The NYT covers the bed-net debate today, if debate it can reasonably be called.
The article itself is good; the main problem is the headline, which says that
of Nets Splits Malaria Fighters". Er, no, it doesn’t. Once upon a time,
there were some "malaria fighters" who thought that "social marketing"
was the best way to distribute anti-malarial bed nets in sub-Saharan Africa:
use the market to get nets to hard-to-reach places, and, by forcing the poor
to pay for their bed nets, ensure that they really value those nets, rather
than using them for, say, wedding dresses.
But the empirical data are in, and social marketing doesn’t work. It’s more
expensive than giving the bed nets away, and it results in many fewer bed nets
being used. The wedding-dress thing was completely overblown and has come to
an end, and now there’s pretty much unanimous agreement that the best way to
distribute anti-malarial bed nets is to give them away for free. Here’s a paper
showing just that:
Over several years questionnaires and surveys of usage and condition of
nets were carried out throughout a town and 15 villages in north-east Tanzania,
where nets and insecticide have to be purchased and in 24 other villages where
over 15000 nets had been donated and annual re-treatment is provided free-of-charge.
There was very high population coverage in the town but, in the villages where
nets have to be purchased, only 9.3% of people used nets which were intact
and/or had been insecticide-treated and could, therefore, provide protection.
However, where nets had been provided free, over 90% of the nets were still
present and were brought for re-treatment several years later.
In the NYT story, no one is quoted defending the social-marketing approach.
And the evidence against it only continues to grow:
With consultant fees, transportation, advertising and shipping, social marketing
added about $10 to the cost of each net beyond the $5 to $7 that Danish or
Japanese makers charged. But even with payments to volunteers, the added cost
of free distribution was only about $1.25 per net.
“There has been a paradigm shift,” Dr. Olumese said.
One of the good things about trying to eradicate malaria is that no one likes
getting bitten by mosquitoes, and that if you offer people a way to avoid mosquito
bites, they’re likely to jump at the opportunity, regardless of whether they
are trying to avoid getting malaria. And if that freedom from bites comes free,
so much the better.