Malaria control is moving so quickly that any snapshot of progress is necessarily a blur.

This is certainly true of the new UNICEF report “Malaria & Children: Progress in intervention coverage,” released today at the Gates Foundation Malaria Forum.

It shows that malaria control efforts have turned a corner, setting the stage for dramatic gains in the next few years—and that the rate of change is accelerating.

It’s a tale of two reports, really. The first draws on data from 2005 household surveys across sub-Saharan Africa, which feels like a lifetime ago. In 16 of the 20 African countries where data was available, insecticide-treated net (ITN) coverage at least tripled between 2000 and 2005. Still, only 26% of households in sub-Saharan Africa owned a mosquito net of any kind at the time of the survey—well below global targets.

Medicine is likewsie a mixed bag. Most African governments overhauled their drug policies by 2005 to prioritize effective new Artemisinin-based combination therapies (ACTs) over chloroquine, which was producing drug-resistannce. But the percentage of children treated in Africa actually decreased between 2000 and 2005 (from 41 percent to 34 percent), reflecting the higher cost of ACTs.

The second report, living between the same covers as the first one, tells a far more inspiring story, reflecting the dramatic strides since 2005. Here, all signs point in the same direction.

Funding for malaria control has risen substantially over the past few years. (more…)

Tuesday to Thursday this week, Malaria No More’s Martin Edlund is live blogging from the Gates Foundation’s Malaria Forum in Seattle.

Perhaps no country in sub-Saharan Africa is being quite so closely scrutinized as Zambia. Landlocked and malaria endemic, it is an ideal proving ground for what’s possible in malaria control.

It’s difficult to exaggerate the role malaria plays in daily life in the country. Nearly 20 percent of Zambian children do’’t reach their 5th birthday, and malaria is the single biggest reason why. There are 4 million reported malaria cases in the country each year, and an estimated 50,000 deaths due to the disease.

Roadside billboards warn about the threat of malaria on the way to and from the airport; Boy Scout troops get merit badges for their knowledge of the disease. In some provinces, as many as 1/3 of all children are sick with the disease at any one time.

But these alarming stats only make the country’s recent turnaround all the more impressive.

Zambia will distribute 3 million insecticide-treated nets by the end of year, putting it on track to reach its goal of 80% coverage by 2008; 62% of pregnant women received preventative treatment nationwide; and indoor residual spraying (IRS) of insecticides has reached 85% coverage in 15 target districts, protecting 250,000 structures (or 1.5 million people).

Part of what sets Zambia apart is the quality of its data. Thanks to its partnership with the Gates-funded MACEPA project, Zambia is able to go beyond mere distribution figures to measure real impact.

Minister Chituwo shared some of the results at the opening session of the Gates Forum. Children 5 and under living in households with two or more mosquito nets had 38% fewer cases of fever, 51% less malaria infection, and 30% less severe anemia than those in houses without mosquito nets or IRS, he reported. “Immediately we have been able to see the numbers of children in hospitals declining.”

Far from satisfied, Minister Chituwo challenged the Gates audience to go further. “If these results are showing success, it is a matter of aiming higher,” he said. “80 percent [coverage] by 2008, with the help we are having surely we can do better. Why not 100 percent?”

-Martin Edlund, Malaria No More

Malaria No More’s mission is simple: no more deaths from malaria. Learn more and help prevent a million child deaths this year by donating a $10 bed net at www.MalariaNoMore.org.

Seattle is welcoming malaria notables with fanfare usually reserved for movie stars. In fact, they’re hardly distinguishing between the two.

A cover article in today’s Seattle Times calls the Gates Malaria Forum malaria’s “Oscars,” its “Woodstock.” “This is probably as competitive a ticket as the Bruce Springsteen concert,” one fortunate attendee is quoted as saying. (Read the full text here.)

Here come some of the malaria A-listers now. As the conference gets underway, it’s worth knowing who they (and the institutions they represent) are…

• Rear Admiral Tim Ziemer is the head of the U.S. President’s Malaria Initiative (PMI), a $1.2 billion five-year initiative to control malaria. Looking dashing in work boots still caked with red dirt, he is just back from one of the 15 African countries where PMI is working to cut malaria deaths by half. By the end of 2007, the program expects to reach 30 million people with lifesaving malaria prevention and treatment.
• Chairman of the Board of the Global Fund to Fight AIDS, TB, and Malaria, Rajat Gupta, comes from the private sector as a senior partner worldwide of McKinsey & Company. The Global Fund was created by the world’s wealthiest countries in 2002 and currently provides 2/3rds of all funding for malaria prevention and treatment programs worldwide — almost $3 billion since 2002.
• And the click of cameras can only mean, yes, it’s Minister Tedros Adhanom Ghebreyesus, the Minister of Health from Ethiopia. Minister Tedros is a rising star in malaria circles thanks to his country’s aggressive distribution of nearly 20 million bed nets over the past two years. As recently as 2003, Ethiopia trailed its neighbors with only five percent of households owning a single bed net. Today, it is fast-approaching an unprecedented goal: providing two long-lasting insecticide-treated nets for all households in malaria-endemic areas.

And with that, the orchestra is warming up and the conference is getting underway. Let us send you inside…

-Martin Edlund, Malaria No More

Malaria No More’s mission is simple: no more deaths from malaria. Learn more and help prevent a million child deaths this year by donating a $10 bed net at www.MalariaNoMore.org.

Tuesday to Thursday this week, Malaria No More’s Martin Edlund will be live blogging from the Gates Foundation’s Malaria Forum in Seattle. Below he provides some background.

Malaria: the Basics

Through a determined military-style effort, the United States managed to eliminate malaria domestically in 1951. Most Americans haven’t thought a lot about it since. As we head into this week’s Gates Malaria Forum, it’s worth reviewing what a massive health crisis malaria remains in the rest of the world.

Malaria kills more children in Africa than AIDS, TB, cancer, or any other disease: 3,000 kids a day, and more than 1 million people a year.

That’s only the tip of the iceberg. There are an estimated 350 million to 500 million malaria cases a year globally. People in malaria-endemic areas often suffer multiple bouts a year, laying them up for weeks at a time (or worse). One area in northern Zambia recorded 1,353 cases of malaria for every 1,000 children in 2005—more than one case per child.

Public health discussions often refer to something called the Basic Reproductive Number, or BRN. It’s the number of people that will become infected with a disease, on average, from a single infected host.

HIV/AIDS has a BRN of one, meaning that one new person gets infected for every one person that has the disease. Measles has a BRN of 12 to 14. Malaria’s BRN is a staggering 100!

The culprit in Africa is an especially effective vector called the Anopheles mosquito, which has a taste for human blood. At the height of the rainy seasons, they descend on the landscape like a haze; there are an estimated 100 billion Anopheles mosquitoes in Africa alone.

Anopheles is nocturnal, so it feeds on humans while they sleep, depositing a few microscopic malaria parasites into the bloodstream as it finishes its blood meal. That’s why bed nets are such an effective first-line of defense: they keep the mosquitoes at bay (and if the nets are insecticide-treated, kills the mosquitoes on contact).

I got a sense for just how pervasive malaria can be on a recent trip to Lusaka, Zambia, with American Idol finalist Melinda Doolittle. We had come to distribute insecticide-treated nets provided by donations from American Idol fans.

One afternoon, we visited a local church where a group of kids had gathered to hear Melinda sing. Following the performance, Melinda asked them, “how many of you know what malaria is?”

All 30 kids raised their hands.

“And have any of you actually had malaria?” more than 20 hands remained in the air.

We spent the next few minutes listening to these precious little kids in church clothes talking about their fevers and racking pains, the vomiting and delirium that are the unmistakable hallmarks of the disease.

Malaria is most often fatal in people with little or no acquired immunity and weakened immune systems: children under 5, pregnant women, and people suffering from HIV and TB.

“Wow, that was really disturbing,” I remarked to Melinda as we left the church.

“And to think they’re the lucky ones,” she said. “They survived to talk about it.”

-Martin Edlund, Malaria No More

Malaria No More’s mission is simple: no more deaths from malaria. Learn more and help prevent a million child deaths this year by donating a $10 bed net at www.MalariaNoMore.org.

This week, global leaders of public health, business, and government will descend on Seattle for the Bill & Melinda Gates Foundation Global Malaria Forum.

Normally, a gathering of the technocratic jet set is not the stuff of headlines. But this meeting promises to be more than just Power Points and plenaries. The ONE Campaign and Malaria No More are teaming up to bring you the inside scoop through a series we’re calling “Gates Crashing: Blogging the Gates Malaria Forum.”

Why all the fuss? Malaria control is at a tipping point; there’s a growing sense that we may be able to scratch this public health crisis off the list. For the first time in a generation, experts and advocates are using the word “elimination” with a straight face.

It won’t be easy, of course. Malaria has been around as long as mankind (probably longer) and it continues to quietly kill a million people a year, mostly kids and pregnant women in Africa. I say quietly because the world is so inured to this tragedy that it rarely merits a mention in the developed world.

But there’s plenty of cause for hope, and the Gates forum will be equal parts progress report and pep rally. UNICEF will release findings of its new “Malaria and Children” report; Ministers of Health for Zambia and Ethiopia, two of Africa’s most dramatic success stories, will update the world on their work; there are even rumblings about a major announcement in the hunt for a malaria vaccine.

For those of us in the malaria-fighting business, the highlight will be the keynote from Bill & Melinda Gates. This power couple for the powerless has done as much as anyone to put malaria on the agenda, adding a whiff of entrepreneurial possibility to the stale air of public health debate.

Join us Tuesday through Thursday at www.ONE.org/blog for dispatches from the frontlines of the fight against malaria. Until then…

-Martin Edlund, Malaria No More

Malaria No More’s mission is simple: no more deaths from malaria. Learn more and help prevent a million child deaths this year by donating a $10 bed net at www.MalariaNoMore.org.