Managing Malaria

Jennifer Zambone | 06 Apr 2004
National Review Online

This past Sunday marked "Africa Malaria Day," a day to remember that malaria continues to rage on that continent, killing at least one million people each year. We should remember these deaths — after all, we helped cause them, even though not so long ago malaria killed us too.

For three centuries, malaria plagued the United States, from the deep south up to Michigan. When falciparum malaria entered the colony of South Carolina in the 1680s, the area developed an international reputation for "unwholesomeness." "Those who want to die quickly, go to Carolina," ran an English saying. "Carolina in the spring is a paradise, in the summer a hell, and in the autumn a hospital," commented a German traveler. As late as 1914, 600,000 people in the United States suffered from locally transmitted malaria.

Mosquito abatement measures, such as draining wetlands and using pesticides, effective drugs, and lifestyle changes ended malaria's grip on the U.S. The disease still occasionally appears in the United States, though. In July of last year, for example, eight residents of Lake Worth, Fla., contracted malaria. Since none of them had been out of the country, doctors concluded they had caught the disease from mosquitoes in Florida. That wasn't any consolation for these victims, who experienced what malaria sufferers around the world experience daily: "It's probably the worst night of my life," said Jeff Smith. "I mean just cold sweats. I mean you don't eat, you just, you know vomit. You just — headaches like you wouldn't believe... I hope nobody else gets it. It's horrendous."

Sadly, other people do get this horrendous disease. Three to five hundred million become ill from it annually, and one to two million people a year die from it, 90 percent of whom are pregnant women and children under the age of 5.

These people suffer because the developed world won't help them use all measures possible to stop the spread of the disease. Indoor Residual Spraying (IRS) — the spraying of tiny amounts of residual insecticide on the interior walls of houses — remains one of the best ways to prevent malaria cases. Safe for the environment and for human health, IRS causes mortality and morbidity to plummet — yet donor agencies, most notably the World Health Organization (WHO) and the Unites States Agency for International Development (USAID), refuse to support it and have been encouraging countries to reduce or abandon it. They object particularly strongly when IRS employs the most effective pesticide available: DDT.

South Africa used DDT to quell a malaria epidemic in 2000, reducing the number of cases by 77 percent in one year alone. Yet despite DDT's successful track record, USAID threatened to withdraw support from Belize if that country's government continued to use DDT in malaria control. USAID also refuses to fund its use in African countries that have specifically asked to use it.

Additionally, international aid agencies are reluctant to fund the most effective drug to treat malaria: artemisinin. The Global Fund for AIDS Tuberculosis and Malaria spends twice as much on two other drugs, chloroquine and S-P, as it does on artemisinin, even in areas where paying for chloroquine and S-P are known to be ineffective. At least the Global Fund purchases some artemisinin-based drugs; USAID doesn't buy any. But then, USAID doesn't buy many drugs to treat malaria, period. Even though it has one of the largest malaria budgets of any aid agency — now about $80 million per year — USAID says that it "typically does not purchase drugs or medicines other than in exceptional or emergency circumstances for any of our programs." Instead its money goes to "building the systems to procure, manage and use the drugs." A valuable task, no doubt, but pointless if the countries with these systems don't have the money to procure effective drugs.

The United States should support the use of IRS and artemisinin-based drugs to conquer malaria. Besides being a truly humanitarian action, reducing the incidence of malaria in Africa will also benefit us. As the West Nile experience shows, the world is getting smaller. Diseases from abroad can find a niche in the United States as long as they can find a way here, and in these days of international travel it's easy for diseases to find a way here. As the Florida experience shows, malaria can still spread in the U.S. Our recent malaria experiences have been small and localized, but that doesn't mean they'll stay that way. Our best chance to stop a coming plague of malaria from hitting the United States is to stop the current plague of malaria in Africa.

Jennifer Zambone is Washington, DC, director of Africa Fighting Malaria, a South African health advocacy group.