The lack of precision in health statistics is astounding. An article published in the Lancet on 4 February 2012, written by Murray et al. (abstract in English only available free on-line) and financed by the Bill & Melinda Gates Foundation, claimed that in 2011 there were twice as many deaths from malaria in the world than was shown by official mortality statistics. The WHO reported 655,000 malaria deaths in 2010 whereas the North American team found 1,240,000 malaria deaths for the same year. There is certainly common agreement that since 2004, when malaria mortality peaked throughout the world (more than 1.8 million deaths), after decades of continuous increase in malaria mortality, there has been a reduction of over 30% in malaria mortality. This is largely due to the combined efforts of international aid. In 2007 the Bill & Melinda Gates Foundation called for the eradication of malaria transmitted by Anopheles mosquitoes. In 2011, the Secretary General of the United Nations set the target of zero deaths in 2015. Between 2000 and 2011, aid to combat malaria increased from $149 million to $1.2 billion. The campaign, although still inadequate, was intense and unprecedented in the face of a disease that is generally disregarded as it is known to be inevitable. In 2011 France, with more than 2,000 cases per year, was the European country with the highest number of autochthonous cases of malaria as the disease is still endemic in Mayotte and Guyana although it was successfully eliminated in the Antilles and La Réunion many years ago, table on page 126 of the 2011 report by the European Centre for Disease Prevention and Control (ECDC) available free on-line in English.
How can action be taken to achieve a target of zero deaths by 2015, or to aim even higher at total eradication, if we do not have reliable measurement systems? Can you imagine your speedometer showing that you are travelling at 30 mph when a speed camera flashes you going at 60 mph in a built-up area? How can one hope to draw up a public health policy based on such a mediocre health information system? Why does health so often seem to be the poor relation of official statistics, to the extent that most of the poor countries in the world do not have records of the causes of death and that, even in countries such as France, we are unable to know precisely how many influenza deaths there are (the discrepancy being even greater, with 300 death certificates officially registered against estimates of 6,000 deaths per year)?
The Global Fund to fight AIDS, tuberculosis and malaria, an institution directed by the excellent French scientist, Michel Kazatchkine, who stepped down early (see his blog), has provided two-thirds of international funding for TB. It is because of this aid and funding from private donors that measures are now being taken – rapidly – to eliminate an endemic disease that is still one of the main causes of death of children under 5 and pregnant women in the southern hemisphere, in particular in sub-Saharan Africa. Let us hope, as does the editor of the Lancet, (4 February, page 385, in English, accessible only on subscription), that the recent destabilisation of the Global Fund, to which France is one of the main contributors, does not threaten the fight against this major plague. Let us accept with optimism the recent promise of an additional $750 million from the Bill & Melinda Gates Foundation but let us ask for more investment in the field of health statistics at international level, otherwise guidance for drawing up government policy will remain very short-sighted for a long time to come.
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