A new push to combat malaria

23 Apr 2009
Financial Times
With a recent sharp jump in funding and advocacy, World Malaria Day deserves more attention than most such contrived anniversaries. The rising excitement also needs a little tempering.

One million people die each year from the parasite, and half a billion are infected - an enormous human and economic toll. Yet existing treatments and prevention methods could sharply reduce the burden. That makes more support to tackle the disease a good investment.

There are good reasons to be optimistic. Since the 1940s, the number of malaria-free countries has doubled. Effective drugs are now available, experimental vaccines are under test and there are new environmentally friendly insecticides and long-lasting bed nets to protect against infected mosquitoes.

But the path to tackling the disease is not easy. Two costly eradication campaigns in the last century flopped, and malaria cases soon jumped as attention and resources switched elsewhere. That must not be allowed to happen again.

Countries which have controlled malaria and want to attempt elimination should be encouraged to do so, although the vast majority of international funding must concentrate on intensifying control programmes in endemic regions.

With $3bn raised from governments, companies and individuals in the past few months, malaria is becoming an industry in its own right. That brings responsibilities, including rigorous evaluation to ensure money is well spent, especially as the global downturn makes fundraising more difficult.

The current short-term focus on delivering vast numbers of bed nets, for example, will backfire if they are not used effectively. The failure of countries to pool procurement to ensure the best prices from suppliers is also wasting scarce resources.

More funding to find new "tools" must be supplemented by more operational research and dissemination of how best to use the current ones.

Malaria must not repeat the mistakes of HIV, which has sucked resources from other under-funded areas in many poor countries. The best approach requires integrating malaria with other disease control programmes, and strengthening health systems more generally.

Finally, governments and regulators must redouble measures to tackle sub-standard treatments, and ensure that artemisinin, the best available drug today, is only used in combination with other appropriate medicines in compliance with international guidelines. Otherwise, the inevitable resistance of the parasite will again give it the upper hand.