From Bob Snow and Kevin Marsh
Nairobi, Kenya
Christian Lengeler and Marcel Tanner claim that we recommend withholding impregnated bed nets in certain areas of Africa (Letters, 20 September, p 61). This is a bizarre claim, certainly not arrived at by the traditional method of reading what has been written on the subject.
Our approach to the scientific basis of malaria control starts from the premise that it is important to understand the relationship between transmission of malaria and consequent morbidity. To this end we and our colleagues have conducted what even our serious scientific critics consider to be the most thorough set of studies in this difficult area.
Aware of the danger that some may misinterpret or misunderstand the data, we were cautious in discussing possible interpretations. This caution was well captured in your original article, where our view was accurately reported as that we “simply do not know how reducing people’s exposure to malaria in infancy will affect their survival in the longer term” (This Week, 16 August, p 16).
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Just in case such caution was insufficient for casual readers we conclude our report with explicit statements that “these considerations do not argue against control methods to reduce transmission” but that “they do emphasise the need to monitor such inventions”.
If it is true, as Lengeler and Tanner imply and others have claimed as fact, that donor agencies may be dissuaded from investing in malaria control by one single scientific paper, then this must reflect either the irrationality of such agencies or the ineffectiveness of those in charge of promoting international support of malaria control. A sad state of affairs in either case but not one that can reasonably be laid at our door.
