The stakes are exceedingly high. Not just millions of lives but also the very capacity of the world to take on big and crucial goals is at stake. In the case of malaria, we have a low-cost and highly effective package of interventions that can restore health and unleash massive economic gain, but only if countless agencies, dozens of countries and hundreds of millions of individuals can effectively take a shared action. Success in this bold venture will enable us to consider similarly urgent challenges in food production, water management, biodiversity conservation and climate control, to name but four crucial areas. The consequences of organizational failure, on the other hand, would be almost too painful to behold. The countdown to 2010 has begun.