Editor's Note: This is an extended version of the "Sustainable Developments" column from the July Issue of Scientific American.
In a dramatic call to action in April, U.N. Secretary-General Ban Ki-moon—backed by the African Union, the World Health Organization, UNICEF, the Gates Foundation, ExxonMobil, the World Bank, the Global Fund to Fight AIDS, Tuberculosis and Malaria, among other key international organizations and businesses—set a timetable for comprehensive malaria control in Africa by the end of 2010. Ki-moon has listened to the best science, weighed the recent evidence, and thrown down the gauntlet: there is no reason why a million or more children should die every year of a largely preventable and wholly treatable disease. Now we have a global timetable and a coalition to end the scourge.
The operational objective is to ensure that crucial interventions to control malaria are taken widely and at the appropriate scale within the next two and a half years. As I described in this space in September 2007, the package of technical control measures is now settled. There should be restriction of the mosquito vector (especially through the use of insecticide-treated bed nets and indoor spraying of insecticides); timely treatment of every clinical case with effective medicines; preventative treatment for pregnant women; and trained community health workers who will link clinics and communities in rural areas. In view of the lives to be saved and the economic benefits of reining in the disease, the total cost of around $3 billion a year is one of the world’s great bargains.
The main challenge of the next two-and-one-half years will therefore be organizational rather than conceptual or scientific. It is now up to a number of key international agencies to get the job done in Africa’s 49 countries, many of which are among the poorest in the world. Many skeptics doubt that this kind of program can work, much less on an accelerated timetable. The international system is a congeries of overlapping public and private institutions without clear mandates, ease of coordination or a single “conductor” to harmonize activities. Many of the key institutions are sporadically funded. The recipient governments are not always noted for their transparency, efficiency and accountability, to say the least.
Yet the chances for success are also strong. Many African leaders have long been committed to this fight. The U.N. secretary-general and the office of his special envoy on malaria represent a clear point of leadership. The Global Fund to Fight AIDS, Tuberculosis and Malaria serves as a dominant funding organization, and though its own budget depends in a complex way on the contributions from many governments, at least this single agency can channel most of the money that will be needed for success. Happily, the U.S. government is committed to its own sizable contribution, which will likely grow in view of robust congressional support. Finally, the Roll Back Malaria Partnership has had years of experience in bringing the multitude of “partner institutions” under one roof.
The needed technologies are relatively straightforward and much easier to use than those, for example, for controlling the HIV/AIDS pandemic. Bed nets and antimalaria medicines could be deployed rapidly to good effect. We may also take heart in the success of an immunization campaign in reducing measles deaths in Africa by more than 90 percent since the year 2000. Other recent triumphs, based on the up-scaling of powerful and easily deliverable technologies, include the control of polio, leprosy and guinea worm.
Still, the timing will be very tight and will require an unprecedented coordination of financing, training, monitoring and logistics. Each sub-Saharan country will need very quickly to adopt, vet, fund and monitor a scaled-up antimalaria plan. The major global commodity manufacturers of bed nets, antimalaria drugs and diagnostics will have to raise production to hundreds of millions of units. Tens or hundreds of thousands of community health workers will need weeks of training on malaria control, including both prevention (such as the proper use of bed nets) and treatment.