Eradicating Malaria Worldwide Seen as a Distant Goal, at Best

A generation after the first attempt failed, people are once more talking seriously about eradicating malaria.

The fight against the ancient, mosquito-borne disease has newfound support almost everywhere, including in the National Basketball Association. The world's richest charity, the Bill and Melinda Gates Foundation, is leading the charge. There's an effective drug -- artemisinin -- that wasn't around 30 years ago, and a consumer product -- insecticide-treated bed nets -- that together are saving tens of thousands of lives.

But whether that will lead one day to the last case of malaria is an open question -- and one that will take another generation to answer.

Yesterday, on the first World Malaria Day, the prospect hovered somewhere between useful fantasy and distant hope.

"Why can't we set our dream high?" Margaret Chan, the World Health Organization's director-general, asked soon after arriving in Washington for events here and in New York. "I don't think we can deny the countries of Africa that possibility, even though we realistically know it will take a long time."

About 500 million people get malaria each year and about 1 million die, the vast majority African children younger than 5. Worldwide, about 2.37 billion people in 87 countries are at risk of the disease, which is caused by a parasite called plasmodium that is passed from person to person by mosquitoes.

The first call for eradication came in 1955 from the World Health Assembly, which consists of the health ministers of U.N. member countries. It was confident that DDT, an insecticide whose use during World War II had dramatically reduced malaria, coupled with postwar economic development could stop the disease.

(Only one eradication effort has succeeded. Smallpox was officially declared gone in 1980 after a campaign that began in 1966.)

The malaria effort lasted 14 years, cost about $1.4 billion and in some places eclipsed other efforts to improve health. By the time the World Health Assembly lowered its goal to malaria "control," 18 countries had become malaria-free, including Spain, Cuba, Taiwan and most of Eastern Europe.

But no countries in Africa, where transmission often occurs year-round, got rid of the disease. Some came close only to see malaria roar back. Sri Lanka recorded only 18 cases in its best year; it now has about 10,000 a year.

The failure greatly disheartened the public-health community. Malaria rejoined malnutrition, diarrhea and pneumonia as seemingly inevitable threats to poor people in the developing world.

This fatalism at least partly set the scene for a resurgence of the disease in recent decades. However, money is pouring again into malaria control -- about $1 billion a year, 10 times the amount of a decade ago.