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Half a century after Cuba despatched military advisers to Africa to spread communism during the cold war, it is sending less ideological specialists to attack a very different foe.
Dozens of salesmen and technical experts from the Havana-based company Labiofam have made inroads across the continent with a product to fight malaria, capitalising on high-level diplomatic connections forged during the early years of African independence. But health specialists have voiced concerns about the cost and effectiveness of the technology the Cubans are selling.
More than 600,000 people a year die in Africa from malaria, according to World Health Organisation estimates, and donors spend about $1.6bn globally on efforts to combat the disease.
Most international support credited with the recent decline in malaria in Africa has been channelled to providing bednets, diagnostics and drugs. The Cubans are instead pushing bacterial larvicides, which destroy the eggs laid by mosquitoes in stagnant water, preventing their reproduction and spread.
“We think larvicides can become a strategic intervention in the fight against malaria,” says Hafez Adam Taher, a representative of Labiofam in Ghana, who says the west African government has agreed to pay Labiofam $74m over two years for a single larviciding programme. “No single thing can do it. If you want to tackle malaria seriously, you have to go to the roots.”
The WHO is more cautious. It is finalising guidance that concludes larvicides have only a “specific and limited” role to play, where there are sites for mosquito larvae that are “few, fixed and findable” – something that is rarely the case in Africa.
Robert Newman, head of the agency’s malaria programme, cautions over the risks of draining scarce resources for tackling the disease. “Our effort is to provide guidelines on the tools that are most appropriate,” he says. “We need to maximise the use of resources, financial and human.” The Ghanaian ministry of health declined to comment.
Scientists fear larviciding is expensive, requiring the use of many specialists and local volunteers who could be better deployed elsewhere. It has to be repeated regularly, and often proves ineffective because it is difficult comprehensively to identify and destroy mosquito eggs. Insecticide-treated bednets can last longer, both killing mosquitoes and protecting people from the bites of those that survive.
Cuba’s actions come as China – through drug donations and support for health centres – has sought to match Western funding in Africa for malaria.
Cuba stresses the public health rather than business side of its work, with the state-controlled company declaring on its website: “The projects of the Labiofam Entrepreneurial Group are not implemented as commercial operations, but as integrated two-year-long projects within existing health programs.”
Yet it is in discussions about contracts in several other countries. Larviciding programmes are under way in Nigeria and the Ivory Coast as well as Ghana. Labiofam also plans to build a factory in Tanzania.
To the frustration of local African malaria specialists, the Cubans have frequently bypassed the technical experts and their demands for detailed data proving the impact of larvicides.
“They go straight to the heads of state, playing the diplomatic connection,” says one African official, who declined to be named.
Mr Hafez says Labiofam has stepped up efforts in recent months to work with other experts dealing with malaria. At a time of growing pressure on donors, suspicion remains.
Stephen O’Brien, the UK minister for international development, says: “I’m concerned there is a marketing campaign for larviciding uncoupled from the science, and we find ourselves going down a route where people think they are dealing with a significant new tool when [it has] only a modest place.”