Yesterday’s New York Times prominently featured an article describing the debate in the public health community about what are appropriate goals for the fight against malaria. Goals for fighting malaria vary between improving access to control and prevention measures and full eradication of the disease. Full eradication of the disease would mean that no person has the disease, but also that it exists nowhere, except as the New York Times notes, in a laboratory. This was last accomplished with smallpox when the last naturally occurring case of smallpox was recorded in 1977 in Somalia. Smallpox was certified eradicated in 1980.

The most recent round of discussions were sparked late last year when Bill and Melinda Gates called for a push towards eradication at a conference they held in Seattle. Despite the excitement created for such an initiative, the announcement enlivened debate among the scientific community about whether eradication is a realistic goal to set for the community and the potential disappointment of setting the goal and not reaching it. Smallpox had a unique set of credentials that made it a candidate for eradication, including that it could only be carried by humans rather than be primarily carried by mosquitoes in the case of malaria.

The past several years have seen a rapid increase in funding for fighting malaria. Spending from the United States, the Global Fund and World Bank on malaria from 2001 to 2003 was only $348 million. From 2004 to 2006, this number rose to just over $1 billion. The current version of the PEPFAR bill just recently agreed to in the House called for $5 billion in spending on malaria over the next 5 years from the United States alone. This would fund the United States’ proportionate share of the global estimates to achieve universal access to control and prevention for those living in endemic countries. Senators Clinton, McCain, and Obama have all committed to significantly ramp up the United States’ spending on malaria if elected president.

Though the debate about eradication versus control is one that is largely restricted to academic settings and concerns about setting realistic expectations, it is one that is likely to increasingly play out in the public discourse as the United States moves to spend more on fighting this disease.

-Josh Lozman