Eradicating Malaria Worldwide Seen as a Distant Goal, at Best

The big funders include the Global Fund to Fight AIDS, Tuberculosis and Malaria, which since 2002 has given $2.5 billion to fight the disease, and President Bush's Malaria Initiative, launched in 2005 with a goal of spending $1.2 billion over five years.

Much of the money is going for drugs and mosquito nets permanently impregnated with insecticide. Widespread use of nets has helped Rwanda and Ethiopia reduce child malaria deaths by more than 50 percent in the past three years. A charity called Nothing but Nets has raised enough money to buy nearly 2 million $10 nets, with help from the NBA and many schoolchildren.

Bush marked the occasion yesterday at a Boys & Girls Club in Hartford, Conn. About 150 clubs around the country raised $25,000 for nets.

"I know the boys and girls will probably never meet any of the lives who are being saved. I had the honor of traveling to Africa, and I can assure all who've been helping, the people of Africa are most grateful to the American citizens for their help," he said.

The strategy of spraying indoor walls of houses with insecticides, including DDT, once or twice a year is also making a comeback.

The cost of scaling up prevention, treatment and surveillance to fully cover malaria-afflicted areas is $3.8 billion to $7 billion a year, according to two recent estimates.

That huge amount did not deter Bill and Melinda Gates. At a malaria summit they held in Seattle last October, the Gateses called for the eradication of malaria. WHO's Chan did not know the announcement was coming but gave it what many took as an unofficial endorsement when she told the audience, "I dare you to come along with us."

Most malaria experts, however, say the goal is currently unfeasible.

That's because transmission rates in "hyper-endemic" parts of Africa are 100 times higher than in any place where the disease has been eliminated. There is no vaccine; without one, eradication is hard to imagine. One candidate tested in Africa reduced infections by 35 percent over two years; a much more effective one is not expected for more than a decade.

In a paper prepared for the British government in December, three malaria experts wrote that "it is not unthinkable that global eradication can be achieved, but it is not possible with current methods."

That doesn't bother Richard Feachem, former head of the Global Fund and now at the University of California at San Francisco.

He and others espouse a two-pronged strategy -- aggressive control in the high-transmission parts of Africa, while simultaneously "shrinking the malaria map" by eliminating the disease from places where it is less intense. The latter includes islands in Oceania, parts of southern Africa and China. He believes that by the time eradication becomes a possibility in Africa, there will be new tools.

"The overall effort is measured in decades," he said recently.