2009 Annual Letter from Bill Gates: Progress on Malaria

27 Jan 2009
Bill & Melinda Gates Foundation
Malaria kills nearly 1 million children per year, but companies and governments have invested very little in new drugs and vaccines because the disease has been eliminated from rich countries. Malaria has a fascinating history. Several Nobel prizes were given to scientists who helped us understand key facts about it—in 1902, 1907, 1927, and 1948. Malaria used to be a serious problem in large parts of the United States, but it was eliminated here by 1951 by large-scale campaigns to kill the mosquitoes that transmit the disease.

Fortunately, the past five years have seen a huge increase in the level of interest and investment in malaria. The foundation can probably take some credit for the increased level of interest in global health in general and malaria in particular. Bono also deserves a lot of credit for his work through ONE. I remember talking with him in 2004 about whether we could ever hope to have candidates discussing these issues during a political campaign. So during the recent U.S. presidential campaign it was fantastic that both Barack Obama and John McCain spoke out on how they would increase funding for global health, including specific commitments on malaria. It is also very exciting that donations from individuals to buy life-saving bed nets have soared.

Malaria is a very tricky disease. The world hoped in the 1950s and 1960s that it could be eliminated by killing mosquitoes with DDT, but that tactic failed when the mosquitoes evolved to be resistant to the chemical. Today a number of new tools are being developed—better bed nets, better drugs, better insecticides, and a number of vaccine candidates. One of the vaccines will go into the last phase of human trials this year and could be ready for wide use by 2014. None of these tools is perfect. To understand how we should combine them, we brought in an expert in mathematical modeling who is applying a technique called Monte Carlo Simulations. This modeling work, which will show where we can eliminate malaria and where we can just reduce the disease burden, is a wonderful use of advanced mathematics to save lives, and if it goes as well as I expect, we will apply it to other diseases. The malaria community has a goal to reduce deaths by over half by 2015, which is aggressive, but it is in line with the results in communities where bed nets and other tools have been rolled out.