On The Trail Of A Ferocious Killer

Last week, everyone who's anyone in global health was in New York City for a series of meetings capped by the United Nations General Assembly. Among the crowds, one gathering stood out. Bono, the activist rock star, was on hand to "set the tone," and Jeffrey Sachs, the Columbia professor and key thinker in efforts to fight poverty, lent his support. The occasion was the unveiling of the most ambitious program in half a century to fight malaria, a disease that kills a million people each year. The Global Malaria Action Plan (GMAP) sets out in detail what health officials hope to achieve over not just the next five or 10 years, but the next 50.

The cooperative mood of the meeting was in marked contrast to a smaller, and sometimes more combative, gathering almost a year ago in Seattle, where the Bill & Melinda Gates Foundation had brought together almost every major malaria researcher and health official in the world in one room for the first time. At the heart of most of the debates was one major question: whether to think big and try to eradicate the disease, à la smallpox, or to settle for what seemed to be the more realistic option of controlling it. On the second day of the gathering, Melinda Gates settled the question for good. The world, she said, now faced "a historic opportunity, not just to treat malaria or control malaria"—the participants shifted in their seats—"but to chart a long-term course for eradicating malaria." One delegate, a philanthropist at a major corporation, said the Gateses had "changed the game" with one word: Where they went, he said, the world would go.

After decades of neglect, African and Western nations are now attacking malaria with a fervor that borders on obsession. The West has boosted funding from $50 million in 2000 to $1.1 billion this year, and it is starting to get results. In Ethiopia, a country once racked by the disease, case reports have fallen to 1.2 million, the lowest number since 2001, down from as many as 9 million in previous typical years. The country is now held up as one of several models for worldwide progress. The goal—to wipe malaria off the rest of the map—is audacious in scope, for the simple reason that malaria is one of the most stubborn of diseases. But the men and women pursuing this goal are some of the world's most powerful; they include British Prime Minister Gordon Brown, News Corp. honcho Peter Chernin and Gates, who has called efforts to combat malaria "the most repeated failure in all of global health." He does not intend to fail this time.

If the new efforts are successful, they will save millions of lives and help lift an entire continent out of poverty. Moreover, they will open the door for future fights against many other diseases such as HIV, TB and pneumonia. "It's a little like putting the first mammal into orbit," says Scott Case, vice chairman and CEO of the nonprofit Malaria No More. "Once you see that it can be done, it opens up a whole new set of possibilities."

But success is not guaranteed. Eradication is probably the greatest challenge in all of public health; it requires that commitment remain high even as infection rates drop and other causes start to look more compelling. Vaccine development will also be daunting; there is very little precedent for immunization against anything as tricky as the malaria parasite. And then there is the sheer difficulty of collecting enough money to pay for what needs to be done. Last week, as part of the GMAP rollout, world leaders committed $3 billion to malaria prevention—but also announced that to fully implement their plan, they'd actually need $5.3 billion for 2009, followed by $6.2 billion for 2010, plus another $900 million or so each year for scientific research. Eradication may turn out to be a luxury we can't afford.

This won't be the first time the world has gone after malaria. After World War II, widespread spraying of the pesticide DDT killed the parasite-bearing mosquitoes in many developed nations. In 1963, at least one developing nation had come close to becoming malaria-free: Sri Lanka, home to a million cases annually in 1955, was down to a measly 18. The world rejoiced—and then abruptly gave up.