"THE BELIEF is growing on me that the disease is communicated by the bite of the mosquito." That insight won Ronald Ross, a British doctor working in India, a Nobel prize. Defying age-old notions that malaria was caused, as its name suggests, by foul air, he showed how it really spread.
Given that more than a century has passed since that discovery, and huge expertise on how to fight malaria has been accumulated, it seems a disgrace that in one area of the world, sub-Saharan Africa, the incidence of the disease has in recent years been rising; and that it claims over 1m victims a year, mostly children.
That is the backdrop to a summit on malaria to be held at the White House on December 14th. In a show of George Bush's belief in using the private sector (its networks and communication skills as well as its money) and the kindness of small donors as well as big ones, the meeting will involve companies, charities and "faith-based" groups, plus politicians and health experts from all over the world.
Timothy Ziemer, Mr Bush's chief malaria adviser, insists the event will be more than a photo opportunity. The White House, he notes, has a record of tackling this problem with funds as well as words. In June 2005, Mr Bush launched a "President's Malaria Initiative" (PMI), offering $1.2 billion of new money to the hardest-hit African countries. Laura Bush, the president's wife, held another malaria meeting this June to expand the programme. The summit agenda reflects some recent changes in thinking about malaria, and global health generally: there is a new stress on promoting awareness of the problem (among people in the rich world who will never suffer or see the disease) and on tough accountability for aid recipients.
Not before time. The history of malaria policy in the past few years has produced an alphabet soup of over-optimistic slogans and titles, such as Roll Back Malaria, a campaign launched in 1998.
Fancy names are still being dreamed up, but in a more sober spirit. "Malaria No More", a coalition of agencies including the American Red Cross, UNICEF and the Global Business Coalition on HIV/AIDS, TB and Malaria, plans a campaign to urge Americans to make donations of $10 to help buy and distribute nets carrying a durable pesticide. The aim is not just to get money, says the coalition's John Tedstrom: it will be the "first effort in this country to rally civil society to fight a disease that doesn't affect America."
Ten-dollar gifts may seem like drops in the ocean. But Regina Rabinovich of the Gates Foundation, one of the largest philanthropic agencies in the world, says small private gifts complement official aid in multiple ways: when simple folk empty their pockets, that bolsters political support for government help.
Another reason for hope, perhaps, is the spirit of contrition among the agencies that have been fighting malaria for years. Arata Kochi, head of the World Health Organisation's malaria programme, has owned up to its past shortcomings.
"It's the WHO's fault we failed on malaria," says Dr Kochi. "We didn't show technical leadership, and that vacuum created a policy mess." His agency did not move fast enough to stop the use of chloroquine (an older drug that no longer works in many countries, because of drug resistance), he says, or to promote the effective but pricier combination of drugs using artemisinin, made from Chinese herbs. He also feels his agency failed to challenge green opposition to DDT, a once-controversial chemical that works safely against malaria when sprayed inside dwellings.
Dr Kochi is also spearheading a global drive for more accountability, with White House support. All the countries getting funds through Mr Bush's PMI must agree to measure aid effectiveness. That might seem obvious—but it rarely happens in practice. Roger Bate of the American Enterprise Institute, a conservative think-tank, points reproachfully at Roll Back Malaria (a grand coalition of the UN agencies, national governments and just about everybody else involved with the disease). When that programme was launched eight years ago, it promised to halve the number of malaria deaths by 2010—but malaria data are so vague that nobody knows the baseline.
Awareness and accountability are fine, but the best reason for cheer is that there is finally some action, some of it from newly energised agencies and governments. This month, the Ethiopian government, with help from the Global Fund, UNICEF and other agencies, is distributing 20m bed nets across the sprawling country, the largest such effort ever mounted.
The World Bank, as part of its campaign against poverty's causes and effects (see article), vowed a few years ago to boost malaria funding, but the money proved to be a trickle. That may change. In the past 15 months, it has launched ten projects, and next week the bank's board will consider its largest malaria initiative ever: a $180m effort in Nigeria, where perhaps a fifth of all malaria deaths occur.
Money by itself is not enough. Even modern technologies are little use unless they reach the neediest. Mark Grabowsky of the Global Fund thinks a surge of malaria funding may be causing "growing pains" as underdeveloped medical systems struggle to absorb the cash. But the distribution of drugs and equipment is an area where private firms could help. Steven Phillips of Exxon Mobil (a board member of Roll Back Malaria) notes that his oil firm makes the pesticide used in bed nets woven in Tanzania and its filling stations could hand them out. And even in countries where state-run clinics are thin on the ground, asks the GBC's Mr Tedstrom, is there anywhere in the world that lacks a sales point for Coca-Cola?