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The Killer Bug

There are solutions, but most come down to one thing: commitment.

June 05, 2005

When the sun goes down in Africa, death stalks the children. It seldom comes from jungle cats or venomous snakes, but often from bugs smaller than a toddler's thumbnail. Every year, their deadly sting kills more people than at Hiroshima and Nagasaki, more than December's tsunami in Asia, more than the combined Union and Confederate casualties in the Civil War. If a biblical plague slaughtered every man, woman and child in Philadelphia, it would not equal some estimates of the death toll from malaria in the last 12 months.

Well, some might say, the world is full of tragedy. We can't cure all disease or save all lost children. But these acres of graves are the needless legacy of a disease that we have known how to cure for a century. And each life might have been saved for about $2 -- less than the price of a latte.

Public health authorities can only guess how many people die of malaria because most of the victims never make it to a clinic; the estimates range from 1 million to 3 million a year. Most of the dead are children under age 5, and 90% had the misfortune to be born in sub-Saharan Africa, a land trapped somewhere between the modern world and the Stone Age.

A Timeless Disease

Malaria's origins can't be traced to a specific time period; the disease may be as old as civilized man (some speculate that it arose around the time humans started clustering in agricultural communities). A Chinese medical text from 2700 BC describes its symptoms. It is a bug carried by a bug -- a parasite carried in the salivary glands of the anopheles mosquito. Humans and mosquitoes live in a vicious circle of infection. The mosquito gets the parasite by stinging a human who is already infected with it, then stings an uninfected human and passes it on.

The word malaria means "bad air" in Italian, because for centuries people thought that fetid vapors, particularly from swamps, were responsible for its spread. Then, in 1897, a Nobel Prize-winning British physician named Ronald Ross discovered that the mosquito was responsible.

The response around the world was to attack the bloodsuckers where they lived. One of the most successful programs started in 1904, when the U.S. military began draining swamps in the Panama Canal Zone -- malaria and yellow fever were killing or disabling so many workers that the completion of the canal was in jeopardy.

In the 1930s, a similar approach was taken in the American South, where the parasite was thriving. During World War II, DDT was developed and sprayed in millions of U.S. homes. The drugs primaquine and chloroquine were added to the older quinine as effective treatments, and, by 1953, malaria was all but eradicated in the United States.

It was a heady time. The world had seemingly conquered a disease that had shadowed man's footsteps for millenniums; anything seemed possible. In the late 1950s, the World Health Organization led a campaign to eliminate malaria from the rest of the world, pumping the equivalent of billions of today's dollars into the quest -- an amount that, given today's politics, seems almost incomprehensible. Workers armed with DDT sprayers descended like Blackhawks over Baghdad on the huts and houses of the Third World.

But the malaria parasite is one of nature's more perfect killers, and this eradication effort was largely a failure. Malaria rates were reduced in some parts of the world, but in places with a more severe problem than this country had ever faced, the mosquitoes simply started developing resistance to the insecticide. And the DDT armies didn't even try to fight the bugs in sub-Saharan Africa, where the problem was deemed so severe that such efforts would be pointless. Today, malaria kills more people than ever.

A Very Modest Goal

The WHO failure discouraged ambitious anti-malaria programs for decades. Then, in 1998, the WHO and the World Bank established the Roll Back Malaria partnership. In 2000, the G-8 club of industrialized nations identified three pandemics that it would work to cure, and in 2002 established the Global Fund to Fight AIDS, Tuberculosis and Malaria.

A very modest anti-malaria goal was set in 2000 by the United Nations as part of its Millennium Development Goals: to halt and begin to reverse the rise in the incidence of malaria by 2015. The Bill and Melinda Gates Foundation (whose president is married to the editor who supervises this page) also focuses on malaria eradication, further attracting attention to the disease.

Yet the U.S. government spends about half as much on malaria per year as it spends in one day in Iraq. It also places a lower priority on malaria than other diseases, spending 30 to 40 times more in the fight against AIDS than on malaria, maybe because Americans get AIDS but not malaria.

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