Malaria may finally be erradicated

Sources: The Washington Post, BBC News.

The malaria summit this week, held in conjunction with the meeting of the United Nations, attracted the heads of more than a dozen countries. It saw the unveiling of the The Global Malaria Action Plan that calls for expanding access to bed nets and treatment to everyone in need by 2010, with the goal of reducing by 2015 the number of malaria deaths to zero.

Pledges were made totalling some three billion dollars.

The new funding commitments include: $1.6 billion from the Global Fund to Fight AIDS, Tuberculosis and Malaria; $1.1 billion from the World Bank; $168.7 million from the Bill and Melinda Gates Foundation; $2 million from Ted Turner's United Nations Foundation; and $100 million from a coalition of corporations, including $28 million from Houston-based Marathon Oil to extend its malaria-prevention program across Equatorial Guinea.

Global malaria statistics are notoriously incomplete and inaccurate. Still it is estimated that 300 million to 500 million people become sick with the disease each year, and more than a million people die from the disease. The deaths are mostly kids. In hyperendemic areas, people get the disease repeatedly (although they develop some resistance over the course of these repeated infections). The burden of this disease increases poverty, and makes all development efforts harder and less effective.

There was a previous, failed effort to eradicate malaria globally. The earlier success of the Italian government in eradicating malaria in Italy and the success of DDT in controlling vectors led the World Health Organization to declare a Global Malaria Eradication Campaign in 1955. By 1969, however, it was apparent that the effort would not succeed, and efforts were scaled back. Malaria remained a plague of the tropical world. While developed countries succeeded in eliminating transmission within their borders, many poor nations limited themselves to trying to reduce the incidence and mortality due to the disease to more manageable efforts.

Paradoxically, the problem has gotten both more worrisome and more amenable to interventions in recent decades. Insects have become resistant to insecticides in many regions, as the disease agent has become resistant to treatment with a range of drugs. Global climate change carries the threat of conditions becoming more conducive to the vectors of malaria in many places, leading in turn to increased transmission of the disease and introduction of endemic malaria to populations with no resistance to the disease.

On the other hand, programs to distribute insecticide impregnated bed nets have proven effective in recent years as affordable nets have become available, a new drug -- artemisinin -- has proven effective and drug combinations have proven at a mimimum to delay the development of resistance, and there is a new acceptance of appropriate utilization of insecticides in malaria programs. Developing nations' governments are much more capable of managing malaria eradication campaigns than they were a half century ago, and there has been considerable economic progress since the last campaign failed.

As was done with Smallpox, it is conceptually possible to eradicate malaria. There is no known animal reservoir for the disease. We know that if we fail again in the effort, the disease is likely to return to the current or higher levels, and the control of the disease is likely to be even more difficult in the future.

The "war" metaphor is overused, but I suggest it fits, and the world should embark on a war against malaria. The disease has killed too many people, and with this coalition it should be possible to end the threat from this disease for good.