The Big Picture: Malaria

This week, I will be taking a break from this daily grind of politics and offer a broader look at a handful of important issues that are having a serious impact on millions of people around the world. Today's topic: malaria.

Diseases of the developing world get very little attention in the US media. The only one that does is AIDS and that has more to do with the fact that can fit in neatly with the American ideological fault lines surrounding reproductive freedom and religious morality. So those groups invoke AIDS for their own agendas. Malaria doesn't really fit into a morality or rights' paradigm.

The other peculiarity about malaria is that its effects are far less obviously visible. An AIDS patient slowly wasting away in a hospital bed makes for better television. An 12 year old AIDS orphan roaming the streets of a major city trying to provide basic sustinence for her younger siblings makes for a better story.

Malaria is caused by a parasite carried by mosquitoes. But it's only carried by one type of mosquito, which is why the disease is no longer present in North America.

Malaria affects between 350 and 500 million people every year, killing a million of them. So that means the overwhelming majority of malaria patients live, but suffer greatly in the process. Typical symptoms include fever, chills, headaches and flu-like illness. Even after recovery, there's a general 'blah' feeling, a lack of energy.

Many people in malarial regions get sick every year or most years.

The economic impact of malaria is staggering. The World Health Organization (WHO) notes that Economists believe that malaria is responsible for a ‘growth penalty’ of up to 1.3% per year in some African countries. When compounded over the years, this penalty leads to substantial differences in GDP between countries with and without malaria and severely restrains the economic growth of the entire region.

It further burdens already weak public health systems with massive costs required to treat malaria victims. Some malaria-heavy countries spend as much as 40 percent of their health care budget on that single disease.

WHO adds: The indirect costs of malaria include lost productivity or income associated with illness or death. This might be expressed as the cost of lost workdays or absenteeism from formal employment and the value of unpaid work done in the home by both men and women. In the case of death, the indirect cost includes the discounted future lifetime earnings of those who die.

WHO offers a more detailed analysis of the economic impacts here.

Bear in mind that the 500 million infected each year represents 9 percent of the entire human population.

And even the one million deaths represents a staggering number. The killing of fewer than 1000 civilians in Lebanon has led to massive international condemnation. Genocide in Darfur leads to world indignation. Malaria kills more people each and every day of the year (for years on end) than died in the Sept. 11, 2001 terrorist attacks.

But 90 percent of malaria victims are in Africa, a place where many have minimal access to health services of any kind.

And that gets to the heart of the issue. Diseases of the developing world get very little attention in the US media but far more importantly, they get very little attention with western pharmaceutical drug manufacturers.

Because 90 percent of malaria victims are from the world's poorest continent, western pharmaceutical multinationals do not see an incentive to invest in research in tropical diseases. As a result, far more research and development money is spent on improving or lowering the cost of drugs that address conditions of the rich world (like erectile dysfunction) than those of the poor world (malaria).

Fortunately, socially conscious foundations and governments are stepping up to fill the massive void left by the profit-driven pharamaceuticals. The international community created The Global Fund to Fight AIDS, Tuberculosis and Malaria.

The US government is the leading contributor, providing a quarter of the Global Fund's revenues this year (that's money paid to date, not merely pledged). Private individuals and foundations have contributed almost $267 million, most of it from the Bill and Melinda Gates foundation, with Kofi Annan being one of the biggest individual donors.

However, the Global Fund is solely a funding mechanism. It's up to local and international non-governmental organizations (NGOs) as well as national health authorities to implement anti-malaria programs.

The preferred anti-malaria drug combination is called ACT. It costs anywhere between $0.40 and $2.40 per treatment. That doesn't sound like much, even to someone who only earns a dollar a day. But if they have to pay for transport to get to a health center (double or triple if it's a parent with kids), then it can represent a significant amount.

The other difficult part is that since the symptoms of malaria mirror those for the flu, the disease is often misdiagnosed. When malaria drugs are misprescribed in such cases, it increases the likelihood of drug resistance developing.

What is being done and what needs to be done?

Some have argued that DDT spraying is needed eliminate mosquitoes. While this might cut back on malaria, DDT causes its own problems, such as fetal development problems, premature birth, premature puberty. And mosquitoes will be much harder to eliminate in moist, hot, tropical Africa and Asia than in the cooler, dryer climates of North America and Western Europe... thus more DDT. Some contend that the risks of DDT are minimal compared to the actual problems and deaths caused by malaria, but this must be fully debated. Before investing in such an enormous program, we must make sure that the cure is not worse than the disease.

There has been much made of programs to distribute to Africans anti-mosquito bed nets dipped in insecticide. This is not a bad idea, but it's a band aid, not a solution. Obviously, bed nets only protect people when they are asleep. That certainly helps, but is not a cure all. Mosquitoes are most prevalent arround dawn and dusk. Most Africans are outside, not in bed, around dusk. Furthermore, it's my understand that the bed nets have to be re-dipped in insecticide every so often, which is obviously not something that everyone is going to do.

One of the most important things that can be done in the short- and medium-term is to increase access to anti-malaria prophylactic drugs. Prophylactics are something you take on a regular basis that builds up the body's resistance to the malaria parasite. Such drugs either prevent you from getting sick or diminish the severeity if you do get infected.

Such drugs cost about $2.40 per treatment in the public and non-profit sector but much higher in the private sector. And while ACT is a one time only curative drug, such prophylactics are preventitive and thus need to be taken regularly. The regular expense is something most people in poor countries can not afford.