The 5-Minute Briefing: Malaria

What is the problem with malaria?

What is the problem with malaria?

Half a billion people in the world are suffering from the disease, one million die each year, and it is getting worse. The scale on which the parasite, transmitted by the mosquito, kills is breathtaking. Yet we know how to prevent and treat it - simply, effectively and cheaply.

Why did the World Health Organisation publish a report on malaria yesterday?

Because we are at the halfway point between the Abuja declaration of 2000 - in which 53 African heads of state pledged to halve deaths from malaria - and the 2010 deadline by which its aims are to be achieved. This is the appropriate moment to take stock.

How far have we got?

Not far enough. The lack of progress is lamentable, despite optimism of the WHO. It says more people have access to prevention and treatment, thanks to the Roll Back Malaria programme launched in 1998 ,"sparking hope that the number of people who become sick and die from malaria will begin to decline." But if the programme had been successful that number would already be declining. Early on, Roll Back Malaria did raise the profile of the disease, and international spending doubled.

Why is the situation so bad?

For 40 years chloroquine was the standard treatment for malaria. Patients swallowed a couple of pills at the onset of the fever and within 48 hours they would be better. It was safe, effective and cheap. But over recent decades, a drug-resistant strain of malaria, Plasmodium falciparum, has grown in Africa and it now accounts for more than 90 per cent of cases. Surveys in east Africa show that almost two-thirds of patients given chloroquine and nearly half of those on its successor, sulfadoxine-pyrimethamine, have died. The only effective therapies are those based on artemesinin, a drug derived from a weed that grows wild in Africa and the Far East.

What can be done?

Since 2001, according to the WHO, 42 countries - including 23 in Africa - have adopted artemesinin-based combination therapies, despite their higher cost. There has been a shortage of the drugs but this is expected to be rectified by the end of 2005. Even so, large sums are still being spent on chloroquine and similar useless treatments.

What about prevention?

Bed-nets impregnated with insecticide not only prevent malaria - they guarantee a good night's sleep. But there is disagreement within the aid community over whether it is better to sell them or hand them out free. Organisations such as Population Services International, the world's largest distributor of bed nets, say selling nets for 50 cents each ensures the buyer makes an investment in their health, provides a commission for the nurse who sells it and pays for prevention programmes. They say a similar principle could be set up on other programmes.