Malaria and the politics of disease

One quick shot may not be enough

A breakthrough moment in awareness of a terrible scourge

See article

Readers' comments



Brazil announced a new malaria treatment that scientists say offers a potentially cheap and effective way to attack a disease that largely afflicts the world's poor. The treatment combines existing malaria drugs artesunate and mefloquine into a single, fixed-dose tablet and reduces the cost of treatment. A key benefit is that it reduces the number of tablets patients must remember to swallow.
The Brazilian government will distribute the medication, known as ASMQ, free of charge and will transfer the technology to India for production and distribution in Southeast Asia, where a full course of treatment should cost around US$2.50 (euro1.58).


I have some personal experience in Ghana.There is little in the way of diagnostic equipmentavailable, and doctors seldom use it. They assume the patient has malaria and prescribe accordingly. That IS the diagnosis. A doctor in europe or north america doesn't need to perform tests to diagnose the common cold. Drugs are cheap because they are sold on the open market. Testing equipment is expensive, and perhaps no more essential than white4 wheel drive vehicles with UN logos for officials to ride in. Any solution has to be based on prevention andmanaged by the local people. The new drugs kill malaria quickly, but taste so bad that people discontinue them. Fortunately malaria has no resistance to artesunate. Also hospitals are very enthusiastic about giving unnecessary injections, and people fear going. I think each village needs one foreign paid, locally respected person to promote bed nets and prompt treatment as a social duty.


It will take ongoing work to motivate people in poor rural areas in Africa to use nets. Nets get sold, or grabbed by high status older people, or simply not used because there isn't a present problem. To take preventive measures requires a concept of the future. Fortunately education through repetition of the message can help. People in the developed world will have to work on understanding the cultural aspects of getting bed nets used and distributed. Giving them to the hospitals didn't work in ghana. Staff sold them. Hiring one high status person to distribute them and follow up might.


AMREF joins with The Economist in celebrating the fact that malaria is nearing the top of the global public health agenda, with significant injections of funding for insecticide-treated bednets, indoor residual spraying and effective artemisinin-combination therapy (ACT) drugs. And we recognise that these efforts are paying dividends. In Ethiopia, for example, the mass bednet programme has reduced child deaths by more than half.
AMREF also shares The Economist’s view that these efforts need to be sustained over a long period of time for malaria control efforts to be effective.
But, it is insufficient to throw money at these interventions alone. A key challenge is to have a better understanding of, and closely involve, the people you are trying to help.
Take bednets for example. Poverty is pervasive in most of the countries where AMREF works and people often sell their bednets to buy food, as they don’t realise how the nets can prevent malaria and hence save them money in medical bills. Net distributions have to be accompanied by education sessions that are culturally specific to the respective communities.
Gender disparities also have to be addressed. Men often use the nets, as they see themselves as the most important members of the family and don’t realise that women and children are much more vulnerable to malaria.
More investment is needed in strengthening health systems. It’s not enough just to supply effective anti-malarial drugs; there has to be an adequate number of trained health workers to test for malaria, diagnose it and administer the drugs. And laboratories need to be adequately equipped and staffed.
More funding is needed for community health workers, especially in remote rural areas, so that people have access to drugs closer to their homes. Too many children die of malaria, as their mothers have to walk for days to get to the nearest health clinic administering anti-malarial drugs.
Health systems also need to integrate the management of malaria, HIV/AIDS and TB, as they are all inter-related. It is widely acknowledged that HIV infections result in a greater risk of death from malaria and malaria infection itself leads to an increase in HIV viral load among adults and possible increased mother-to-child transmission of HIV during pregnancy. HIV weakens the cells in the immune system that are needed to prevent TB and TB is the leading cause of death among HIV-positive people.
To effectively tackle any of these diseases, it is important to manage them together, and health staff at all levels need the knowledge, skills and resources to be able to do this.
In short, malaria cannot be tackled in isolation. A much more comprehensive approach is needed, and funding opportunities have to take this into account.
Michael Smalley, Director General, AMREF


Linking prevention of malaria to
increased GDP helps everyone understand the value of this investment.
This also supports the long term commitment that is needed to combat
any of these disease areas. Thank you for the excellent article.



Products and events


Take our weekly news quiz to stay on top of the headlines

