What will you do with the next 1,000 days of your life? Buy a car? Change jobs? Lose those 10 extra pounds? Save the lives of 4.4 million children?
On December 31, 2015, 1,000 days from April 6, we'll reach the deadline for achievement of the Millennium Development Goals. These goals represent the most important effort to improve lives in history, endorsed by leaders from 193 countries and 23 international agencies, and they include three that are dedicated to global health, focused largely on children under five and pregnant mothers:
- Goal 4: Reduce Child Mortality -- specifically, reducing by two-thirds, between 1990 and 2015, the under-five mortality rate
- Goal 5: Improve Maternal Health -- including reducing by three-quarters the maternal mortality ratio
- Goal 6: Combat HIV/AIDS, Malaria, Tuberculosis and Other Diseases -- including eliminating mother to child transmission of HIV and reducing deaths from malaria to near zero
To reach the goal of decreasing deaths of children who have not yet reached their fifth birthday to four million in 2015, we estimate that 4.4 million children's deaths must be averted in the next 1,000 days. Can the global community from the South, North, East and West, government leaders, business people, community health workers, moms and dads and students across the world work together to reach this goal?
With the progress we have seen in the last decade my answer is a simple, yes.
Despite population growth, the number of deaths in children under the age of five worldwide has declined from 12 million in 1990 to 6.9 million in 2011, which translates into about 14,000 fewer children dying each day. Maternal mortality has been nearly halved, going from 540,000 deaths during pregnancy and childbirth to fewer than 287,000 today (though access to reproductive health still remains inadequate). To meet our goal of reducing maternal deaths to an annual number of 140,000 by December 31, 2015, we estimate that we will have to avert 230,000 casualties of pregnant women between now and then.
The malaria story is perhaps the most amazing of all. In 2005, as I was broadening the scope of my philanthropic work and learning more about global poverty and development, I was shown a photo of six tiny children, two or three years old, dressed in the brightly-patterned fabrics characteristic of southeastern Africa, sleeping together on a blanket. I learned however that these beautiful children were not sleeping -- they were in malaria-induced comas, and most would never get up. I was deeply saddened, but more importantly I was motivated to find a way to do something. What could be done?
It turns out that the answer was -- a lot.
Malaria has been sickening and killing men, women and particularly children around the world for as far back as history can say. The latest DNA analysis of the mummified remains of King Tutankhamun suggests he died of severe malaria. Today, 33 centuries later, millions of people are suffering in the same way, with many dying, most of them small children like the ones I saw in the photo.
A blood disease caused by the Plasmodium parasite, malaria is spread from person to person by a startlingly specific cause -- the bite of the female Anopheles mosquito. Once it enters the bloodstream, the parasite finds its way to the liver, where it multiplies, causing symptoms that include fever, headaches and vomiting. If cerebral malaria develops, it can lead to comas, life-long learning disabilities, and death.
In parts of the world, thanks to the draining of mosquito-breeding swamps, indoor residual spraying and effective medicines, malaria is now virtually unknown, suffered only by a relative handful of travelers who come into contact with the parasite during overseas visits to countries with malaria. (Golf star Natalie Gulbis recently contracted the disease during a tour of Asia.) But for almost half the world's population, the disease is still rampant. Just over a decade ago, more than a million children under the age of five were dying horrible deaths from the disease every year. It was just one of a number of timeless scourges, many of them long eradicated in the West, that seemed to be a permanent fixture in the Global South.
Yet today, remarkably, there's reason for hope. There is reason to believe that with controlling malaria and the other conditions that lead to child deaths, we can save more than four million lives in the next 1,000 days.
Over the past seven years, deaths from malaria have fallen from more than one million to about 600,000 in Africa -- still far too many, yet a dramatic reduction by any measure. Keys to the improvement: Leadership from the countries where malaria occurs, to end these preventable deaths; recently-developed diagnostic tools; targeted mosquito-spraying programs; new medicines that can save an infected child for just a dollar; and, crucially, the distribution and use of millions of mosquito nets treated with insecticide. It turns out that in Africa the Anopheles does her biting mostly after 10 p.m. So if an African mother puts her children to bed under a net, the likelihood they'll contract malaria reduces dramatically. Moreover, when the mosquito lands on the net, it dies because of the insecticide -- thereby breaking the cycle of transmission.
Why is this happening today after decades of struggle against the disease? Because we've finally pieced together the requisite combination of effective prevention and treatment, public awareness, political will, business tools, collaboration and funding from the global community--the Global Fund to Fight AIDS, TB and Malaria, the World Bank, the private sector, contributions from countries around the globe like the United States and United Kingdom, and ALMA, an alliance of heads of state and government of 49 African nations. In the five years since UN Secretary General Ban Ki-moon asked me to become his Special Envoy For Malaria, our partners have raised over $4 billion, distributed over 400 million mosquito nets, provided millions of courses of medical treatment, and saved almost a million lives.
On one of my earliest trips to Africa, I saw hundreds of stricken boys and girls like those in that original photo, crowding clinics and hospitals two to a bed, many having arrived too late to be saved. But more recently, I've visited hospitals where the pediatric wards are practically empty -- where the sound of parents sobbing no longer fills the air. That dramatic change should inspire all of us -- those who are far away from the problem, and crucially, those volunteers, doctors, nurses, health aides, and other frontline health workers who have devoted their lives to supporting healthier communities.
The momentum has been on our side. Yet we're now at an historic crossroads -- a moment when the progress we've made is threatened and when the future of this promising movement may soon be decided. What can we do in 1,000 days...?
The past year has seen a slowdown in contributions by national governments to the Global Fund. The result is a current shortfall of approximately $3.6 billion in the funding required for anti-malaria programs between now and 2015. Of that total, to prevent immediate backsliding and a loss of much of the progress already made, some $2.4 billion is urgently required, including $1 billion in Nigeria alone, the country with the highest malaria burden.
The fact that progress has been so impressive and hopes are so high, makes today's funding crisis all the more heartbreaking -- and all the more urgent. Fortunately, there are signs of a turnaround. Just a few weeks ago, the Global Fund released its largest funding round in almost three years.
This column is the first in a series of reports I plan to provide on the continuing efforts to achieve the health Millennium Development Goals by our December 31, 2015 deadline. Secretary General Ban Ki-moon has been a tireless leader in this quest and has appropriately coined the goals as "Every Woman, Every Child." In the weeks to come, I'll share with you some fascinating glimpses of intriguing, inspiring people and the work they're doing to make this ambitious goal come true -- community health workers traveling the dusty roads on foot, armed with precious medicines and life-saving mosquito-killing mosquito nets; local religious leaders, Christian and Muslim, who have banded together to create educational programs to spread life-saving knowledge to thousands of local villages; unwavering Africa leaders who have committed their administrations to this cause; and some of the world's most brilliant researchers, racing against time to develop vaccines that may make malaria, AIDS and other illnesses things of the past.
I'll also explain exactly what you can do to make a difference. Increased public awareness -- and the political will it engenders -- has been a major factor in the progress we've achieved so far. Ending death from diseases like malaria, AIDS, tuberculosis, pneumonia and diarrhea is now possible and can be accomplished at little cost. If we hope to finish the job in the next two years and nine months, your support will be crucial. We need you to spread the word -- and in these columns, I will do my best to provide the ammunition you need to do just that.
Will you join us in the effort to save the lives of more than fourmillion children by the end of 2015? The next 1,000 days? The countdown begins April 6.