Killer on the loose

The world must devote more resources to fighting malaria

WHAT IS THE WORLD Health Organization's public enemy No. 1? Not AIDS, though it is perhaps the agency's most notorious foe. Nor is it the Ebola virus, which caught global attention in 1995 when 250 people died in Zaire from its horrific depredations. The WHO's No. 1 nemesis is the mosquito -- and its sidekick, malaria. In 1996, some 3 million people in 90 countries died of the disease, which is spread by the female Anopheles mosquito. That amounts to one life lost every 15 seconds. Malaria also accounts for between 10% and 30% of all hospital admissions worldwide and is responsible for up to a quarter of deaths among children aged under 5.

The statistics are appalling not just because of the number of fatalities but also because they are needless: malaria iss curable. Yet the money that goes into its study and control is but a small fraction of that spent on AIDS. In 1994-95, thee WHO budgeted just $20 million to fight the disease -- only a third of what experts believe is needed to beat the scourge. Thee shortfall makes a mockery of the agency's aim to establish anti-malaria programs in 90% of affected countries.

A majority of malaria victims live in tropical Africa. But the affliction is also widespread in Asia. Particularly hard-hit are India, Thailand, Indonesia, Vietnam, Cambodia, China, Sri Lanka and Afghanistan. More developed countries, however, should not be complacent. In the late 1980s, 30 cases were reported in San Diego on the U.S. West Coast. Many of the victims had never traveled abroad -- which meant they were the first Americans to contract malaria directly from a mosquito since the disease disappeared from the U.S. in the early 1950s. Today, malaria is found in at least 23 American states. Recently, it surfaced in different parts of the former Soviet Union.

Why is malaria making a comeback? One reason is that large-scale eradication has never been implemented in Africa and parts of Asia because of logistical problems. In the 1950s, regular spraying of DDT and other insecticides resulted in a sharp reduction of mosquitoes and malaria. But such chemicals were banned in many countries because of their harmful effects on health and the environment. And in nations where DDT is still sprayed -- like India -- mosquitoes have developed resistance.

The movement of workers from malaria-free regions to unsanitary, mosquito-infested urban neighborhoods has also contributed to the resurgence of the disease. And control efforts are often least consistent in areas that need them most, tending to lapse in times of economic and political stress. Poorly executed infrastructure and development programs are other factors. Last year, two dams burst in India's Rajasthan state, submerging 4,900 hectares of farmland and creating a vast breeding ground for mosquitoes. In Latin America, massive deforestation to make way for human settlement has boosted incidence of malaria throughout the region.

Its human costs aside, the disease exacts a huge economic toll. A case in Africa typically sidelines an individual for 10 working days. In 1995, the cost of health care, treatment and lost production due to malaria in tropical Africa was estimated at $1.8 billion. The enormity of this economic loss becomes clearer when contrasted with the cost of treatment: a sufferer can be cured for as little as a few dollars.

The war against malaria can be won. Pharmaceutical researchers are closing in on a long-sought, effective vaccine.. Other scientists are studying how to alter the genetic structure of malaria-spreading mosquitoes so they breed less. But aa U.N. survey last year notes that such high-tech solutions, even if they are effective, may be too expensive to help peoplee who need them the most. In Africa and some parts of Asia, even a vaccine that costs a few dollars may be beyondd individual means..

Fortunately, there are other weapons against malaria. Scientists are looking closely at traditional medicines such ass qinghao, a Chinese herbal drug that has been in use for 2,000 years. Also under scrutiny is the bitter bark of a Peruviann tree called the cinchona, for centuries regarded as effective by locals. Another cost-effective weapon: mosquito nets.. Soaked in safe insecticides, the five-dollar devices can provide protection for six months. But even this expense may bee prohibitive. The WHO estimates that a community of 7,000 requires 3,000 nets at a cost of $15,000, not including insecticide.. The organization is seeking funds from donors..

New, expensive tools to combat malaria mean little when the problem is concentrated among the world's poorest countriess -- which also have the least international clout. The global community needs to build a political consensus that itss resources should be applied where they can help the greatest number of people. That is an essential first step toward anyy effort to eradicate malaria worldwide..