Last week I was in Geneva, trying to understand the WHO fight against malaria, when - to my delight - the folks at CERN announced that they had found the Higgs Boson! In fact we were driving out near Geneva Airport, right over the Super Hadron Collider, when they made the announcement. But it made me wonder about WHO. Why was it easier for CERN to find the Boson than for WHO to suppress malaria?
Finding the Boson took 50 years and about $10 billion. But we have been fighting malaria in Africa for about 70 years, with only partial success, and shrinking funding. The combined budget needed to suppress malaria to about half its current transmission rate is about $6 billion per year, and we have less than $2 billion available currently. So in comparison, finding the Boson was easy.
The mythological vaccine won't change things either, judging by the one currently being celebrated. It gives protection about half the time and for only a year or two. That has no practical public health value. When a good one comes along someday, of course we would use it, but I don't see one in my life time.
Instead, we should approach suppression of malaria as a normal public health program, in which governments establish career positions for malaria epidemiologists and entomologists who will run malaria suppression as part of normal operations. As these people gain field experience, they will develop broad, integrated strategies which take into account the local populations, ecology and epidemiology. In the meantime they will be reducing the death rate drastically. Malaria won't go away, we have to deal with it as a continuing problem and suppress it to low prevalences that we can live with. There is no Super Hadron Collider to use on it, so we have to use all available methods, concentrating on the sustainable ones like permanent environmental modifications, integrated management of larval habitats, drainage, improved irrigation, improved water management, improved housing with screens, community empowerment and health education. A fine example of this is in Malaysia where they have been holding malaria incidence at microscopic levels for decades. See http://www.actmalaria.net/IRW/IRW_Malaysia.pdf And be sure to see all the pages following their chart of incidence vs time at the end of their website. We have to use drugs and biocides judiciously, as they inevitably produce resistance. The replacement drugs and biocides cause spiralling costs, which eat up funds needed for all the other sustainable methods.
However we need to focus on suppression of malaria NOW, and we have to use all available methods instead of focussing on only drugs and biocides. If we put our money into African efforts, it would save the lives of more children than if we put our money into gleaming laboratories in the North. For me, the best investment is to protect African children now, rather than let them die from malaria while Northern scientists look for a miracle. Finding the Boson was great fun for the physicists, and finding a vaccine would be great fun for the immunologists, but what about all the people who are dying in the meantime? Maybe a million people a year? Let's go for malaria suppression NOW. We can do it.