Sonia Shah in The Wall Street Journal

Sonia Shah in The Wall Street Journal

September 21, 2011

There was a time when it was de rigueur for those concerned with the well-being of the global poor to rail against big business. Not anymore. In recent years, the private sector has become the most sought-after source for global aid groups in search of leadership and financing. In 2008, Raymond Chambers, a phenomenally successful financier and major philanthropist, was appointed the first-ever United Nation special envoy for, of all things, the mosquito-borne disease malaria, which kills nearly one million people every year.

Journalist Alex Perry started shadowing Mr. Chambers as he set about cajoling health ministers, religious leaders, business leaders and the directors of international agencies to help him meet the goal set by the U.N. secretary-general: to provide an insecticide-treated bednet to everyone in the world who needed one, some 3.3 billion people, by the end of 2010. As documented in “Lifeblood,” Mr. Chambers didn’t meet that goal, exactly. Still, by December 2010, with countdown clocks ticking on their desks, Mr. Chambers’s team had overseen the financing and distribution of a staggering 289 million bednets, an achievement that Mr. Perry calls “one of the most successful aid campaigns of all time.”

But Mr. Perry goes further, crediting Mr. Chambers’s achievements primarily to protocols drawn from the private sector. Figuring that Africa suffers the brunt of the malaria burden, he explains, Mr. Chambers applied the “old 80/20 rule of business” and focused on the seven countries that account for two-thirds of Africa’s malaria cases: Nigeria, Sudan, Tanzania, Kenya, Ethiopia, Uganda and the Democratic Republic of Congo. Mr. Chambers proved himself a formidable fund-raiser by emphasizing the ambition of the effort rather than the severity of the suffering. Mr. Perry holds the effort up as a model of a new kind of business-driven aid that offers something “extraordinary” to the aid world: “reinvention, even salvation.”

Distributing 3.3. billion insecticide-laced bednets by year’s end is ambitious, but will it stop malaria?

Mr. Perry, Time magazine’s Africa bureau chief, is a wonderful observer of the uneasy interactions between Westerners and Africans: In one scene, the director-general of the World Health Organization, Margaret Chan, wipes angry tears from her face while berating Ugandan health officials for failing to meet anti-malaria targets. In another, Mr. Perry watches aid workers in Goma waterskiing, “carving out turns in front of the refugees they’d come to help.”

Mr. Perry’s eye seems less incisive when it comes to his grand claims about Mr. Chambers’s work. We’re variously told that treated bednets reduce child mortality by 20% or by 40%; that they can exterminate all mosquitoes in a given area; even that they can eradicate malaria all by themselves. In fact, only the 20% figure is supported by the most rigorous scientific evidence. Mr. Chambers’s campaign revolves around the mantra that saving a life with a bednet costs just $10. Only in the final pages of “Lifeblood” does Mr. Perry explain that—presumably because of troubles with distribution and usage—the true figure is more like $3,500.

As for the most critical result of all—the number of malaria deaths averted by Mr. Chambers’ campaign—the math is even less certain. Mr. Perry notes that malaria deaths declined to 781,000 in 2009 from 863,000 in 2008—a promising, if short-term, drop. Then, in a single dizzying page, we’re told that this result must mean steeper drops to come. “Chambers had delivered twice as many nets in 2010 as 2009,” Mr. Perry writes, “so the numbers of lives he saved should also have roughly doubled.” The author accepts the hopeful guess, made by the U.N.’s own Roll Back Malaria partnership, that universal coverage, if maintained for five years, would save 2.95 million lives by 2015. “By finishing in 2011, Chambers could be expected to be somewhere in between,” Mr. Perry writes. “The number of people saved was literally countless.”

To drive home his point, Mr. Perry shows us the sad state of malarious Apac, Uganda. Before nets are distributed, it’s a mosquito-ridden ghost town. A year later, it’s all open-air bars and empty malaria wards. But Mr. Perry’s first visit occurred during the rainy season and the second during the dry season, suggesting that the before-and-after depiction may be a bit misleading.

In fact, none of Mr. Perry’s statistics can tell us much about the effectiveness of Mr. Chambers’s campaign. The decline in malaria deaths occurred during a period in which new drugs and insecticidal spray campaigns were introduced alongside nets; in any case, seasonal diseases such as malaria fluctuate from year to year. Treated nets must be replaced every three to five years; and mosquitoes that are resistant to modern drugs and insecticides are already emerging. Malaria has frequently seen periods of decline and resurgence. Economic development and foreign investment may make this decline stick, but it is too early to tell.


By Alex Perry
PublicAffairs, 241 pages, $25.99

Mr. Perry’s partiality shows itself most clearly in his insistence that Mr. Chambers is pioneering a better form of aid. The author seeks to contrast this intense results-oriented model with the practices of traditional aid groups, such as Oxfam, which drum up donor support with an “endless stream of speeches and press releases” warning of global catastrophes that don’t occur. “I found it hard not to conclude that the aid world, or part of it, sees crisis as opportunity,” Mr. Perry writes.

Mr. Perry contends that such groups are flashy operations that offer aid in areas in which they have no expertise, undermine self-sufficiency and avoid measuring the effect of their efforts. Fair enough. But then he describes how Mr. Chambers zooms around in a leather-seated private jet and rides into African cities in cavalcades of SUVs. Mr. Chambers, too, knew little about malaria before jumping into the fight against the disease, and his strategy has been to shower Africans with free bednets donated by foreign powers.

Readers may wonder how this new business-driven aid substantially improves on the old—which to date has eradicated smallpox, exterminated malaria from 18 countries and nearly eradicated polio. To achieve its goals, old-style aid may have sometimes exaggerated the depth of the problems it sought to address. But the new aid, as depicted in “Lifeblood,” seems to exaggerate the value of its interventions.

—Ms. Shah is the author of “The Fever: How Malaria Has Ruled Humankind for 500,000 Years.”

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