issue 03 – sum m er 2014
xxxxx
3V VETS
WHAT’S IN STORE?
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CONTENTS
Issue 3 – Summer 2014
4
6
Foreword
The right direction
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14
aid or
investment?
the fight against
sleeping sickness
commercial
practice
cows against
malaria
Professor Ian Maudlin
assesses the lasting
impact of the SOS
initiative in Uganda.
A Round Table hosted
by COCTU has paved
the way for greater
coordination in the fight
against sleeping sickness.
How the 3V vets have
learnt how to maximise
their potential.
A trial study uses cattle as
live bait in the fight against
outdoor malaria mosquitos.
The past 12 months have seen developments on several fronts for IKARE. In
Uganda, we commissioned consultancy firm EY to assess and advise the 3V vet
practices. Their work – from a non-profit unit within the group - proved really
helpful both operationally and strategically.
In Kenya, we contributed to a major study to reduce the incidence of outdoor malaria, using cattle as live bait. The trial follows a similar principle to that
adopted in the Uganda SOS (Stamp Out Sleeping Sickness) initiative. We are
pleased with this extension of our range, and hope the analysis yields results.
We are also delighted that the UK Government recently announced the
willingness to look into the launch of the first ever development impact bond –
potentially to help prevent sleeping sickness in Uganda.
During the year, the SOS initiative and IKARE were presented with awards
in recognition of our work on sleeping sickness. We know there is much still to
do, but we are happy with our achievements since last summer and optimistic
about the future.
KEY SOS DATA
IK/IKARE has invested approximately
$700,000 since 2006
1,175 Rhodesiense cases averted
since 2005; at a cost of treatment
per person of $300, total savings on
treatment costs amounts to $411,250
1,175 cases averted adds
approximately 25 years of healthy
life per person. If each contributes
$365 to GDP, that equates to a total
contribution of up to $10.7 million.
Add in the estimated 10:1 undetected
cases....
ABOUT IKARE
IKARE LTD (pronounced “I care”) is a UK registered charity applying venture
local farmers and key stakeholders on sleeping sickness and the links between
philanthropy principles to the causes it supports. IKARE aims to overlay private
animal and human health, and by helping to set up a group of private veterinary
equity investment techniques and other business expertise and practices into the
practices in the region. This ensures that treatments are both available and
causes it supports or ‘invests in’, thereby contributing more than just funding.
affordable so farmers can treat their cattle on a regular basis.
Since its inception in 2006, IKARE’s resources have principally been
IK Investment Partners has been IKARE’s main donor since 2006,
dedicated to the SOS campaign, launched in Kampala, Uganda, in October of
providing both financial and non-financial support. For further information, visit
the same year. Working together with the universities of Edinburgh, UK and
www.stampoutsleepingsickness.com
editorial director:
Charlotte Laveson Girard
125
new jobs
created =
500
people + lifted out of
poverty and children
able to attend school on
a regular basis
Assuming 5% lower fatalities to
Nagana among cattle in area gives
$5 million in savings
Makerere Veterinary College has
changed its curriculum to allow
in-field practice
Makerere, Uganda, as well as with the international veterinary pharmaceutical
company CEVA, headquartered in France, the SOS campaign aims to c­ ontrol
sleeping sickness in Uganda, the only country to be affected by both forms of
this lethal disease, spread by the tsetse fly, which kills more than 100 people
every day in Africa.
Initially, emergency treatment was provided for close to 500,000 cattle in
seven districts in Northern Uganda. Since then, IKARE and its local partner HHS
Ltd have focused on delivering long-term, sustainable improvement by educating
2
Production
Editorial Director: Charlotte Laveson Girard, [email protected]
Texts: Charlotte Laveson Girard, Joanne Hart, Anne Holm Rannaleet
Art Direction: 25AH Design Studio AB, www.25ah.se
Photo: Joanne Reid and Charlotte Laveson Girard
© 2014 IK Investment Partners Ldt. All rights reserved. Neither this publication nor any part of it may be
reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical,
photocopying­, recording or otherwise, without the prior per­mission of IK Investment Partners. IKARE News is
published by IK Investment Partners, Brettenham House, Lancaster Place, London WC2E 7EN, UK.
3V Vet activities have created
awareness, pull for products and
spray demand
5 out of 11 vet shops are still
standing and operating on a purely
commercial basis
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SOS – AID OR
INVESTMENT?
Professor Ian Maudlin from the University of Edinburgh has
been working in the sleeping sickness field for more than 45 years.
Looking back over the decades, he assesses the impact of the SOS
initiative on sleeping sickness in Uganda.
In 1968 I started work as a r­ esearch
scientist in what is now the ­Livestock
Health Research Institute in Tororo,
South East Uganda. The aim of the
Institute was to find new ways to
control trypanosomiasis, a major
­constraint to human and animal
health in sub Saharan Africa. ­Human
trypanosomiasis – sleeping s­ ickness –
occupies a special place in the history
of Uganda, with three major sleeping
sickness epidemics in the 20th century,
resulting in many thousands of deaths.
In South East Uganda s­ leeping sickness is an acute disease, fatal within
weeks if left ­untreated – a frightening
prospect, a little like the medieval
plagues in Europe.
Trypanosomes are transmitted by
tsetse flies and, historically, control of the disease relied on very
blunt methods for remvoing them
- by ­destroying their environment
(known as ‘bush clearing’), ­removing
their hosts (killing wildlife) or,
later, indiscriminate spraying of
insecticides. None of these options
was environmentally acceptable.
Cattle could be treated with drugs
4
“The ‘invisible hand’ of the
free market ensures that
resources are allocated in
the most efficient manner,
in contrast to a process
that relies on a centrally
planned system.”
Professor Ian Maudlin,
University of Edinburgh
that killed trypanosomes and had
a ­prophylactic effect but this was
not an option in humans. Drugs
designed to treat human infections
were difficult to administer and had
toxic side effects. To complicate
matters further, it was discovered
that wildlife and domestic livestock
also carried the trypanosomes that
infected humans. Unfortunately, in
the 1960’s, the only way of determining whether trypanosomes in animals
were human infective was to inject
blood from infected animals into
human ‘volunteers’.
Returning to Uganda in the 1980’s
at the height of a sleeping sickness
epidemic, and armed with new DNA
technology, we aimed to determine
the extent of the animal reservoir of
human disease. We found that cattle
were a significant problem but the
technology was painstakingly slow.
To the rescue came scientists in
Belgium who discovered a genetic
marker in trypanosomes. By 2001
Professor Sue Welburn from the
University of Edinburgh was able
to develop a simple field diagnostic
test based on this marker. The results
were quite shocking – the majority
of cattle in South East Uganda were
carrying human infective trypanosomes. The message was clear: to stop
humans from becoming infected, it
would be ­necessary to remove the
reservoir of disease in cattle – which
were providing tsetse with infective
feeds. Otherwise outbreaks of disease
would remain a problem in the region.
At the same time the tsetse population
would have to be reduced.
The control of trypanosomiasis had
always been viewed as a top-down
activity – in economic terms ‘a public
good’. Unfortunately, across Africa,
most government driven and funded
schemes aimed at removing tsetse
flies had proved both expensive and
unsustainable. The 18th century
Scottish economist, Adam Smith, put
his finger on the problem of public
goods. He was firmly of the opinion
that individuals pursuing their own
interest promote the good of society:
“It is not from the benevolence
of the butcher, the brewer or the
baker, that we expect our dinner, but
from their regard to their own self
interest. We address ourselves, not to
their humanity but to their self-love,
and never talk to them of our own
­necessities but of their advantages.”
This ‘invisible hand’ of the free
market ensures that resources are
allocated in the most efficient manner,
in contrast to a process that relies on a
centrally planned system.
How then to apply the ‘invisible
hand’ to the problem of sleeping
sickness in Uganda? First, we needed
a method that could be used by cattle
owners themselves – so that they
could act in their own self-­interest.
The answer came from scientists in
Zimbabwe who, after many years’
work, had developed the perfect
tsetse control system. Their method
involved applying a m
­ inimum
amount of insecticide to the front
legs of a cow – they had shown the
front legs were, for a tsetse fly, the
most ­desirable part to attack for a
blood meal. Not only was this technique (RAP – restricted application
technology) efficient, but it also reduced the cost per cow by reducing
the amount of insecticide needed.
Combined with the ­application of
simple drugs, we now had a method
of removing trypanosomes from
cattle (and the threat posed to
humans) that poor cattle keepers in
Uganda could afford.
The history of disease control is
­littered with ‘silver bullets’ that
sound good on paper; but it is the
delivery of treatments that presents
the real problem. How do you get
the majority of cattle treated in
what amounted to one quarter of
the area of Uganda? We realised that
we must call on the ‘invisible hand’
to promote and sustain ‘a market’
in sleeping sickness control. This is
where IKARE ­entered the picture.
Through ­contacts in the veterinary
­pharmaceutical ­business CEVA, I was
introduced to Anne Holm Rannaleet
of IKARE who ­offered to bring her
business expertise to bear on the
problem. A public-­private partnership
(Stamp out Sleeping Sickness) was
established involving IKARE, CEVA
and the U
­ niversities of Makerere and
Edinburgh. Anne quickly got to the
heart of the problem with Professor
Charles Waiswa. Small veterinary
businesses were set up in sleeping
sickness-affected districts of Uganda,
which had the potential of being
profitable and hence ­sustainable in
the long term. Professor John David
Kabasa of Makerere University
provided candidate veterinarians for
these businesses - selected from the
final year students at his veterinary
college.
The pieces are now in place. We
have a tried and tested system: RAP
plus drug treatment of cattle; smallscale veterinary practices; a market
among cattle farmers and a means
of quality assurance using simple
molecular markers. Our aim now is
to apply this system over the whole
of the sleeping sickness threatened
area of SE Uganda. This will require
serious funding that SOS will need
to raise from the private and public
sector. We aim to eliminate sleeping
sickness from Uganda - a worthwhile
investment in the country’s future.
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Round
the Table
In February of this year, the Ugandan
government body COCTU convened a Round
Table on sleeping sickness. The first of its kind
in Uganda, the event marked a new stage in
efforts to stamp out the disease. IKARE gave
one of the keynote presentations.
In 2005, the World Health
Organisation (WHO) warned that
two types of human sleeping sickness were at risk of convergence in
Northern Uganda. The situation was
potentially catastrophic and the WHO
called for emergency intervention.
That was the start of SOS, the
Stamp Out Sleeping Sickness initiative, formed through a public private
partnership between the Ugandan
authorities; Makerere University and
Edinburgh University; animal health
company CEVA, and IK Investment Partners, which channelled its
­support via IKARE. The initiative
helped avert a major crisis but it
was also the beginning of a long and
fruitful collaboration between the
Ugandan authorities, academia and
the private sector, that has persisted
to this day.
Hundreds of thousands of c­ attle
6
have been treated, thousands of
deaths have been avoided and
­veterinary shops have been established in five of the most at risk
­districts, each supplying products
that keep sleeping sickness at bay
in cattle and therefore also p
­ revent
the animals from passing the
­infection to humans.
Change has not just occurred on
the ground but also at government
level. Back when the SOS venture
began, IKARE enlisted the help of
Charles Waiswa, then Assistant
Professor at Makerere University.
At the time, it was clear that sleeping
sickness could not be rooted out
unless cattle were routinely sprayed
but there was almost no veterinary
infrastructure in the most-at-risk
districts to undertake this task.
The SOS consortium stepped in and
The Round Table convention was held
in Kampala, the capital of Uganda
set up the so called 3V vets practices.
Waiswa mentored the vets and used
his family business to procure and
supply them with the sleeping sickness related products they needed.
Promoted to Professor of Veterinary
Medicine at Makerere University in
2011, Waiswa was appointed chair of
the Coordinating Office for ­Control
of Trypanosomiasis in Uganda
(COCTU) two years later, in the
­summer of 2013.
COCTU is the government body
responsible for coordinating efforts to
rid Uganda of sleeping sickness and
tsetse, and Waiswa’s appointment
was, at least in part, a recognition of
the success of SOS and his contribution to it.
COCTU’s mission is challenging. Uganda is a sizeable country;
resources are slim; there are different
strains of sleeping sickness, and
many stakeholders involved in the
various efforts to control the disease.
To gain a better understanding of the
current situation and improve communication between interested parties,
pulling together different people,
who have been working on sleeping
sickness and tsetse control in different ways so we could share what we
had done, what had been achieved
“We wanted to create a platform for stakeholders
to share their initiatives and innovations.”
Charles Waiswa, Executive Director, COCTU
Waiswa convened a Round Table in
Kampala, the capital of Uganda.
Attended by government ministers,
researchers, professors and students
from Makerere University, NGOs,
private sector funders and the press,
the event involved presentations
from ten delegates, including IKARE
director Anne Holm Rannaleet.
“The Round Table was a way of
and how our e­ fforts could be better
coordinated,” she explains.
“We wanted to increase the
visibility and understanding of
­COCTU among all stakeholders and
give them hope that the platform is
there to help all operations targeting tsetse eradication and sleeping
­sickness elimination,” adds Waiswa.
In recent years, as different parties
have endeavoured to help rid Uganda
Charles
Waiswa,
Executive
Director,
COCTU
of sleeping sickness, coordination
has been a major challenge. This has
sometimes led to duplication and,
occasionally, cannibalisation of effort.
In his new role, Waiswa is determined to minimise such practices.
For COCTU therefore, ensuring that
major stakeholders were at the Round
Table sharing their experiences was a
significant achievement.
“We wanted to create a platform for
stakeholders to share their initiatives
and innovations,” says Waiswa.
The Round Table was also intended
to highlight that stakeholders do not
just need to share initiatives with
one another but also with COCTU.
COCTU may in turn eventually share
developed Ugandan best practices
with PATTEC (the Pan African Tsetse
and Trypanosomiasis Eradication
Campaign) for the broader benefit of
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need to enforce existing policies and
provide an enabling environment.
The private sector can only do so
much,” says Rannaleet.
Other members of the SOS
­consortium agree.
“We hope to roll out a more
­defined 3V vet model to other
­districts and we need to establish
better links with Government
­agencies and policy makers so they
enact institutional change,” says
Martin Mitchell, group communication director at CEVA.
Infrastructure in rural Uganda is weak. Roads
are poor, communication can be difficult and
many areas have little or no electricity
A rewarding moment
sub-Saharan countries suffering from
sleeping sickness.
“We need transparency and
­information flow. Quite often, in
emerging markets, NGOs own the
data they have collected but for
COCTU to really fulfil its role, it has
to build up its own data bank. And
to do that, it needs to own the data
or at least be given full access to it so
that it can be properly compiled and
analysed,” says Rannaleet.
“Everyone at the meeting was
aware of past difficulties and we
are now looking to the future. For
COCTU, the meeting gave Charles
Waiswa the chance to raise its profile
and to pool information, which he
can present to the government in
order to move to the next stage in the
eradication of sleeping sickness in
Uganda,” she adds.
Fortunately, this objective was
broadly achieved. “The Round Table
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“In the beginning, we worked bottom up. Now things
are starting to happen at policy level too. Once the
top-down and bottom-up efforts converge, we can
create a truly sustainable solution.”
Anne Holm Rannaleet, Executive Director, IKARE
was very helpful,” says Waiswa.
“COCTU achieved what it wanted
to; the Round Table went well and
we intend to hold another one next
February, using the experiences of
the 2014 event.
For IKARE, the Round Table meeting
provided the opportunity to meet
others involved in the fight against
sleeping sickness and discuss the
broader challenges around the SOS
initiative.
“From the start, we wanted to
empower and engage communities so we could lay the foundations
for a sustainable approach to the
eradication of sleeping sickness
Our achievements to date suggests
sustainability is possible. Five vet
practices out of the eleven originally
­established are still standing and selfsustaining, the Makerere Veterinary
College has changed its curriculum to
allow in-field practice, more than 150
spray persons have also set up businesses and approximately 20 per cent
of cattle are now sprayed on a regular
basis. But challenges remain and need
to be addressed,” says Rannaleet.
On a logistical basis, infrastructure
in rural Uganda is weak. Roads are
poor, communication can be difficult
and many areas have little or no
electricity. This makes it difficult to
dispatch goods, travel around, engage
with local farmers and explain the
need for 3V anti-sleeping sickness
products. The process is made all
the more challenging because the
3V products are costly but efficient.
That means farmers buy them in
small volumes and profit margins are
low. Unless vets are appropriately
incentivised, they may concentrate
on higher volume and higher margin
products, which will help their
­businesses but could adversely affect
local communities.
“The public sector has a role to
play here. They could contract 3V
vets and spray persons to undertake
treatment of cattle and disease surveillance in the interest of the public
good. This would incentivise vets to
sell the 3V products. But they also
There are signs o
­ f change, however,
and progress is being made.
“In the beginning, we worked
bottom up. Now things are starting to
happen at policy level too. Once the
top-down and bottom-up efforts
converge, we can create a truly
sustainable solution,” says Rannaleet.
Having held the Round Table,
COCTU has begun to provide
personnel in the relevant ministries
with information on what needs to
be done in different parts of Uganda.
Waiswa is also clear about next
steps, which include increasing
COCTU’s budget so it can execute
its mandate effectively, encouraging
transparency among stakeholders in
the fight against tsetse and sleeping
sickness, and disseminating information and programmes to avoid
duplication of effort.
Looking ahead, the road to success
may not be easy. But steps have been
taken – and the Round Table provided
useful lessons to all the delegates.
“The main takeaway from the
Round Table was this: there is not
one single solution. You will need a
mosaic of different solutions to tackle
tsetse and sleeping sickness because
there are different strains, different
social and geographic environments
and different challenges in each area.
So there is no one silver bullet but
we need to leverage our resources
and work together. Only in that way
can we hope to do what needs to be
done,” says Rannaleet.
Public
recognition
The Stamp Out Sleeping Sickness
initiative and IKARE each received
awards in public recognition of their
efforts in Uganda.
Ugandan Prime Minister, Patrick
Amama Mbabazi presented COCTU,
as representative of the SOS consortium, with an award for its collaborative
and innovative approach to the control
of sleeping sickness. The prize - the
Collaboration and Networking across
Government award - was a public
vote of confidence in the SOS team
and took place at the 2013 Uganda
Innovations Conference.
‘I thank you for this innovation. It is
awesome and the country will learn
from you,’ said Enoch Mutambi of the
Uganda Ministry of Public Service.
Just one month later, at the Round
Table event, IKARE and the other SOS
partners were awarded Certificates of
Recognition from COCTU, presented
by Charles Waiswa.
Ahead of the award ceremony,
Waiswa explained: ‘COCTU would like
to recognise IKARE and its ­principal
donor IK Investment Partners for the
tremendous work they have done in
Uganda, as members of the Stamp
Out Sleeping Sickness consortium, on
the control of t­ rypanosomiasis.’
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EY consultants Natalie
Bretherick and Alasdair Reid
with 3V vet Eddie Omaido
Maximising Potential
IKARE’s 3V veterinary initiative has been up and running
for almost five years. To assess how the vets have progressed
and how best to take the initiative forward, IKARE enlisted
the help of specialist consultants from EY Enterprise Growth
Services (EGS). The results were highly informative.
10
The 3V vets stores are located in
rural parts of North East Uganda
IKARE’s involvement in the SOS
initiative to combat sleeping sickness
in Uganda dates back to 2006, with
a grant to fund emergency intervention. But it was soon clear that more
sustainable measures were needed
to help Uganda stamp out sleeping
sickness.
Three years later, therefore, IKARE
provided funding and mentoring for a
group of private veterinary practices
in the SOS area, with the help of a
local partner, High Heights Services.
Today, there are five 3V vets, as
well as more than 150 self-employed
spray persons, who play a crucial
role in delivering sleeping sickness
products and know-how to remote
rural areas, and buy what they need
from the 3V vets.
Although the establishment of
the veterinary practices has clearly
been successful, IKARE wanted
an ­independent assessment of the
­initiative to date and its potential.
“We wanted to see how viable the
veterinary practices really were, we
wanted an external perspective and
we wanted to explore the possibilities
for scaling up the veterinary services,”
says IKARE executive director Anne
Holm Rannaleet.
“We came across EY’s Enterprise
Growth Services division (EGS), which
provides top-scale service at a much
reduced rate for SMEs in emerging
markets and similar cases. Fortunately,
they had the time and the enthusiasm
to take us on,” she adds.
In September 2013, EY
­consultants Alasdair Reid and
­Natalie Bretherick – on s­ econdment
to Enterprise Growth Services - set
off for Uganda.
“We had two primary goals: to see
if the vet practices were sustainable,
individually and collectively, and to
see if they were having a sustainable
impact on sleeping sickness,” says
Alasdair Reid.
“We were also looking at how
best to expand the project, whether
via a franchise model or some other
­structure,” says Natalie Bretherick.
The 3V vets’ stores are located in
rural parts of North East Uganda.
Shortly after arriving in the country,
Reid and Bretherick visited each of
them in turn to determine the state
“We had two primary
goals: to see if the
vet practices were
sustainable, individually
and collectively, and to
see if they were having
a sustainable impact on
sleeping sickness.”
Alasdair Reid
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Gerard De Geer,
Director, IKARE
of their individual businesses.
“We asked them how much
business they were doing, how they
managed their shops and how they
kept records. We discovered that
most of the vets were viable but
their book-keeping was very basic,”
says Reid.
Given that the five individuals
were trained as vets, rather than
entrepreneurs, it was perhaps unsurprising that some found it hard
to run their own businesses. What
became clear however, was that all
five would derive substantial benefits
from more efficient ­record-keeping
and book-keeping.
“We quickly identified a h
­ andful
of things we could do to start
­delivering change – improving
profitability and sustainability and
upskilling the vets,” says Reid.
“The first thing we did was design
a simple, paper-based accounting
system for the vets and made sure
that they knew how to use it,” says
Bretherick.
The exercise was sorely needed.
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Some vets had too much stock, some
had too little. In some cases, stock
was going missing but the vets were
unclear exactly what had disappeared
and when.
“Some had suffered from fraud
or theft from their assistants,
­particularly if they were absent from
the shop doing other work. Now,
more of them have family members
as assistants but they still really
needed some transparency around
stock-keeping,” says Bretherick.
Most of the vets were also unclear
about which products were most
profitable and which had relatively
low margins.
“We wanted to help them plan
ahead and value their stock properly.
We wanted them to see how long
goods were sitting on the shelf and
whether some goods sold better at
certain times than at others. All this
would help them to calculate their
profits and improve profitability,”
says Reid.
The system that Reid and
­ retherick designed was flexible so
B
it could be used on a computer or
on paper. Two of the vet shops do
not have electricity and some are
more comfortable with paper-based
­systems. All of the vets were happy
with EY’s work however.
“The feedback was very p
­ ositive.
They said we made a tangible
­difference,” says Bretherick.
The EY duo also helped set up a
joint purchasing system so the vets
could benefit from bulk discounts of
between 5 and 10 per cent. A similar
scheme had been tried before but
had to be abandoned because the
record-keeping was not sufficiently
robust. This time however, Reid and
Bretherick are hoping that things
will be different.
“The idea behind our scheme is
that the vets will open a joint bank
account and, whenever they want to
order something, they pay the full
price for it into the bank account.
They then use the same bank account
to make discounted purchases. The
difference between the full price and
the discounted price will accumulate
in the bank account and can then
be used when the vets want to buy
products or expand their business,”
says Reid.
“It encourages them to save
money, which they all said they
found hard to do, especially as most
of them are supporting an extended
family,” he adds.
“The first thing we did
was design a simple,
paper-based accounting
system for the vets and
make sure that they knew
how to use it.”
Natalie Bretherick
Helping the vets to improve their
businesses was one of EY’s tasks. But
they also wanted to explore the
opportunities for expansion.
“Originally, there was a thought
that the five vets could form the
spine of a franchise structure – and
they still might. But we concluded
that it might be better to have a more
formal structure in place, possibly
even a normal company where each
of the vet shops is run as a branch.
This would give more control over
stocks and it would help the vets,”
says Reid.
“Overall, we felt that the five
vets we visited don’t need too much
­ usiness help but if you wanted to
b
add two new vets a year, you would
need a more formal structure for
them to join. The original vets
could then join that structure or
company if they chose, or remain
­independent,” he adds.
Such plans will be discussed
over the coming months. For now
however, IKARE has received
­independent verification that
the vets are running sustainable
practices and that there are several
expansion possibilities.
“We were very happy with EY’s
work. They helped the vets to
­understand their own businesses
­better and they helped them with
pricing and purchasing mechanisms
so they are now in better shape
than they were. EY have also given
us a more granular understanding of the vet practices, which
will be helpful as a basis for future
­decision-making. We are now
looking at a number of options to
take the SOS project ­forward,” says
IKARE director, Gerard de Geer.
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FIGHTING MALARIA
WITH LIVE BAIT
tool to combat malaria, that is really
­interesting. As farmers t­ ypically need
to spray cattle to avoid tick borne
diseases, choosing the right ­insecticide
may kill several flies in one go, and
­provide a huge return of ­investment
for the farmer, could be very
­gratifying,” says IKARE director
Anne Holm Rannaleet.
Malaria is one of the deadliest diseases in the world, affecting
millions of people a year. Now, an IKARE-funded study –
Cows against Malaria - is adopting a new approach to try and
combat the disease, using techniques learnt in the Stamp Out
Sleeping sickness initiative.
Malaria affects more than a ­million
people a year and is responsible for
over 600,000 deaths annually. It is
most prevalent in Africa. In recent
years, for example 90 per cent of
malaria-related deaths have been in
sub-Saharan Africa and most of the
victims were c­ hildren under five.
The statistics are shocking
but they used to be much worse.
According to the World Health
Organisation, preventative measures
undertaken over the past decade
have reduced fatality rates by around
49 per cent since 2000.
Clearly progress has been made.
But more needs to be done. To date,
the reduction in fatality rates can
be attributed principally to greater
use of bed nets and insecticide
within the home. These measures
work well indoors but in Africa,
many ­communities sit outside in the
­evening and their children fall asleep
in the open air.
For certain varieties of mosquito,
this is ideal because they prefer to
remain outdoors, biting people as
they relax at the end of the day and
into the night.
“One of the mosquito species that
takes most pleasure in the outdoors
is the Anopheles arabiensis species of
mosquito which does not just feed
14
Traps erected to catch
mosquitoes attracted to cattle
on humans but on cattle too,” says
Professor Steve Torr from the Liverpool School of Tropical Medicine.
Live bait tactics
Pondering this phenomenon and
inspired by the success of the Stamp
Out Sleeping sickness (SOS) initiative in Uganda, Torr and some fellow
scientists began to think that it might
be possible to reduce the incidence of
outdoor malaria by applying effective
insecticide to cattle.
“A mosquito picks up the parasite
which causes malaria from infected
humans only – cattle are immune
to malaria parasites. It takes about
20 days for the parasite to develop
within the mosquito into a form that
is infective to humans and during
that period the mosquito feeds every
three days. If cattle near homes are
treated with the right insecticide then
there is a high probability that insects
feeding on cattle will be killed before
the ­malaria parasite matures,” Torr
explains.
The researchers investigated
possible insecticides and discovered
another link with the SOS campaign.
Deltamethrin – the insecticide that
is being used to control tsetse flies
in Uganda - is also effective at killing
mosquitoes which land on cattle.
“If we can show proof
of principle, we will be
looking for support for a
wider trial. Studies like
these can be complex but
the partnership between
academics, business and
organisations such as
IKARE really makes a
difference.”
Professor Steve Torr, Liverpool
School of Tropical Medicine
Armed with this information, a
group of researchers began to work
collaboratively: the Liverpool School
of Tropical Medicine, the London
School of Hygiene and Tropical
Medicine, the University of Durham
and African insect research body
ICIPE.
Aided by IKARE and animal health
group CEVA, the scientists spent many
months gathering relevant data and
preparing a pilot study. As the study involved local farmers, ethical clearance
was required from the Kenyan authorities and this took some time. Finally
however, a pilot study was launched
in April to coincide with the onset of
the rainy season, when mosquitoes are
most prevalent.
“For the trial, we selected a dozen
herds, of about 20 cattle each, owned
by smallholders in western Kenya,
near the shores of Lake Victoria. Six
herds are being treated with ­Vectocid,
a formulation of deltamethrin
manufactured by CEVA, and six will
be treated with Amitraz, a pesticide
which is effective against ticks but not
mosquitos,” says Torr.
Vectocid is one of the very same
drugs being used in the SOS initiative
so for IKARE, the link is fascinating.
“We became involved in this research because, like the SOS initiative
in Uganda, it involves using cattle as
live bait. If the same mechanism - of
spraying cattle to prevent disease in
humans - can be used as an additional
Field research
The Vectocid pilot study runs until
the end of June, assessing the ­effect
on the numbers of mosquitoes
­biting humans and hence potentially
­infecting children with malaria.
“Naturally, anyone involved in the
study who catches malaria will be
treated but we feel this is a ­potentially
important study and we will be
monitoring its effects throughout the
rainy season,” says Torr.
“Obviously, this sort of treatment
has had a dramatic effect on ­sleeping
sickness in Uganda and a similar
method has worked with regard to
malaria in Pakistan. The integrated
approach to disease is really exciting,”
he adds.
If the results of the Kenyan pilot
study are promising, this partnership
of scientists, industry and venture
philanthropists will seek support to
carry out a far more extensive programme to examine its impact on the
incidence of malaria in humans.
“We wanted to help finance a trial
study and get some proof of concept,
which can then be developed by
those with a greater focus on malaria.
We are playing a bit of a catalyst role
here,” says Rannaleet.
Having taken a while to launch,
the research is now on track and
making progress. The results will
be revealed later this year and, if
successful, could lead to a more
extensive study.
“If we can show proof of principle,
we will be looking for support for a
wider trial. Studies like these can be
complex to get off the ground but the
partnership between academics, business and organisations such as IKARE
really makes a difference.” says Torr.
15
Learning from the past:
looking to the future
IKARE’s involvement in Africa dates back to 2006, since when the
SOS initiative has saved lives and introduced a new way of combating
sleeping sickness. Anne Holm Rannaleet reflects on achievements to
date and plans for the future.
IKARE has now been engaged in
­venture philanthropy for almost
eight years. With the continued
­support provided by IK, I think we
can all agree that our involvement
has been productive.
In Uganda, we have helped to
provide more than 400,000 cattle
with e­ mergency treatment against
­sleeping sickness and thereby played
an active role in the reduction of this
disease also among humans.
Overall, we estimate that our
­involvement has saved more than
1000 people from contracting the
disease and thus saved more than
$400,000 in direct treatment costs.
If you add in the contribution these
people can then make to the economy
and the amount of cattle deaths
avoided, we are probably talking
about $10 million of improved GDP.
We have also helped to establish five
sustainable veterinary businesses,
which collectively provide selfemployment for more than 150 spray
persons. Overall, we believe that this
work has lifted more than 500 people
out of poverty and a­ llowed children
to attend school on a regular basis, as
their families have the wherewithal
to send them and support them.
Looking ahead, there remains
much to do to fight sleeping s­ ickness
in Uganda. But we have made a
good start, testing and i­ nnovating
better models. Last year, our vets
­significantly improved their b
­ usiness
­practices, with on-the-ground
help from consultants EY through
their Enterprise Growth ­Services
­division, which provides low-cost,
­high-impact work for SMEs in
developing countries.
“As we have continued
to offer our venture
philanthropy approach
to specific initiatives in
Africa, we have built up
a considerable knowledge
base and will eventually
need to see how best to
leverage this in the future.”
We also provided initial funding for
the Cows against Malaria study, to
see if spraying cows with effective insecticide can reduce the incidence of
outdoor malaria mosquitos in Kenya.
Like the SOS campaign, this
is u
­ sing cattle as ‘live bait’ so, in
­private equity terms, we are leveraging our knowledge to move into new
markets (Kenya rather than Uganda)
and new services (fighting malaria
rather than sleeping sickness).
As we have continued to offer our
venture philanthropy approach to
specific initiatives in Africa, we have
built up a considerable knowledge
base and will eventually need to
see how to best leverage this in the
­f uture.
In the meantime, we are glad that
our joint approach with IK and all
our efforts have delivered tangible
­benefits in Uganda. We are also
hopeful that the study in Kenya will
help to provide another tool with
which to curb one of the world’s
deadliest diseases.