How to Stop a Serial Killer

Malaria is a mass killer. This year, 1 to 3 million children, or roughly 7,000 per day, will likely die from the mosquito-borne disease. Around 90 percent of the staggering illness and death will occur in Africa. There is no excuse for inaction, especially because malaria is largely preventable and wholly treatable. Besides the massive loss of life, the disease drives down productivity, undermines school attendance and learning, and depresses economic growth. Malaria is a major factor in slowing the demographic transition to lower fertility rates, thereby blocking a key step of the path out of poverty. It’s not as though we don’t know how to solve this crisis. A simple package of technologies could bring malaria under control by 2010 across Africa. By combining malaria prevention (through insecticide-treated bed nets and malaria treatment) with highly effective drugs known as artemisinin-based combination therapies, it is possible to reduce disease transmission markedly and to save lives. These core measures, along with indoor spraying of insecticides where appropriate, and with improved drug logistics and training of community health workers for effective diagnosis and prompt treatment, could produce a sea change in Africa’s health and economic prospects. The burden of severe malaria illness and death could be reduced by perhaps 90 percent or even more in areas where intensive prevention, diagnosis, and timely treatment are applied. With support from the U.S. government, malaria admissions to clinics and hospitals have been reduced by more than 90 percent on Zanzibar’s Pemba Island by an application of these methods. Malaria deaths there have declined to nearly zero.

So, who should pick up the tab? My colleagues and I estimate that the total cost of comprehensive malaria control in Africa would be roughly $3 billion per year until 2015. That is too much for impoverished Africa, but it’s pocket change for the rich world. There are more than a billion of us in the high-income countries, so the cost is less than $3 per person. In other words, the total yearly cost comes to one eighth of Wall Street’s 2006 Christmas bonus. Comprehensive malaria control in Africa offers an unparalleled way for developed countries to promote the world’s long-term security, saving lives by the millions and bolstering the economic prospects of many of the poorest places on the planet.