For Western travellers to malarial parts of the world such as sub-Saharan Africa, Asia and south America, the parasite holds few terrors. Dose yourself with the right prophylactic drug – Malarone is the current gold standard for areas where there is drug resistance – douse yourself with insect repellent and you are unlikely to fall victim to the lethal disease.
The indigenous population has fewer choices. Prophylactic drugs, at about £2 a day for Malarone, are beyond their reach. Bed nets, impregnated with insecticide, offer effective protection at minimal cost and millions have been distributed by charities. But most people in the affected countries accept malaria as an illness to be endured, suffering regular attacks.
The usual response to a fever was to reach for a dose of chloroquine, available for a few pennies from any village store. For 40 years, chloroquine was the standard treatment for malaria. Sufferers swallowed a couple of pills at the onset of the sweats that signalled infection and within 48 hours they would be better. It was safe, effective and cheap.
But, in recent decades, a drug-resistant strain of malaria, Plasmodium falciparum, has grown across the world and now accounts for over 90 per cent of cases in Africa. Surveys in east Africa in the late 1990s showed that almost two-thirds of patients given chloroquine and nearly half of those on its successor, sulfadoxine-pyrimethamine, died.
Children, with their undeveloped immune systems, are especially vulnerable. More than eight out of 10 malaria deaths occur in sub-Saharan Africa and the World Health Organisation estimates that the disease kills 3,000 children a day. In countries such as Malawi, the disease claims more lives each year than Aids, yet receives a fraction of the attention, even though children are its chief victims.
In 1998, the WHO launched the Roll Back Malaria programme with a target to halve the number of deaths by 2010. Instead of declining, however, in the early years of the programme the toll rose by a quarter and by up to half in some areas. The UN identified the disease as one of the top four causes of poverty with many African governments spending up to 40 per cent of their health budgets on malaria control. Current spending on malaria in Africa is estimated at $1bn (£500m) a year.
Countries worst affected by the disease have been reluctant to buy the new artemesinin-based drugs because, at $1 to $2, a dose they are 10 times more expensive than chloroquine.
The promise of an unlimited supply of affordable artemesinin from the partnership between the Gates Foundation and the French pharmaceutical company, sanofi, will make effective treatment accessible once more to the people in greatest need.