Silent Violence: Global Health, Malaria, and Child Survival in Tanzania

9. Conclusion: From Malaria Control to Malaria Elimination

217 chapter nine Conclusion From Malaria Control to Malaria Elimination The anthropological tactic of attempting to expose social suffering by bringing the local worlds to the attention of global audience runs the risk of legitimating social inequality if it fails to challenge the global pretentions of elite accounts, to bring out the global critiques often found in the narratives of poor and racialized populations, and to confront the gatekeeping mechanisms that provide broad audiences for some narratives and restrict others to home. briggs and mantini-briggs 2003:327 Discursive Practices This book was not written as a policy prescription for malaria control or malaria elimination but as an anthropological critique of the shifting global discourses and practices on malaria. On the basis of insights developed during my ethnographic research in Tanzania, I have argued that global efforts to deal with malaria have become overzealously hegemonic , technocentric, and oriented toward eliminating the disease. Few would question the praiseworthiness of this philanthrocapitalism-driven discursive shift in recent years—from malaria control to malaria elimination . However, malaria historians and many of those at the forefront of the global malaria elimination strategy have warned against throwing caution to the wind when dealing with a global killer that has defied humanity for centuries (Feachem et al. 2010; Najera, Gonzalez-Silva, and Alanso 2011; Packard 2007; Stephen 2011). Notwithstanding the encouraging announcements regarding some successful malaria vaccine trials, or new funding mechanisms to enable even the poorest of the poor to have access to insecticide-treated bednets and highly effective antimalarials, malaria 218 · The Way Forward remains an intractable problem in many parts of sub-Saharan Africa. The WHO has renewed its commitment to eliminate, if not completely eradicate , malaria. Therefore, the logical question to ask is, What are the prospects that this goal might be achieved in the next few years or decades, and what is the best way forward? While “cautious optimism” is the WHO’s way forward, Richard Feachem and Oliver Sabot’s reality check on the current push to eliminate malaria is noteworthy. They assert: Barring a magic bullet, which even the most promising vaccine candidates are not, even the most optimistic malaria experts agree that eradication is decades away . . . even with the large arsenal and war chest available today, an indiscriminate push to eliminate malaria could lead to epidemics and erosion of years of work and investment. . . . Maintenance of intensive interventions will be difficult once malaria is no longer a major public-health threat and donors and populations lose interest. A breakthrough intervention, such as a highly protective and long-lasting vaccine, will not be available for at least 20 years. (2008:1633) The dominant public health explanation for the persistence of malaria in sub-Saharan Africa has centered on the twin problems of the parasite ’s resistance to antimalarials and the vector’s resistance to insecticides, demanding new antimalarials, insecticides, and vaccines. This book offers a very different analysis of the problem, with its focus on the social basis of malaria. Based mainly on ethnographic research in a regional context of Tanzania, I have argued that the persistence of childhood malaria in sub-Saharan Africa can be better explained from an anthropological perspective by framing it within a critique of neoliberal global discourses on malaria control and elimination. Through case studies, illness narratives, and life history interviews, I have highlighted not just the social burden of malaria, as mothers who are single and/or previously married experience it, but the salience of the diversity of experiences within a specific sociocultural context. In analyzing illness narratives, I have tried to bring “the local life worlds,” that is, people’s lived experience with malaria and the local context in which malaria-related social suffering is embedded, to the attention of “the global,” that is, a global audience of readers and policy makers , to demonstrate how top-down policies are locally experienced. In this regard, medical anthropologist Craig Janes’s observations are worth noting: As anthropologists we are uniquely positioned, by virtue of our global expertise and yet local focus to advocate such reforms and, at minimum, From Malaria Control to Malaria Eliminatio · 219 challenge the dominance of economics and efficiency-based rationality in global health. The grand challenges in global health are not, as Bill Gates would have us believe, related to technological roadblocks. . . . They are instead social in character and ethical in principle. For medical anthropologists, indeed for all...