Malaria eradication: it's back

The Lancet provides a brief history of the attempt to eradicate malaria.

In 1955, WHO set out to rid the world of malaria. The campaign, called the Global Malaria Eradication Programme, focused on vector control. The plan was to interrupt malaria transmission primarily by attacking the malaria's mosquito vector with the potent, new insecticide dicholoro-diphenyl-trichloroethane (DDT). It was thought that if the parasite's cycle of transmission from human to mosquito and back again could be blocked for 3 years, the parasite, and with it the disease, would disappear.

Scores of nations joined the programme. Poor nations shifted substantial portions of their health budgets to malaria eradication, and donor nations poured the equivalent in today's money of billions of dollars into the effort. Eradication teams spread out around the world; wetlands were drained; forests and fields were dusted; and millions of homes were sprayed.

There were remarkable successes. Malaria was eradicated from southern Europe as well as parts of north Africa and the Middle East. From 1955 to 1963, Sri Lanka saw the number of clinical cases drop from 1 million a year to 18. But soon the effort began to falter. Insecticide-resistant mosquitoes and drug-resistant parasites began to emerge. Eventually, funding slowed and by the end of the 1960s malaria eradication was abandoned for the less ambitious goal of eliminating the disease where possible and controlling it where it could not be eliminated.

But now there is a new movement afoot to eradicate malaria:

Last week, Bill and Melinda Gates, whose foundation has donated US$1 billion to a variety of malaria programmes, called for the world to launch a new campaign to eradicate the disease. At a conference in Seattle convened by their foundation, they argued that new scientific advances and growing financial and political support for malaria initiatives have made the goal of eradication realistic. They pointed to new drugs being developed by the Medicines for Malaria Venture, including four fixed-dose artemisinin combination therapies that are likely to obtain international registration by the end of next year and 20 other new drugs in the Venture's development pipeline. They pointed to the Malaria Vaccine Initiative's eight vaccine candidates, three of which are in clinical trials, including the promising RTS,S vaccine, which is expected to enter phase III trials in eight African countries next year. They highlighted progress being made in a number of sub-Saharan countries where insecticide-treated bednets, intermittent prophylactic treatment, household spraying, and other measures are already reducing the incidence of the disease. And they point to unprecedented financial support now flowing from the Global Fund to Fight AIDS, Tuberculosis and Malaria, the US President's Malaria Initiative, and the World Bank's Booster Program for Malaria Control in Africa.

The World Health Organization has joined the Gates' call. The Economist has a crude estimate of the cost:

Eradication would not be cheap. A back-of-the-envelope estimate suggests it would cost about $9 billion a year for two or three decades to make and distribute the necessary vaccines, drugs and equipment. But that compares with $3 billion a year indefinitely, merely to contain the problem--not to mention the economic damage done by the disease.

It's uncertain whether it's even possible to eradicate malaria but if we succeed the payoff is enormous. Steve Levitt has links to papers that estimate some of the benefits:

Hoyt Bleakley, a professor at the University of Chicago Graduate School of Business, documents the long-term benefits of malaria eradication in the American South in the 1920s, and then later (when DDT became available) in Mexico, Brazil, and Colombia. By comparing areas that did and did not have malaria problems before the eradication campaigns, Bleakley cleanly measures some of the benefits of abolishing malaria. Using individual-level census data, he finds that getting rid of malaria led to higher wages and literacy rates for children who grew up post-eradication. Wages rose 10 to 40 percent after eradication in the places that were worst affected by malaria.

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$9 billion a year is peanuts for the US, not to mention for the industrialized nations as a whole. Which reminds me of the report I saw about the use of peanut butter to reduce starvation among the poorest children in Africa. Why not toss in a few more peanuts and do away with starvation, too?

$6 billion in excess dollars per year ($9 billion for eradication - $3 billion for status quo) for 3 decades is a total of $180 billion or about a tenth of the $1.9 trillion Congressional Budget Office estimate of the ultimate cost of the Iraq War to the US government. Sounds like a good deal to me.

I am ever so thankful to Levitt for putting his econometric clout behind the anti-malaria campaign by referencing some dubious analysis by a business-school professor showing that preventing disease is profitable. Clearly, saving lives is not a good enough reason to spend money - there must be some profit to be made to justify any costly undertaking.

Wouldn't wiping out malaria be bad for climate change though, and the environment?

No.

Any other stupid questions?

At face value ben that would be one of the more asinine comments seen on this blog lately. Consider the quality of the competition for that honour!

So - is there some justification for it that I'm missing (in which case please accept my sincere apologies)?

Ah ... just back from reading other threads and I believe the answer may be that elspi has been rude enough to ben to probably justify a disemvowelling, consequently ben may have exhausted his reserve of manners and common sense.

consequently ben may have exhausted his reserve of manners and common sense.

That can't have taken long. :)

All I meant was that if malaria was wiped out, then fewer people would die from malaria (a good thing) but that this would lead to an increase in population (not so good a thing) which would be tough on the environment/climate.

One of those things where you wipe out malaria (yay!) and then see further degradation of the environment (oh crap!), as an unintended consequence.

I'm trying to look at this objectively. Clearly we don't want anyone to suffer and die from malaria, but we also don't want to see a population explosion as a result, that in some worst case scenarios could lead to more problems and more death and suffering in the long run. And this is all very easy for me to write, sitting here in the comfort of my home, while someone, somewhere is sitting in a mud hut suffering from sickness that I easily avoid, simply by luck of the draw in where we were born.

It's a cruel world.

Eradicating malaria would mean that people in malaria ridden countries/areas wouldn't have to breed so much in order to beat the odds and continue their bloodline. Also a less disease affected society is a stabler one, allowing for greater education etc, which would normally go hand in hand with lower procreation rates.

It's quite probable that it would lead to an initial rise in population however, but this could be offset by birth control education programs. (Which might piss off the Catholics, but hey... bonus!)

It's something to be aware of, but it certainly isn't a reason to not take steps to try and remove malaria from its public enemy number one spot.

Ben, you don't seriously buy into the whole "Environmentalists hate people" malarkey do you?

Eliminating malaria would free up vast amounts of resources currently being wasted, it'd lift living standards in Africa dramatically without the need for deforestation or resource depletion.

Take a look around the world, population growth is almost invariably linked to poverty - reducing poverty (and educating women) is the surest way to slow population growth and minimise environmental damage.

By Ian Gould (not verified) on 26 Oct 2007 #permalink

So Ben; the elimination of smallpox contributed to global warming did it?
Applying your argument, simply banning public health should be enough to offset all the hummers in the US. And think of the money we'd save on unnecessary stuff like potable water supplies, sewage disposal and trash collection.

Ben

I think even the World Bank and IMF have stopped dragging that one out now, and Malthus has been dead a long time. So people used to say that you can't be free of disease until you get in some decent economic development (and we'll help you with that by charging you for medicines and water). The fact of the matter is that fertility rates tend to stay high because you have to compensate for the stupidly high probability of your children not making it beyond five, and as soon as that gets sorted out e.g. by dealing with malaria, then fertility rates drop and everyone gets richer.

By jodyaberdein (not verified) on 26 Oct 2007 #permalink

Hunh? You mean you're all taking Lomborg's arguments seriously now? That there are relatively cheap things to improve the human condition that we can and should be doing and that prioritising them is important?
Rather, than, say, blowing the stash on Kyoto?
Excellent if you are of course.

Dear Tim

I'm not sure that one needs Lomborg in addition to the wealth of material on development, fertility, poverty and disease. Neither am I sure where I mentioned Kyoto or climate change in regard to the above. I have however previously pointed out that playing these issues off against each other is quite disingenuous, especially when the solutions are infact synergistic. What then do you make of the purported effect of climate change on vector borne disease and diseases associated with water scarcity and quality? And the diseases associated with malnutrition seen in the light of projected African crop yields under a warmer climate. And the costs in terms of carbon emmissions of not curtailing population growth cf water and food scarcity and population growth. And of course why are we suggesting it is such a small pot of money when we can lavish so much more on helping the middle east in our own very special way?

By jodyaberdein (not verified) on 27 Oct 2007 #permalink

Tim Worstall wrote, You mean you're all taking Lomborg's arguments seriously now?

No, because Lomborg and his ilk never seem to point out that instead of taking the moneys out of programs like Kyoto, we could take them out of things like the budget for the pointless occupation of Iraq, or ballistic missile "defense".

"projected African crop yields under a warmer climate."

Couldn't be much worse than they are under Mugabe and half the other leaders in Africa.

Tim,

You guys seem to be running an ad from 'malware.com' offereing me a free download for a 'malware detector.' Ive opened Deltoid from three different computers this morning, and in each case, I got a series malware.com popups - when I cancelled, it crashed my browser window. Once on a windows computer, twice on Mac.

This is, to say the least, irritating.

I consider the notion that it's good that poor people die young to be appalling. That this has supporters on the far Right and the far Left (if these directions can truly be valid classifications for such extremist views) says to me that there's much to be said for being moderate.

It's been well explained to ben above why eradication of malaria could be expected to also have some good environmental effects. Now I'm wondering whether Tim Worstall could possibly believe the average Deltoid reader to be in need of a lesson in anything meaningful from his egregious Danish expert in self-promotion and anti-science?

1) Eradicating malaria is good, not just for the places that have it now, but for the places to which more mosquitoes may migrate. Overall, helping poor people take care of themselves, grow their own food, etc, seems a good investment, i.e., Norman Borlaug gets it right.

Given Peak Oil, with competition between food and biofuels for land, pressure on water supplies, etc, shipping subsidized grain halfway across the world isn't going to last for many decades. [Some people would argue that first-world ag policies haven't helped third-world much, so that might be just as well in the long run.] Actually, when petroleum gets expensive, even getting the crops from Kansas to New York will get "interesting."

2) One may or may not care what happens to poor people Somewhere Else, but it is interesting that some people, who might not seem to care otherwise, get all excited about the awfulness of biofuel production ever competing for food production that should go to the poor. But strangely, I've yet to see any of them point out another crop whose disappearance would:
- save more lives than eradicating malaria
- save a lot of money, in fact, more than cover the cost above
- free up really good farmland for other purposes
- avoid existing deforestration for drying

But of course, I suspect tobacco will be hard to get rid of...

~1M/yr deaths from malaria http://www.unicef.org/health/index_malaria.html
(Of course, the economic hit comes from its debilitating effects on the vast number of sufferers.)

~5M/yr deaths from smoking

~10M/yr deaths from smoking in 2030. 70% in developing countries
http://www.wpro.who.int/information_sources/databases/regional_statisti…

"The multinational tobacco corporations have moved their production and marketing efforts overseas, causing experts to predict that by 2010, 87 percent of the world's tobacco will be grown in the developing world...
That means one in eight trees cut down each year worldwide is being destroyed for tobacco production. In South Korea and Uruguay, tobacco-related deforestation accounts for more than 40 percent of the countries' total annual deforestation. While in Malawi, in a region where only three percent of the farmers grow tobacco, nearly 80 percent of the trees cut down each year are used for the curing process....
Scientists affiliated with the climate research group Global Canopy Programme in England have reported that the 51 million acres cut down every year account for nearly 25 percent of heat-trapping gases. By that standard, the 9 million acres being deforested annually for tobacco production account for nearly 5 percent of greenhouse gas emissions."
http://www.inthesetimes.com/article/3324/tobacco_stains/

By John Mashey (not verified) on 27 Oct 2007 #permalink

"Hunh? You mean you're all taking Lomborg's arguments seriously now? That there are relatively cheap things to improve the human condition that we can and should be doing and that prioritising them is important? Rather, than, say, blowing the stash on Kyoto? Excellent if you are of course."

Well first off, let's remember that Lomborg's right wing fans are exactly the same people who would fight tooth and nail in any other context against increasing foreign aid.

More generally, Lomborg is proposing a false dichotomy.

Why didn't he ask his panel to choose between spending money on addressing global warming and, let's say, fat farms for overweight pets or anti-missile defense screens or abstinence-only birth control programs which have been proven not to work?

Most of the projects Lomborg proposed made sense (although his free trade argument was very shaky since trade liberalisation tends to both increase private incomes and raise government revenue hence the wholw idea of "spending money" on free trade is pretty silly). but with a world economy of $30 trillion - and growing at possible the fastest pace in history - we can afford all of them.

Secondly, global warming has the potential to undo the benefits of most of the other projects. So the proects are, in a sense, not independent.

By Ian Gould (not verified) on 28 Oct 2007 #permalink

"Couldn't be much worse than they are under Mugabe and half the other leaders in Africa."

That'd be the "other leaders" who delivered Africa its best decade in terms of economic growth and peace since records started.

I know its handy to dismiss all African leaders as crooks, thugs and dictators but increasingly that isn't the case.

Hell even Pat Reobertson's best buddy Charlie Taylor got the boot.

By Ian Gould (not verified) on 28 Oct 2007 #permalink

Dunno what the gouldmeister was saying in #23. Looks like hogwash. But I have to say i agree with Gouldiechops in #24.

I feel there's life in the frontal lobe. If Tim allows me a few more months of knocking some sense into the Gouldmeister I could just help him make a long term permanent recovery from this Hells kitchen of leftism. Keep it up Gouldie, we're making progress. Pretty soon I'll teach you why spending $35 trillion to recover $12 trillion with Kyoto is a rotten idea. Don't get nevervous now. I won't spring that on you for a coupla weeks.

Thank God for JC, he's leveraging the high regard we all have for his grasp of facts where we know everything like the backs of our hands and invoking it to convince us his economic school is equally well-thought-out, fact-based, and good for people.

With friends like him, I think the Austrian fanatics won't need enemies.

By Marion Delgado (not verified) on 28 Oct 2007 #permalink

Tim -

Just confirming the compaint from Tim and huxley that some ad for malware scanner software has popped up on me a couple times from your site. I don't know if you have any control over the ads you get, but this one should go, and not come back.

By Mark Shapiro (not verified) on 28 Oct 2007 #permalink

thanks marian. appreciate the compliment. Keep it up and you'll get a popsicle in the next class. You can skulk in to Gouldie's re-education class too if you like. Let me know.... and don't be a stranger.

"Hunh? You mean you're all taking Lomborg's arguments seriously now? That there are relatively cheap things to improve the human condition that we can and should be doing and that prioritising them is important? Rather, than, say, blowing the stash on Kyoto? Excellent if you are of course."

Posted by: Tim Worstall

Tim, I would say that even for you, this is rather dishonest, but it's not.