Malaria kills about 1 million people each year, mostly African children.
"When you look at the number of people who have died, it's a genocide," said R. Timothy Ziemer, coordinator of the President's Malaria Initiative (PMI). "One million people are going to die, knowingly. That's a human crisis, and we've got to respond."
Malaria, which is spread by the female Anopheles mosquito, was essentially eliminated from the United States by the 1950s, but it is still devastating parts of the world. It is the leading cause of death for children younger than 5 in sub-Saharan Africa.
In 2005, President Bush committed $1.2 billion over five years to prevent and treat the disease in 15 of the hardest-hit African countries, with the goal of reducing malaria deaths there by 50 percent. The program uses government money but harnesses funding and manpower from partners as well.
Those private businesses and groups — such as the Global Fund to Fight AIDS, Tuberculosis and Malaria, the Global Health Council, the U.N. Foundation's Nothing But Nets campaign, the World Health Organization and the World Bank — are trying to raise public awareness about the disease, which can be treated with proper drugs and largely prevented by spraying insecticides onto walls and sleeping under insecticide-treated bed nets.
In December, Mr. Bush held the first White House Summit on Malaria, where he brought together all the groups to come up with a strategy to fight the disease. On April 25, the United States marked the first Malaria Awareness Day — a day already acknowledged each year by African countries.
First lady Laura Bush visited Africa last month to talk about the efforts to fight AIDS, tuberculosis and malaria.
"Defeating this epidemic is an urgent calling, especially because malaria is preventable and treatable," Mrs. Bush said June 27 at the Maputo Seminary in Mozambique, where she announced a $2 million PMI grant to a group of 10 national faith leaders.
Although many groups have toiled for years to eradicate the disease, the momentum has grown, advocates said.
"There's been a sea change on this issue that has lain dormant," said Kathy Bushkin Calvin, executive vice president of the U.N. Foundation. She said the changes are a result in part of technological advances that have led to more effective indoor sprays, longer-lasting and less-costly bed nets and effective drugs. Mrs. Bushkin Calvin also credited retooled malaria efforts at WHO and stepped-up U.S. involvement.
"You put this all together, and you've got some real momentum," she said.
Thomas Sorenson, who works for Vestergaard-Frandsen — an international company that manufactures bed nets — agreed that efforts to combat malaria have increased.
"When these big waves start, you've got a lot of [little] ones following," Mr. Sorenson said.
Richard Green, director of health, infectious disease and nutrition at USAID's Global Health Office, called it "a snowball effect" and predicted "big gains."
Still, they all agreed there is a long way to go.
"I think a lot is being done, but not enough; far from enough," Mr. Sorenson said. "It's a huge disease, and it needs a lot more attention. The good thing is, [attention] is increasing."
Treating the disease
Mali native Coumba Makalou described it as lightning jolting through her body.
The young woman contracted malaria while visiting her home country in December to film a documentary about the disease, which typically causes fever, headache and vomiting about 10 to 15 days after a bite from an infected mosquito.
Ms. Makalou, who plans to finish her documentary this year, said it took about $200 and two months for her to beat the disease.
Many aren't so lucky.
"If I was a typical Malian, I'd probably be dead," she said. "The survivors are going to be the ones who can afford to purchase the medicine."
Although tensions have been raised in the outreach community about priorities, most endorse a comprehensive anti-malaria strategy of insecticide-treated bed nets; indoor residual spraying (IRS) that leaves walls covered in a bug-killing pesticide; and malaria treatment known as artemisinin-based combination therapy (ACT). The strategy also often includes educating villagers about how malaria is spread and training local professionals.
So far, ACTs haven't run into any resistance from the malaria parasite. This is a key victory, scientists said, because the parasite developed resistance to the most common anti-malaria drugs. Drug resistance became prevalent in Africa, Asia and South America, WHO specialists said. They said the problem was largely man-made because anti-malaria drugs were poorly managed and disbursed on a large scale, one type at a time.
Some also are working on developing a vaccine for malaria. One program is the Malaria Vaccine Initiative, funded with a grant from the Bill & Melinda Gates Foundation. It has nine vaccine-development projects around the world, two of which have clinical trials under way in Africa.
Many groups are working together to deliver the malaria-fighting tools to villages and, more importantly, make sure they are used properly. The PMI is working with several groups and operating in Angola, Malawi, Mozambique, Rwanda, Senegal, Tanzania and Uganda.
Last year, the PMI targeted Angola, Tanzania and Uganda, spraying 414,456 houses, providing 855,305 treated nets, delivering 1.2 million drug treatments and training more than 8,000 locals on how to treat the disease.
Mrs. Bush said that by the end of this year, 70 percent of families in PMI-focus countries will have insecticide-treated nets.
The largest amount of money available, advocates and specialists said, is from the Global Fund, a partnership among governments, civic and social groups and the business world. The fund, founded in 2002, has collected and disbursed billions of dollars to fight AIDS, malaria and tuberculosis. Its grants are helping to distribute 109 million bed nets and 264 million ACTs.
Businesses with interests in Africa also have reason to join the effort because malaria affects the work force. WHO estimates that malaria costs the continent of Africa about $12 billion in lost revenue each year.
Exxon Mobil — which has about 3,000 employees in Africa, along with thousands of vendors and suppliers — has spent about $40 million on malaria projects in Africa in the past seven years, including partnering with PMI.
One of its malaria-related efforts is a three-year-old partnership with Medicines for Malaria Venture and drug manufacturer Novartis to develop a child-friendly version of the popular ACT malaria drug. The drug is scheduled to be available early next year, said Dr. Steven Phillips, medical director for global issues and projects at Exxon Mobil.
Ms. Makalou hasn't let her bout with the disease stop her. She is in Africa coordinating a tour with popular Malian singer Salif Keita. The tour, aimed at educating villagers about malaria, is sponsored by Vestergaard-Frandsen.
The U.N. Nothing But Nets campaign — whose founding members include the NBA, the United Methodist Church and Sports Illustrated — started a little more than a year ago and has collected $7 million from 60,000 donors. It delivered 150,000 insecticide-treated bed nets to Nigeria in November and plans to deliver 500,000 to other African countries this year.
"It shows that the American public is very interested," campaign director Elizabeth McKee said.
Fox's "American Idol" recently held a benefit concert that raised almost $70 million for various nonprofit groups, including Malaria No More.
Several challenges remain, one of which is tension over funding.
Congress allocated $30 million in fiscal 2006 for PMI and $135 million in fiscal 2007. A $300 million request for fiscal 2008 is pending on Capitol Hill. A proposal in the House would cut about $30 million from that request, something the Senate also is considering, said Nicole Bates, director of government relations for the Global Health Council, an advocacy group pushing for more funding.
She said the PMI has "done fabulous work in a short amount of time," and should receive its funding.
The PMI is addressing another pressing issue: accountability for how the money is spent. According to its annual report, PMI will place an emphasis on accountability and transparency, and conduct surveys to track the malaria death rate.
Some groups contend that the PMI, while welcomed, is not large enough to eradicate the disease by itself. They say more funding should be directed to international groups such as the Global Fund.
"It needs to be balanced by the multilateral side as well," David Bryden, spokesman for the Global AIDS Alliance (GAA), said of U.S. malaria funding.
The U.S. government has contributed more than $2 billion to the Global Fund since 2001, or about 27 percent of its funding to date, Bush aides say.
Mr. Bryden argues that the administration's request of $300 million for the Global Fund in fiscal 2008 isn't enough, saying the government should give $1.3 billion and challenge the rest of the world to increase their contributions.
"They've not been smart enough in channeling money that grows the overall pot," he said.
Mr. Bryden's group and others, such as the Global Health Council, are lobbying Congress as 2008 funding bills progress on Capitol Hill. He said the House has proposed $850 million for the Global Fund and the Senate has proposed $890 million.
Dr. Paul Zeitz, executive director of GAA, said the Group of Eight leaders' recent pledge of $60 billion to fight AIDS, malaria and tuberculosis — while welcome — is only one-third of the $192 billion that the United Nations estimates is needed over the next five years.
"This is not an issue of 'more money is always needed when it comes to poverty,' " he said. "Rather, the full amount is needed so that we can actually get ahead of these health crises."
Spraying pesticides also has been criticized.
WHO stopped actively promoting indoor residual spraying of DDT and other pesticides to control malaria in the 1980s because of heightened concerns about the safety of DDT.
In September, WHO endorsed the spraying of DDT, saying it poses no health risk when used properly.
Some still aren't convinced.
The Pesticide Action Network North America argues that DDT is "incontrovertibly linked" to health issues, including increased miscarriage and developmental delays in children.
Another challenge is delivering the help to outlying areas with little or no infrastructure.
Exxon Mobil's Dr. Phillips said that while nets, indoor sprays and drugs are effective in stopping malaria, it takes a highly coordinated effort to make sure these tools make it to the people who need them.
"It's doable, but it takes a type and level of effort, frankly, that is a challenge," he said.
Specialists said another key challenge is ensuring all of the groups coordinate efforts and figure out funding priorities and strategies.
"That's the stage we're at right now: How do we coordinate, how do we respond to crises, how do we identify where the biggest needs are, or make decisions as to where the money goes?" Mrs. Bushkin Calvin said.
Some groups are discussing whether more investment in developing a malaria vaccine would be more helpful than nets, sprays and other tools, Dr. Phillips said. He estimated that 80 percent to 90 percent of malaria funds are used for on-the-ground control tools, while 10 percent to 20 percent is spent on research for new drugs and vaccines.
The good news, Mrs. Bushkin Calvin said, is that "there's a real willingness to collaborate."
Dr. Phillips said Africa was "virtually untouched" by past international campaigns to eradicate malaria in other parts of the globe, but that has changed. "Now the world has said, 'This is unacceptable,' " he said