Malaria quagmire

    Progress in addressing Africa's largest health problem remains painfully slow.

    Tackling malaria in Africa should not be beyond our means. For a few billion dollars a year, it ought to be possible to save the lives of millions of people and lift some of the world's poorest areas out of poverty.

    All that is required, say specialists in the field, is access to tried and trusted remedies for those in Africa who need them most. Although vaccines and other new treatments would be helpful in the long term, some basic means of combating malaria, such as bednets impregnated with insecticide, are available now. Why aren't people getting them?

    The economist Jeffrey Sachs is asking the question in his latest role as director of the UN Millennium Project, an ambitious initiative to reduce global poverty by 2015. At a meeting in Stockholm earlier this week, he gathered public-health officials, drug company executives, African politicians and others to try to find the answer.

    Given the turf wars and squabbling that afflict this sphere, even the title of the conference — “A Malaria and Neglected Tropical Diseases Quick-Impact Initiative Meeting” — was likely to be greeted with scepticism, as the recent battle against malaria and other tropical diseases has been characterized by neither speed nor impact.

    The World Health Organization's Roll Back Malaria Initiative, which in 1998 pledged to halve the malaria burden by 2010, has struggled to establish itself and looks set to fall far short of its main goals.

    Even so, the past decade has seen considerable progress in global public health. Malaria, tuberculosis and AIDS are high on the public agenda, and funding for control measures and for research has grown rapidly. On the ground in Africa there has been considerable, if uneven, progress.

    The Stockholm meeting nevertheless provided ample evidence of the huge obstacles that remain in the way of implementing control measures. It was told, for example, that manufacturers can already produce 75 million bednets a year. But instead of agencies simply buying them and shipping them on, they have to pass through a tortuous circuit of tenders and approvals.

    Charity Ngilu, Kenya's health minister, also pointed out that most African countries have next to no health infrastructure for the efficient distribution of drugs and bednets.

    None of these problems will be addressed overnight, as the interminable nature of some of the discussion in Stockholm demonstrated. The world's attention must remain firmly focused on these diseases, however, until donor nations, African governments and international organizations find solutions, and achieve universal access to these basic control measures.

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    Malaria quagmire. Nature 439, 510 (2006). https://doi.org/10.1038/439510a

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