Malaria prevention

Most people think of malaria as a problem faced only by humid, hot countries. But just over a century ago, the disease thrived as far north as Siberia and the Arctic Circle, and was endemic in 36 states of the US.

Much of the developed world eliminated malaria in the 1950s through an increase in prosperity, housing and breakthroughs in medication and insecticides.

As people became wealthier, mosquito breeding ground marshes were drained, and an increase in livestock meant mosquitos had animals to bite instead of humans.

Improved nutrition made people healthier and less vulnerable, while increased incomes afforded better homes and insect screens. Quinine and then synthetic chloroquine gave developed countries affordable treatment, and insecticides wiped out many mosquito populations.

Deaths

Outside of sub-Saharan Africa, annual deaths plummeted from more than three million in 1930 to fewer than 30,000 today.

Yet, much of the malaria problem has stubbornly remained in Africa, where it kills more than half a million people every year.

In 2021, Ghana had 3.8 million malaria infections and 12,500 malaria deaths.

There are two key reasons.

First, the malaria parasite found in Africa is the deadliest, and strains have developed resistance to the common medicine chloroquine.

Second, the prevalent malaria-spreading mosquitos in Africa almost exclusively bite humans.

There was progress against malaria in Africa at the start of the 2000s, but that was halted by COVID-19, which disrupted basic medicine and caused around 60,000 more deaths.

Eradication

The world has long promised to get rid of malaria for good.

The Global Malaria Eradication Programme was established in 1955, then abandoned in 1969 because the goal was deemed unachievable.

In 2015, world leaders renewed the pledge.

In the UN’s global promises known as the Sustainable Development Goals, all nations undertook to fix almost every global problem by 2030, including malaria.

Progress has been glacial, which means the malaria goal will be achieved some 400 years late.

This is just one of many spectacular failures of the big UN promises.

Politicians simply promised too much: the global priorities include an impossible 169 promises, which is indistinguishable from having no priorities at all.

This year, the world will be at halftime for its 2030 promises, yet it will be nowhere near halfway.

It is time to identify and prioritise the most crucial goals.

My think tank, the Copenhagen Consensus, is doing exactly that: Together with several Nobel laureates and more than 100 leading economists, we have been working for years to identify where each dollar, rupee, or shilling can do the most good.

Our new research on malaria, written by Rima Shretta and Randolph Ngwafor at the University of Oxford, proposes a 10 per cent point scale-up and use of bednets in the 29 highest-burden countries in Africa alongside insecticide resistance management strategies, between now and the end of the UN’s 2030 promises.

Ensuring people sleep under an insecticide-treated bednet is one of the most effective ways to prevent malaria.

Mosquitoes are blocked by the netting and killed by the insecticide.

Bednets each cost less than $4, yet result in a dramatic reduction in transmission by ensuring mosquitos die before parasites can mature and spread.

It is important that budgets are not just distributed but actually used correctly, which requires social behaviour change and communication and information sharing.

Even allowing for this – and for the higher price tag of responding to resistant strains of malaria – the cost across this decade is about $1.1 billion a year.

To put this into context, that is one-third of what the US population spends on lipstick each year.

This investment will save 30,000 lives even in 2023. By the end of the decade, the number of malaria deaths will be halved, saving some 1.3 million lives in total.

Fewer infections

Bednets also mean many fewer infections with malaria.

The research shows that 242 million fewer people will get sick in 2030, drastically reducing healthcare costs.

Moreover, reducing the number of sick people means adults can go to work, children can go to school and caregivers are not stretched, which  at a country level increases productivity.

Putting all these factors together, every dollar spent on this campaign would yield societal benefits worth $48  a phenomenal return on investment.

We have allowed malaria to turn into a disease of poverty in Africa.

And while we cannot deliver on all the global UN promises, we ought to deliver on the smartest things first.

Distributing and using insecticide treated bednets will cost little but save 1.3 million lives.

The writer is President, Copenhagen Consensus/Visiting Fellow, Stanford University’s Hoover Institution.