It is playoff season for the NBA, and each time the basketball star Stephen Curry hits a three-point shot, he donates three mosquito nets to Nothing But Nets, a United Nations Foundation campaign that fights malaria one bed at a time. Last season, Curry sank 402 three-pointers and helped deliver 1,206 nets. With the Golden State Warriors making it to the final round again this season, he is likely to send many more.
He is not alone: Since 2006, Nothing But Nets has raised $65 million and delivered 12 million bed nets, most of them in Africa, where malaria is a leading cause of death among children. The nets, which are laced with a long-lasting insecticide, are known as L.L.I.N.s, and they are distributed by a host of aid groups, saving millions of lives. Sub-Saharan Africa, a region that accounted for 92 percent of malaria deaths worldwide in 2015, took in 1.2 billion nets from 2004 to 2016, including 505 million from 2014 to 2016 alone.
In 2017, however, an increase in malaria cases occurred in the Americas, Asia, Western Pacific and certain countries in sub-Saharan Africa (Nigeria tops the list). Possible culprits, according to the 2017 report on malaria from the World Health Organization, include heavy rainfall in sub-Saharan Africa and India, declining malaria funding, insecticide resistance and decreased access to interventions.
Nevertheless, the nets save lives. The nets also generate jobs — few of them, a close look reveals, in the African nations where they are used.
Thirteen companies dominate the billion-dollar industry, and only two have factories in Africa. One of them, A to Z Textile Mills, in Arusha, Tanzania, is locally owned and works with the Japanese company Sumitomo Chemical, a partner in Nothing But Nets, and together have a joint venture called Vector Health International. The second factory in Africa, in Aba, Nigeria, is owned by Tana Netting, which is headquartered in Dubai. Most of the factories that make bed nets are in China and Vietnam.
Factories cluster in those countries partly because raw materials tend to be cheaper there. But some experts argue that shifting production to malaria-ravaged nations would help struggling economies, indirectly improving public health.
“An awful lot of money went into those international L.L.I.N. companies, and that leaves them considerably stronger, in terms of manufacturing capacity and technical expertise, than they were before,” says Jo Lines, a professor of malaria control and vector biology at the London School of Hygiene and Tropical Medicine, who has studied the situation in Tanzania. “I just can’t help wondering what would have happened if that same scale of investment had gone into strengthening the manufacturing capacity and technical expertise of local textile manufacturers.”
Lines calls it “a missed opportunity” to help local net makers gain “access to the means to make L.L.I.N.s.”
Tanzania has been at the forefront of the battle against malaria. It was one of the first African countries to experiment with L.L.I.N.s, aided by Sumitomo and the Global Fund, a public-private partnership organization that fights AIDS, malaria and tuberculosis. Over the past 10 years, the country’s malaria death rates have dropped by half.
A to Z Textile Mills, established in the 1960s, opened its L.L.I.N. plant in 2003; early on it held a virtual monopoly in Africa, and at one point employed 8,000 people, most of them women. On the production side, it was Arusha’s largest employer. But today it must compete with Western companies like Vestergaard, Real Relief and Disease Control Technologies.
As the market expanded, the price of nets dropped, from about $10 to about $2 now, according to the Nets Mapping Project, a program of the Alliance for Malaria Prevention. Lower prices mean more bang for the donors’ bucks, but they also make it increasingly hard for local companies to enter or stay in the business.
“There is a huge overcapacity in terms of production, and margins are extremely low as a result,” says Nicolas J. Brown, A to Z’s business development manager. “No one in their right mind would invest in this business today at current price levels.”
Where the nets are made is an issue that falls outside the purview of Nothing But Nets, says Margaret McDonnell, executive director of the UN Foundation campaign. “We don’t have the capacity to engage in that,” she says.
The foundation, which is not affiliated with the United Nations and had net assets of $296 million in 2016, raises money to send bed nets to malaria-ridden countries, but does not distribute them — that work is left to UN organizations and other entities working on the ground.
Yet local production could have an impact on the effectiveness of the malaria prevention campaign.
In East Africa, for example, “the big issue is how much local production makes the nets more acceptable and accessible,” said William Brieger, a professor at the Johns Hopkins School of Public Health, who studied an effort in Rwanda two years ago to open a net factory.
Brieger added that before jumping into the business, a company would need commitments from the international organizations that buy and distribute nets. A local company would also benefit from setting up distribution networks as well as improving coordination and agreements with local governments.
“Given the current excess of global capacity, it would only make sense for international organizations to push for more Africa-based production of bed nets (bearing in mind that there is already a lot, but in one place, i.e. Arusha) if i) some of the current surplus capacity was physically encouraged to move and ii) the Global Fund and PMI proactively sources a higher percentage of their procurement from companies such as ours,” Brown, the A to Z official, says. (PMI refers to the President’s Malaria Initiative, a US government program to end malaria.)
He added: “Currently donor procurement is skewed towards suppliers offering the most attractive FOB prices, which benefits suppliers who manufacture close to the sources of raw materials and disadvantages those suppliers, like ourselves, who have to import raw materials from a long way away.” (FOB, or Freight on Board, is the price once the nets are loaded on to a ship.)
From the beginning, net distribution has been “top down” and externally driven, Lines says, “giving the whole project a slightly neocolonial flavor.”
At the same time, international donors and net distributors have made an impact. In sub-Saharan Africa, according to the WHO, “more than 663 million cases have been averted since 2001. Insecticide-treated nets have had the greatest impact, accounting for an estimated 69 percent of cases prevented through control tools.”
[This article was updated to reflect more precisely information on the status of A to Z Textile Mills’ relationship with Sumitomo Chemical and the number of its employees; that A to Z at one time held a virtual monopoly on production of malaria nets in Africa; and the full quotation from A to Z on African-based production of bed nets.]