Counting malaria out

Observations on millennium development

I have spent my entire working life trying to combat tropical disease. But I was aghast when, in October 2007, Bill Gates called for the eradication of malaria.

The calamitous state of Africa’s public health had, I suppose, begun to engender a sense of cynicism. Were those of us seeking remedies for neglected tropical diseases merely pissing in the wind, as a pharmaceutical industry executive once told me? Even if we came up with new drugs, she said, there was no money to develop them. This attitude of doom and gloom, however, is now changing.

Every thirty seconds a child dies from malaria, usually in sub-Saharan Africa. Even non-fatal malaria has rampant effects in endemic countries: the workforce is hit, children miss school.

Consequently, one of the UN’s Millennium Development Goal targets is to provide protection to 80 per cent of those at risk by 2015. World Malaria Day, on 25 April, is a reminder of this ambitious goal.

The last global anti-malaria campaign, in the 1950s, failed. It was hoped that the insecticide DDT would eradicate mosquitoes, which transmit the disease. Sadly, the programme collapsed as a result of insecticide resistance and concerns about DDT’s use. By the 1980s it was seen as distasteful even to discuss eradicating malaria.

To some degree, I remain fearful that our current ambitious targets risk a repeat performance. But my colleague Heather Ferguson, a malaria expert who spends much of the year in Africa, disagrees. “If you are a mum of eight kids from Sagamaganga village, Tanzania, where people get exposed to hundreds of bites a year, you can’t afford to be cynical and nor can we. We have a duty to act now.”

Things certainly have changed. We have drugs. Even vaccines are emerging. Along with targeted insecticide spraying and the use of bed nets, we have the tools to beat malaria. We also have the cash. Gates and the world’s richest governments are pumping billions into combating the disease. This month it was announced that £150m is to be put aside to subsidise the best class of anti-malarial drugs, artemisinin-based combination therapies. Public-private partnerships such as the Medicines for Malaria Venture and Malaria Vaccine Initiative are also pushing new interventions. And there are entrepreneurs like Dr Stuart Smith, founder of the Scottish Global Health Foundation, who aims to develop affordable drugs for diseases such as malaria. In some areas, we are already seeing huge reductions in incidence.

We may not reach the 2015 goal, but we will eventually “count malaria out”, as the World Malaria Day campaign entreats, if we sustain the present momentum.

Mike Barrett is professor of biochemical parasitology at the University of Glasgow