Can the War on Malaria be won?

The Economist writes;

Dr Alonso's paper, then, is a bit of good news in an area—global health—that is more usually associated with misery. It is not, however, the only optimistic note as far as malaria is concerned. A newish and very effective drug called artemesinin is now being deployed, and the campaign to distribute insecticide-laced bed nets through large parts of Africa is also showing signs of success. A few people are therefore daring to whisper a word that has not been heard much in malaria circles since the 1960s: eradication.

On October 17th, the day Dr Alonso's paper was published, someone dared do more than whisper the word. Bill Gates almost shouted it at a conference on the disease which was organised in Seattle by his foundation. The Gates Foundation helped to finance the trials in Mozambique and Mr Gates used their success to give a rousing speech to the gathered experts, challenging them to raise their sights. Rather than continue with today's strategy of merely controlling malaria, he argued that it is time for the world to aspire to exterminate it altogether.

This is not a new idea. The last attempt to eradicate malaria began in 1955 (coincidentally, the year Mr Gates was born) and relied on a new wonder chemical called DDT to kill the mosquitoes. For a time, it was successful, but then evolution struck back, as natural selection favoured the spread of insecticide-resistant genes. Shortly afterwards, politics struck back, too, as the environmental movement successfully demonised DDT because of the damage it does to many other animals.

Given this history, cynicism about the idea of eradication is understandable. Steven Phillips, chief medical officer of Exxon Mobil, a firm whose African operations are inevitably affected by malaria, argues that eradication is technically impossible and favours emphasis on “bread and butter” disease control. But Regina Rabinovich and Tachi Yamada, the scientists responsible for running the Gates Foundation's anti-malaria effort, argue that eradication was never seriously attempted in Africa in the past. They think that today's money, technologies and political will are strong enough to make eradication a realistic aspiration.

Dr Phillips is right, in the sense that even the finest vaccine cannot do much good if it does not reach villages in endemic areas. However, things change—even in Africa. A report released this week by Unicef, the United Nations Children's Fund, suggests several countries, including Ghana, Tanzania, Benin and Gambia, are making progress in spreading artemesinin and bed nets.

Eradication would not be cheap. A back-of-the-envelope estimate suggests it would cost about $9 billion a year for two or three decades to make and distribute the necessary vaccines, drugs and equipment. But that compares with $3 billion a year indefinitely, merely to contain the problem—not to mention the economic damage done by the disease. Big ideas have to await the right time to be realised. But for malaria that time may be now

For Discussion: A lot of Africans I know carry with them an assortment of 'malaria drugs' when they travel. Often use the drugs when they have some symptoms of fever (since the costs of getting Malaria infection is so high)without proper medical diagnosis. How prevalent is such misuse of 'malaria drugs'? What could be the broader immunology consequences of excessive use of such drugs?

Related;
Mosquitoes fighting Malaria
Malaria eradication: it's back

The Economics of Mosquitoes;

Hoyt Bleakley, a professor at the University of Chicago Graduate School of Business, documents the long-term benefits of malaria eradication in the American South in the 1920s, and then later (when DDT became available) in Mexico, Brazil, and Colombia. By comparing areas that did and did not have malaria problems before the eradication campaigns, Bleakley cleanly measures some of the benefits of abolishing malaria. Using individual-level census data, he finds that getting rid of malaria led to higher wages and literacy rates for children who grew up post-eradication. Wages rose 10 to 40 percent after eradication in the places that were worst affected by malaria. (He also has some surprising and powerful findings with respect to worms).

The Mosquito Killer

The Long-Term Economic Impact of In Utero and Postnatal Exposure to Malaria