Malaria claims at least one million African lives each year – 90 percent of all malaria deaths worldwide – and incapacitates millions of more people who fall sick. An African child dies from the disease every 30 seconds.
In addition to the human toll, malaria is estimated to cost African countries U.S. $12 billion a year in lost GDP, according to the Global Business Coalition on HIV/Aids, Tuberculosis and Malaria (GBC). Seventy-two percent of businesses in Africa report that malaria affects their productivity and half of these report serious fiscal impact, says the World Economic Forum (WEF).
However, in the past decade the world has begun to respond to the threat of malaria like never before. The international Roll Back Malaria (RBM) campaign began with about $60 million in 2000 and now has almost $1 billion at its disposal to fight the disease.
"Today we are starting to see success stories," says Awa Marie Coll-Seck, RBM's Senegalese-born executive director. "Some countries went from two percent of coverage for long-lasting [treated] bed nets to 80 percent today… [In others] we also have [malaria-related] morbidity going down, mortality going down."
RBM was launched in 1998 by the World Health Organization, the United Nations Children's Fund, the UN Development Program and the World Bank to provide a global approach to fighting malaria. It is now made up of a wider range of partners, including malaria-endemic countries, the private sector, development agencies, and research and academic institutions.
Coll-Seck attributes recent successes partly to the improved global partnership. The spread of the disease can be stemmed by using insecticide-treated bed nets, spraying homes indoors and reducing standing water where mosquitoes breed. In addition, new medication has made the illness much more treatable.
Private sector help
Coll-Seck cautions that despite recent progress in fighting malaria, many challenges remain. To step up the battle, the private sector is becoming increasingly involved.
"What's becoming more and more important is that the private sector not only has a role to play in producing things like bed nets and insecticides and drugs, but it also has become a way of getting all these things to people in remote parts," says Prudence Smith, communications and advocacy coordinator with RBM.
Private companies, especially those such as beverage distributors and oil companies, have well-established supply networks. In one unique program Smith described, mothers in Tanzania can pick up a voucher at an antenatal clinic and then exchange it for a bed net at a local petrol station.
In addition, Smith explains, the private sector also has a role in advocacy, prevention and treatment at the workplace. If all employees and their families are under bed nets, the practice extends throughout communities and helps stem malaria transmission.
Another way the private sector is becoming involved is by establishing factories that produce bed nets within the continent. One in Tanzania employs at least 4,000 women and exports nets to other African countries.
"It helps to create jobs and it has helped Africa to have a homegrown prevention product, which is very effective," Smith says.
Insecticide in the latest bed nets lasts longer than it did in the past. The newest technology puts the insecticide in the fiber of the nets, making them effective for at least four years. By 2010 RBM is aiming to achieve 80 percent protective coverage and treatment in malaria-endemic areas.
Private sector hindrance
While the private sector can be instrumental in the fight against malaria, some companies actually pose a threat to combating the disease, according to health specialists.
The latest, most effective drug to treat malaria is artemisinin, which is used in combination with other medications so that malarial mosquitoes do not easily build up a resistance to it. However, some companies are selling mono therapies, the widespread use of which leads to drug resistance.
Health experts warn that it will be extremely difficult to treat malaria effectively if mosquitoes become resistant to the artemisinin. Already, chloroquine and sulfadoxine-pyrimethamine have lost their effectiveness in many areas.
Also, some companies are producing poor quality, or even fake, medication. This not only contributes to building drug resistance but endangers individuals' health and lives. The public sector, advised by health ministries, knows the proper medication to purchase, but substandard medication enters through the private sector, making it difficult to monitor.
Other measures debated
An additional way the private sector can help fight malaria is by distributing insecticides. But this effort is not without controversy.
Smith says about a dozen products are considered safe and effective to spray indoors. One of them is the insecticide, DDT, which was banned in many countries for many years but which experts now say is safe if used correctly.
"It is probably one of the most effective [insecticides] and seems to have a longer life" than many of the others, Smith says. It is dangerous only if it gets into the water table.
Some southern African countries have used DDT with great success, Smith says. But they are countries whose infrastructure is better than many of the others where malaria is endemic.
Growing commitment
Despite the difficulties in fighting malaria, health specialists are heartened by a growing commitment on the part of African countries and their international partners to tackle the disease.
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"A lot of things need to be done, but at least people can now have hope that control is possible," says Coll-Seck. "We will be working hard to do that for more countries and maybe one day be more ambitious and decide to eliminate malaria."
In April 2000, African countries signed the Abuja Declaration, endorsing a concerted strategy to fight malaria. Since then, almost 20 countries have reduced or eliminated taxes and tariffs on insecticide-treated nets to make them more affordable. In addition, more than half of malaria-endemic countries have established strategic country plans to achieve the RBM's goal on malaria.
Despite these positive signs, Coll-Seck warns that much more work needs to be done. She says people need to realize that control is possible, because without that understanding fundraising will be difficult.
"If we do not have the technical support, the money for intervention and to buy commodities … we will continue to lose [economically], we will continue to see people dying, we will continue to have health systems over-burdened," she says.
"Productivity will continue to be impacted and we will not meet the Millennium Development Goals. All of this is necessary for people to understand that investing in malaria is investing in development."
