On The Trail Of A Ferocious Killer

Still, not all the news out of Africa is good. Coverage levels (the measure of how many people are benefiting from bed nets and pesticide spraying) in many countries hover around 10 percent. In two nations—the Democratic Republic of Congo and Nigeria—the situation is especially dire. Neither country has much of a health budget. Congo is currently sending bed nets out by trucks, bicycles and canoes, but even so it is vulnerable. And since, as the saying goes, "mosquitoes don't respect borders," the whole continent could still backslide.

To succeed in the long term, scientists eventually will have to develop new drugs and a vaccine. Drug research is already showing some potential. One intriguing candidate mimics the action of Coartem, but unlike that drug, it can be given in a single dose and thus would be much more practical for use in developing countries. Unfortunately, malaria will ultimately evolve around whatever new drug is used against it—so widespread use of any medicine can work for only so long. Without a vaccine, we will be condemned to a never-ending cycle of outbreaks.

There is some reason to hope that a malaria vaccine could be developed. "We know there is potential to create an immune response [against malaria], because our bodies do it if assaulted by this disease repeatedly in childhood," says Sachs. How our bodies build that immunity, however, is still a mystery. There has never been a vaccine for any parasitic disease, let alone one as complex as malaria. Today, more than 30 serious candidates are in development. One, from GlaxoSmithKline, may progress to large human trials in Africa within the next few months. Even so, Gates himself—probably the world's biggest proponent of vaccination—says no vaccine is likely to be available for at least two more decades. By then, who knows what the fight against malaria will look like?

The idea of outlining the 50-year Global Malaria Action Plan is to harden people's resolve for the battle ahead. The report advocates "front-loading" money, or spending a lot in the first few years, a strategy that proved successful in Ethiopia. It addresses all the nations where malaria is a serious threat, but reserves a special focus for Nigeria, Congo, Ethiopia, Uganda and Tanzania, which account for half of malaria deaths worldwide.

Even if $11.5 billion somehow comes through, even if it's all well used, even if malaria deaths drop by 95 percent in the next 20 years, there is yet another possible pitfall: that success will once again breed failure.

The responsibility for eradicating malaria, then, will rest not just on the shoulders of the researchers and the public-health workers. It will be on everyone: the donors who may turn to other causes, the villagers who receive nets but don't or can't use them properly, the Westerners who could so easily again forget about the disease and assume it's "just not a problem." If the world is to succeed in wiping out malaria this time around, all parties will have to stay in the fight. The malaria parasite certainly will.

With Jason Mclure in Ethiopia

© 2008