We Can Eradicate Malaria—Within a Generation
By Bill Gates
on November 2, 2014
I’m in New Orleans, where I just had the honor of speaking at the annual meeting of the American Society of Tropical Medicine and Hygiene (ASTMH). As you can imagine, given that this is a gathering of experts on infectious diseases in poor countries, Ebola is on everyone’s mind.
Even though I am confident that the U.S. and other countries with strong public health systems will contain the cases that are popping up within their borders, it’s devastating to see what this virus is doing to entire families in West Africa. At times like this, it’s easy for organizations like ASTMH to make the public case that global health matters to all of us in our increasingly interconnected world. I hope that will help strengthen the public will to do more to help poor countries lift the burden of disease—not just from emerging killers like Ebola but also from pathogens that have held back human potential for thousands of years.
That’s why, in my remarks at the conference, I addressed the Ebola crisis but devoted the bulk of my time to another killer disease: malaria. Based on the progress I’m seeing in the lab and on the ground, I believe we’re now in a position to eradicate malaria—that is, wipe it out completely in every country—within a generation. This is one of the greatest opportunities the global health world has ever had. Melinda and I are so optimistic about it that we recently decided to increase our foundation’s malaria budget by 30 percent.
Melinda and I first called for eradication back in 2007 along with Margaret Chan, who runs the World Health Organization. Melinda was eloquent and passionate in her call to action: “Any goal short of eradicating malaria is accepting malaria; it’s making peace with malaria; it’s rich countries saying: ‘We don’t need to eradicate malaria around the world as long as we’ve eliminated malaria in our own countries.’ That’s just unacceptable.”
Some people said then (and still say today) that we’re overly optimistic to be talking about eradication. After all, malaria is an enormously complex target and has defeated efforts to stamp it out in the past. They’re right that we shouldn’t promise the moon—you don’t get rid of a disease this complex overnight—but I am confident that the future will be different from the past.
Why? Because we’ve seen a huge scale-up in the resources and brainpower focused on this disease. Four countries have eliminated malaria since 2000, and two dozen more could do it in the next decade. Mortality rates worldwide have gone down by a remarkable 42 percent in that time—a good-news story that ought to make critics wary of trumpeting claims that foreign aid doesn’t work. More than 3.3 million people who would have died of malaria are alive today.
And we have tools today we’ve never had before—not everything we will need to achieve eradication, but more than we’ve ever had. Here are two of the recent innovations that fuel my optimism:
Diagnostics: Malaria is not only treatable but also curable, thanks to a class of drugs derived from a flowering plant called Artemesia annua, or sweet wormwood. But until recently, there was no good way for most people who came down with a fever to find out whether they had malaria. In 2010, we got a great new tool, called the RDT (rapid diagnostic test). Armed with this 50-cent test, community health workers with little training can determine in minutes with 99 percent accuracy whether someone has malaria or not. Last year, we deployed 200 million of them in Africa alone.
Modeling Systems: The digital revolution has produced fantastic new tools for tracking the disease. Public health experts are combining anonymous data from mobile phone records with data on malaria incidence to identify the key migration hotspots—allowing countries to target their resources in the most cost-effective and strategic ways. In Kenya, for example, these maps helped experts target large-scale tea plantations in the country’s Lake Zone. Comprehensive efforts at the plantations could make it possible to eliminate malaria from large swaths of the country’s highlands without even having to run elimination efforts there.
Just as important as any specific innovation, our team has converged on an eradication strategy that will make the whole greater than the sum of the parts. That strategy has three components: Complete Detection, Complete Cure, and Complete Prevention.
Complete Detection is a departure from current approaches, which focus on finding and treating only those people who have active malaria cases. To achieve eradication, health workers need to find all people who have the parasite in their blood, regardless of whether they’re showing symptoms. (I wrote about this work earlier this year, after Melinda and I saw it in action in Cambodia.) We’re supporting many efforts to develop and bring to market a new generation of diagnostic tools that are even more sensitive than the RDTs now in use and can identify the presence of malaria parasites in all infected individuals.
Complete Cure means using treatments that clear all malaria parasites from the body. Our best anti-malaria treatment today, known as ACT, generally cures the patient clinically but does not eliminate all forms of the parasites that are responsible for continued transmission. So we are trying to supercharge efforts to develop long-lasting, single-dose treatments for malaria that can completely clear malaria parasites from the body and provide a period of protection following the treatment. We believe that our largest partner in this effort, the Medicines for Malaria Venture, could bring these complete-cure drugs to market within five years.
Complete Prevention means reducing opportunities for mosquitoes to pass the parasite on to humans, and preventing the emergence of strains that resist drugs and insecticides. We’ll need next-generation vaccines that block transmission for six months to a year, so that once an area is cleared of the parasite, it stays clear. We’ll also need new insecticides to offset the widespread emergence of mosquito resistance to the chemical compounds we use most frequently today. We may even need cutting-edge approaches, like introducing special fungi into mosquito populations to kill them off or introducing modified genes that can stop mosquitoes from reproducing.
I believe it’s not only possible to eradicate malaria; I believe it’s necessary. Ultimately, the cost of controlling it endlessly is not sustainable. The only way to stop this disease is to end it forever.