A Stakeholder Approach to Fighting Malaria in Equatorial Guinea

The Social Challenge

Health Care

For generations, families on Bioko Island, Equatorial Guinea, have lived with the risk of losing loved ones to the scourge of mosquito-borne malaria. For oil and gas companies operating on Bioko Island in the early 2000s, malaria accounted for over one-third of all deaths on the island and was the primary cause of death among children. Malaria directly affected upward of 2 percent of Equatorial Guinea’s GDP due to lost productivity. Companies realized that reducing malaria transmission was critical to reducing business risk so they could develop human as well as natural resources.

The Partnership

Bioko Island Malaria Elimination Project (BIMEP)

The Partners

• Atlantic Methanol Production Company, private funding partner
• Ifakara Health Institute, nonprofit and principal clinical investigator
• Marathon Oil, private funding partner and contract oversight
• Medical Care Development International, nonprofit and project implementation partner
• Ministry of Health and Social Welfare — Government of Equatorial Guinea, public sector procurer
• Noble Energy Inc., private funding partner
• Sanaria Inc., vaccine manufacturer
• Swiss Tropical and Public Health Institute, vaccine laboratory services provider

The Idea and the Action

Initially, the partners set out on a different course than the government-run malaria control programs and industry public health programs of the time. The multifaceted, community-based program offered indoor residual spraying, long-lasting insecticide bed nets, intermittent therapy for pregnant women, case management, entomological surveillance, behavioral change, mass communication, monitoring and evaluation, and training to serve over 30 percent of the Equatoguinean population.

The sustained effort has accomplished dramatic, positive health-related results and laid the groundwork to introduce an anti-malaria candidate vaccine through the Equatoguinean Malaria Vaccine Initiative (EGMVI), which is part of the Boko Island Malaria Elimination Project. The initiative has successfully completed three clinical trials of PfSPZ vaccine showing that the vaccine is safe, tolerable and immunogenic in adults and youths.

EGMVI continues the commitment to innovation pioneered by the partnership. The PfSPZ vaccine aims to be the first licensed vaccine against malaria — and the first live whole-parasite vaccine against any disease. Completing the licensure of the vaccine and integrating it into standard malaria control efforts could have far-reaching effects, demonstrating that malaria elimination is possible for a large sub-Saharan African population with extremely intense malaria exposure.

Ultimately, the BIMEP partners hope that by 2025, the interventions and vaccine projects will eradicate malaria from EG altogether.

The Impact

Working together for over 15 years, the public-private Bioko Island Malaria Elimination Project partnership achieved technical, public health and social successes that the individual partners could not have accomplished working alone. They have provided $124 million to tackle the evolving obstacles that malaria has presented, and the data shared with the international scientific community has provided a clear strategy and strengthened global efforts to eliminate malaria.

The life-saving health impacts have been substantial. Overall, malaria prevalence has decreased by 76 percent from 2004 to 2008. In children under 5 years old, there’s been a 63 percent reduction in all-cause mortality and a 90 percent reduction in severe anemia, while anemia in pregnant women has decreased by 77 percent. And the rate of transmission — potentially infected bites per person — has decreased by 99 percent.

The BIMEP partnership has led to big-picture improvements, creating the infrastructure and building national capacity to implement malaria controls, diagnose and treat the disease, conduct research and carry out clinical trials. The poorest citizens spend less money on diagnosis and treatment — the overall cost of malaria care has been cut in half.

The partnership has made great strides in support of the United Nations’ sustainable development goals, in particular:

• Ensure healthy lives and promote well-being for all at all ages.
• Build resilient infrastructure, promote sustainable industrialization and foster innovation.
• Strengthen the means of implementation and revitalize the global partnership for sustainable development.

The Faculty Insight

The Bioko Island Malaria Elimination Project illustrates the power of public-private partnerships (P3s) and the profound difference that approaching business through a stakeholder lens can provide — both for businesses and for the communities in which they operate. Rather than assume businesses only care about financial returns and shareholders, a stakeholder approach to business sees the interconnection among primary stakeholders and their dependence upon each other to create value over time. Their interests are linked and largely supportive of each other, rather than being primarily conflicting and competing with each other.

In the context of Equatorial Guinea, this idea shows up powerfully in the instance of malaria. In traditional terms, tackling malaria is the province of government and nonprofit organizations, not a “business” issue. The firms involved in this case took a different view and saw how the widespread effect of malaria was having a deep impact on the local community, workers and other key stakeholders. As a result, they saw the need to get involved — both because they cared about the local community and workers and because they saw how the health effects of the disease were impacting their businesses. Through their willingness to get involved, provide resources and work with other organizations to provide solutions, the companies involved made an incredible difference — which benefits the people of Equatorial Guinea as well as many of the people involved in the value chains of their businesses.

Business doesn’t operate in a vacuum. Companies are part of the communities and the lives of stakeholders with whom they operate. Thinking about the well-being of stakeholders is the right thing to do, and often goes hand-in-hand with serving long-term financial interests. Indeed, a big part of why people want to work with — or buy from — a company is because they see that firm as committed to more than just itself and its narrowly defined self-interest. A company can care and stand for something while also running an efficient operation that is financially successful. The Bioko Island Malaria Elimination Project P3 finalist is a great illustration of this idea and the power of business to help make a better world.