African children are dying of malaria at the rate of one every 30 seconds. Take a minute to try to comprehend that number – and two more die.
Malaria kills an estimated million people worldwide every year, 90 percent of them in Africa. That relentless toll saps energy, money and hope from communities all over sub-Saharan Africa. "Malaria is also a major cause of anemia in children and pregnant women, low birth weight, premature birth and infant mortality," the Roll Back Malaria partnership says. "In endemic African countries, malaria accounts for 25–35 percent of all outpatient visits, 20–45 percent of hospital admissions and 15–35 percent of hospital deaths, imposing a great burden on already fragile health-care systems."
During most of the past decade, the burden of malaria and other tropical diseases was largely overlooked by international policy makers and media. But recently, and particularly in the last year, the issue has achieved a new prominence.
The Global Fund to Fight Aids, Tuberculosis and Malaria, launched four years ago, has provided funds for 109 million bednets and 264 million treatments of new artemisinin-based combination drug therapies to replace the chloroquine-based formulations that have become ineffective. The decision to include malaria in the Fund's mission helped to put the illness back on the international policy agenda.
The Bill and Melinda Gates Foundation provided initial funding for the Malaria Control and Evaluation Partnership in Africa (Macepa), whose intensive work in Zambia is aimed at modeling a comprehensive, coordinated nationwide effort to cut malaria-related deaths by 75 percent within three years. After a year of planning and initial action, Macepa has brought over a dozen international partners into a collaboration with Zambian government interventions to create an integrated response.
The project has already fast-tracked the distribution of 526,000 bednets and the insecticide treatment of 500,000 more for the current malaria season and has begun intensive training of district health managers and neighborhood health committees for hard-to-reach rural areas. Macepa's program director, Dr. Kent Campbell, a former chief of the U.S. Centers for Disease Control's malaria branch, says the project will document the work through scientific records, case studies and personal narratives, to facilitate replication elsewhere.
The United Nations Millennium Project, led by Jeffrey Sachs of the Earth Institute at Columbia University in New York, convened a meeting in January at the Nobel Forum, Karolinska Institute in Stockholm, bringing together government officials, scientists and tropical disease experts, representatives of donors, international organizations and businesses. The two-day session, called the Malaria and Neglected Tropical Diseases Quick Impact Initiative, led to plans to break the bottlenecks to scaling up an integrated attack on the deadly combination of malaria and other tropical diseases. One of the envisioned mechanisms is a pooled procurement strategy to facilitate the acquisition and delivery of bednets, medicines and other necessary tools.
Ten African countries – Ethiopia, Ghana, Kenya, Malawi, Mali, Nigeria, Rwanda, Senegal, Tanzania and Uganda – are participating in the initial phase of the quick-impact initiative on malaria. The goals are to achieve, by 20008, 100 percent coverage of children and pregnant women with long-lasting, insecticide-treated bednets, 80 percent of at-risk people protected by locally appropriate interventions, and 100 percent of children under five years of age treated with effective anti-malarial medicines within a day of illness onset. " My hope is that by 2008 we have comprehensive malaria control in place across rural Africa, which is where the malaria burden is so remarkable, so extreme and so controllable," Sachs told the BBC's "Focus on Africa" radio show.
"The malaria problem can be overcome," says Roll Back Malaria executive director, Dr. Awa Marie Coll-Seck, a former Minister of Health of Senegal. Malaria is a disease of poverty, she says, and thus has been largely ignored by the industrialized world. But she says growing awareness of the burden malaria imposes on societies trying to develop economically and the availability of the new class of artiminisin-based drugs has given renewed impetus to the effort.
That growing awareness has also spawned a variety of civil society responses, exemplified by the efforts of Lance Laifer, a young hedge fund manager in the United States, who learned that malaria still exists while watching a television show. Fighting malaria quickly became a personal passion, and he has organized several recent high-profile public education responses, including a fan-participation "Dunk Malaria" event at a New York Knicks professional basketball game.
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Another element of current optimism is the progress towards formulating a malaria vaccine. Clinical trials among children have shown promise, with the largest African trial of a malaria vaccine in Africa, conducted by GlaxoSmithKline Biologicals, the Hospital Clinic of the University of Barcelona and the Manhica Health Research Center in Mozambique, reducing the rate of infection by 29 percent and the incidence of severe malaria by 49 percent among 2000 children.
Macepa, which is helping to develop a policy framework for evaluating currently available interventions, is also turning its attention to advocacy. Too often, project leaders say, public health successes are poorly documented and little noticed. The data collected in Zambia, and support for more effective communication of the results, is expected to add additional momentum to a process that malaria fighters say is now well underway on this Africa Malaria Day of 2006.
