Apr 21, 2008

Turning a Corner on Malaria?

by Tim Ogden

It seems hard to argue that malaria is a “neglected” disease. It certainly is not neglected in comparison to the official “Neglected Tropical Diseases” like lymphatic filariasis, schistosomiasis and ascariasis, which infect more than 1.5 billion people. In contrast to those lesser known culprits malaria has never been far from the media spotlight. Yet despite that attention, and the more than one million people the disease kills every year, it has generally not received the resources that the sickness and fatality rates would warrant. This passivity toward a major killer is surprising given that the medical community knows how to cure and prevent the majority of cases—the same cannot be said of HIV/AIDS or cancer.

The Economist suggests that the political will and the funds to make a major dent in malaria transmission and death may finally be coalescing. The United Nations is soon to launch a major new umbrella initiative to virtually eliminate deaths from malaria worldwide in the next five years. The impetus, apparently, comes from the advocates’ old argument: We know what works. Many in the international development field apparently see the benefits of investing more resources into an effort that is likely to succeed and from which the gains will be easy to see (and measure). A McKinsey study estimates that eliminating malaria deaths in the 30 worst affected African countries would cost about $11 billion while resulting in an additional $80 billion in economic output from those countries. (The paper that makes these claims unfortunately provides very little of the underlying data on how they reached these estimates.)

Never one to leave skepticism aside, the Economist article rightly lays out the downside of a five-year plan to fight malaria. What has happened repeatedly in global health battles is that once the corner is turned, attention and funds ebb away and the disease comes roaring back. This has happened with malaria in Sri Lanka, and is the case as well with dengue fever, a disease that, like malaria, is carried by mosquitoes. Dengue became quite rare in Latin America by the 1980’s due to successful efforts to control mosquito populations. This year, however, Brazil overall is seeing the worst epidemic in decades; and the worst ever in Rio de Janeiro. According to Dr. Peter Hotez of the Global Network for Neglected Tropical Disease Control a similar situation is evolving in African sleeping sickness. A combination of neglect and conflict brought eradication efforts to a halt and now the disease is surging again.

It’s helpful to remember the case of Guinea worm. It’s taken 20 years of focused effort so far to eliminate a disease that was endemic in only 20 countries. Experts at the Carter Center, which has spearheaded the eradication campaign, estimate that it will take another few years and an additional $35 million to finish the job. That represents percent of the total spent already, all to manage less than 10,000 cases in the world today. Of course, if those efforts aren’t carried through, Guinea worm will return to many of the places where it has been eliminated.

None of this is to say that a focused effort on malaria is not worthwhile or is doomed to failure. But we should watch the rhetoric of the campaign carefully, and be prepared for a long fight—a fight that will demand the attention of thoughtful donors long after the current spotlight has moved.