is a phenomenon everywhere in the readily replicable and that can be world. There has to be very strong documented and rigorously costed – diligence. We have to use ICT to make To find out more, visit: is why this project is so important. sure inputs go where they’re supposed Roll Back Malaria: www.rbm.who.int We’ve also issued a world report to go and to make sure we’re tracking on optimum deployment of community outputs and outcomes so that we health workers and we’ve estimated the know how these projects are doing and cost of such deployment to be roughly can make adjustments as necessary. $5 to $6 per villager in a rural area. We’re working with governments to What would you like to see scale up community-based health happen next? workers as a frontline tool in the control The single most important thing of disease. Not just for malaria, but also right now is that the Global Fund Malaria is an with other problems such as chronic for financing malaria control should hunger and safety in childbirth. remain robust to 2015 and should absolutely controllable So the whole project is designed support the scaling-up of primary disease, and one can for scale-up by using open source health systems globally – especially ICT and using vigorous costing and community-based malaria control make tremendous system development. strategies around community health progress in fighting workers. If this is done – if the Global Why is such an integrated Fund is properly financed, and if it at very low cost. approach so important? countries are able to obtain funding Jeffrey Sachs Significant gains have been achieved from it for effective community-based by the mass distribution of LLINs – malaria control, we will succeed.

18 | Creating Chemistry Creating Chemistry | 19 Malaria: The reality

Left The introduction of Interceptor®, BASF’s long-lasting insecticidal bed net, led to a 97% reduction in cases of malaria in São José do Jabote, Brazil. The entire community of São José do Jabote benefited, particularly young people who are most affected by malaria.

Making a difference

While sub-Saharan Africa bears the brunt of the malaria burden, Left The São José do Jabote other areas of the world are under similar strain. In some states community in Brazil is located in the lower Amazonas region in Brazil, particularly those located near the Amazon forest, in the district of Urucará, on malaria is the major public health problem. The small community the left bank of Jatapú River. of São José do Jabote, Urucará, is in one such malaria hotspot.

Here, the warm climate and abundant water supply offer ideal conditions for the malarial mosquito to survive, thrive and infect the human population. The consequences for São José do Jabote’s men, women and children have been dire.

Four years ago, malaria was as rife as the common cold, with each person in São José do Jabote contracting the disease at least three times a year. School attendance had plummeted and, unsurprisingly, the community’s educational objectives were under threat. It was here that BASF, in partnership with Foundation for Health Surveillance in Amazonas (FVS – AM), launched a study to assess the effectiveness of Interceptor®, BASF’s long-lasting insecticidal net.

In late 2008, the project kicked off: Interceptor nets were placed in every house in São José do Jabote. Residents were also coached on how to use the nets and what they were for. The results were impressive. Just two years later, the incidence of malaria had fallen by 97%, with only one person in every 12 contracting the disease. The positive effects rippled throughout the community. Free from malaria, the children were finally able to regularly attend school – allowing the community to meet its literary objectives in just two years. These effects typify one of the major targets of the U.N. Millennium Development Goals – namely, that a healthier, more educated population is key to sustainably support .

BASF is convinced that supporting and engaging in simple local projects can bring life-changing benefits. The results in São José do Jabote bear this out.

20 | Creating Chemistry Creating Chemistry | 21 Malaria: The reality

One of the biggest advantages of the Interceptor® nets is that they can easily be installed by a single person. Residents in São José do Jabote received Left There is no major road simple coaching on how to infrastructure in the region, use the product, and could thus river transport is the then set up nets in their homes main form of travel. FVS – AM themselves, without the need teams traveled monthly to for any complicated tools, skills São José do Jabote to monitor or help. This ease of use has how the fight against malaria helped Interceptor nets become evolved. The results were widely accepted in the area. astonishing: The rate of malaria fell from 3.52 cases per person in 2007 to only 0.12 cases per person in 2010.

Below Education is another key element of the initiative from BASF and FVS – AM: Schoolchildren color pictures of mosquitoes to learn more about the that caused 465 cases of malaria in 2007 among a population in São José do Jabote of just 132.

Right A nurse takes a blood sample from a São José do Jabote child. The blood will be tested for the presence of the Plasmodium falciparum parasite.

Below To successfully combat malaria, the villagers learned more about how to use and care for the Interceptor® bed nets. This included special education programs for São José do Jabote’s children that helped them understand the importance of .

22 | Creating Chemistry Creating Chemistry | 23 Malaria: The science Net value The science behind BASF’s contributions How BASF’s Interceptor® the innovation to fighting malaria mosquito nets save lives The Interceptor® mosquito net by BASF Our 5-Pillar Action Plan focuses not only on 1 ® remains effective against mosquitoes products designed to control the that Interceptor nets even after several years. So how does disseminate disease, but also actively pursues it work? collaborative partnerships and initiatives with the international public health community, as well as developing innovative solutions to help through the or flying on to find These circumvent the research costs, win the battle against malaria. other unprotected victims. Not until the which inhibits development activities net has been treated with an insecticide at research companies. can the cycle of malaria transmission be effectively disrupted. Developing a new solution Interceptor nets are coated with Despite the challenges, BASF still has Interceptor nets offer protection, especially alpha-cypermethrin. Harmless to humans, a solution up its sleeve: the insecticide 1. The net fibers are coated with a polymer at night, from mosquitoes that spread malaria. this active ingredient had already been chlorfenapyr. The company is currently binder combined with an insecticide. They are treated with Fendona®, an insecticide The binder attaches the active agent to used in the BASF insecticide Fendona® in the process of developing a next To find out more, visit: that kills mosquitoes on contact. the fiber in such a way that it remains evenly before the company began research on generation of malaria control products distributed across the surface for years. www.publichealth.basf.com Above BASF’s Interceptor® nets in action in Brazil. Interceptor in 2004 at WHO’s request. based on this active ingredient, which The biggest challenge was attaching the has already proven safe and effective Nearly 165 million mosquito nets active ingredient to the net’s synthetic in other BASF insecticides for crop made by different producers fiber in such a way that the net would protection and urban pest control – 2 3 were supplied to malaria zones remain effective for at least three years thus making it possible to accelerate Fendona® Abate® in 2010 – with around 145 million and 20 washes. The solution was development. In the fight against going to sub-Saharan Africa Interceptor’s special odorless coating, malaria, however, the insecticide marks alone. The percentage of at-risk which continues to protect against an innovation: Whereas traditional households owning at least one mosquitoes after multiple washes. insecticides affect structures of the 2. The mosquito lands on the net. net has risen from 3% in 2000 While LLINs like Interceptor have mosquito’s central nervous system, to 50% in 2011. According to the been a positive milestone in the fight chlorfenapyr disrupts cell metabolism. World Health Organization (WHO), against malaria, there are still challenges Because it works differently, this as long as there is no effective ahead. Widespread use of the active insecticide will help stem malaria in vaccine against malaria, mosquito chemical agents can result in mosquitoes areas of current insecticide resistance. nets will continue to be a decisive developing resistance. This can trigger Introducing this insecticide into The insecticide Fendona is applied Residential areas can be protected tool in malaria control. a fatal cycle: If the insecticide fails to public health schemes still involves to interior residential walls by trained when standing water is treated affect even a minimal proportion of a lot of investment and work. BASF professionals. The mosquitoes die with the larvicide Abate to prevent To meet WHO recommendations, nets mosquitoes due to natural resistance, is working with the London School of 3. Brief contact with the net is enough to seal after touching the treated walls. mosquito larvae from developing. must last for three years and 20 washes these mosquitoes survive, reproduce Hygiene & Tropical Medicine (LSHTM) the mosquito’s fate. and contain an insecticide that kills and multiply while their contemporaries and the Innovative Vector Control mosquitoes after brief contact – such die off. In a worst-case scenario, the Consortium (IVCC). While both institutes as BASF’s mosquito net Interceptor®. resistant mosquitoes could eventually are responsible for lab testing and field It is thus recommended by the WHO become so numerous that the malaria studies, BASF is handling development, 4 5 as a “long-lasting insecticide-treated infection rate increases again. registration, approval and sales. Partner organizations New products net” – or LLIN. Dr. Robert Sloss, Portfolio Manager The nets are most effective when Breaking the cycle for public health products at the used in combination with other malaria It’s possible to break this cycle by IVCC, stresses: “New approaches that control products (see box on right). developing a new active agent – but safeguard and expand the arsenal 4. A few minutes after contact, the stunned Dr. Egon Weinmüller, Head of the Public at around $200 million, development of active agents currently available mosquito falls to the ground – this is called the Health business at BASF, explains that costs are high. So high, in fact, that are essential. That’s the only way ‘knock down.’ The insecticide has disrupted the structures in its central nervous system. collaboration between the private the last time a new active agent for we are going to get a handle on the sector and aid organizations is also mosquito nets was introduced was ever-increasing levels of resistance.” essential: “For instance, we work very 23 years ago. “Financial resources Initial tests have confirmed the closely with aid organizations who are limited, especially in the area of effectiveness of the new active agent BASF is a partner with various aid Mosquitoes are becoming immune to distribute the nets as they are crucial public health,” explains Weinmüller. against insecticide-resistant mosquitoes. organizations that are trying to put the existing active ingredients. BASF is in supporting the process on-site.” Companies have to go through a costly Weinmüller says: “We also hope that an end to malaria and improve health therefore working on a new generation process to gain WHO approval for their this cooperation and the positive results systems in the affected countries. of products to combat malaria. Making nets truly effective public health products; often, shortly will provide additional motivation for While ordinary nets will keep mosquitoes after a product has been brought to all parties involved in the fight against 5. Almost all mosquitoes die within a few minutes. at bay, they won’t prevent them biting market, copycat goods start to appear. tropical diseases.”

24 | Creating Chemistry Creating Chemistry | 25 africa’s water loves treatment In Africa, Guinea worm cases have been drastically reduced since 1986 by using our Abate® larvicide: an efficient water treatment product that kills insect larvae and makes contaminated sources safe again. When eradicating life-threatening diseases means helping communities to grow stronger, it’s because at BASF, we create chemistry. www.basf.com/chemistry ZOAC E 1201