The great benefit in saving so many children by suppressing malaria, might have a negative consequence - malnutrition. As more and more children survive, who will feed them? This reflects the classic dilemna enunciated by the Rev. Malthus some centuries ago. He saw it as a race between population growth and growth in food supply - with the food supply losing. Do we face that same dilemma when we suppress malaria? Let us look at some recent data from Africa.
There is some good data on malaria suppression in Africa, both from the US Presidential Malaria Initiative, and from World Bank figures on crop production. This gives us a sound data base.
We do know some really good things about suppressing malaria in Africa, which might offer hope. Suppressing malaria boosts the productivity of adults, so they can grow more rice, maize or corn. Suppressing malaria saves the lives of children whom we cherish.
But a question raised by Malthus around 1830 was whether increased productivity will keep ahead of the growing population in agricultural countries? Malthus was an English cleric and scholar who made the dismal prediction that increases in population would outstrip increases in productivity, leading to famine. And certainly by lowering the death rates, malaria suppression might increase this dismal spiral downward.
In this same dismal spirit, a recent very complex computer estimation of malaria deaths and disease - including extrapolations about impacts on economic consequences - led to the conclusion that it was not economically profitable to fight malaria in Africa (Ashraf et al from Brown Univ, USA in NBER Macroeconomics Annual 2009 April 23:157-294). He concluded that the increase in population because of suppressing malaria would eat up the increase in agricultural productivity, a la Malthus. Thus malaria suppression would increase malnutrition.
However we must be cautious - because of the myriad assumptions, coefficients and extrapolations inherent in such complex computerized simulations. Their predictions should always be compared with reality before basing any policy decisions on their predictions.
Perhaps according to Ashraf we should hand out condoms along with those bednets. And perhaps as part of our attack on the mosquitoes, we should use backhoes or shovel brigades or ditching, to reclaim swamps, and turn them into cornfields, or rice paddies.
Additionally, condoms prevent HIV transmission, and backhoes increase agricultural productivity, both good objectives by themselves and doubly so in the context of suppressing malaria. So maybe condoms and backhoes are good ideas anyway!
Now, let us examine some recent data from Africa on malaria, food production and population to see if the dismal theory of Malthus and the dismal computer simulation of Ashraf should concern us in our attack on malaria.
The US Malaria Initiative began suppressing malaria in Mali in 2006. The population of Mali in 2006 was 12 million and by 2012 it had increased to 14 million people.
Rice production increased from 684,000 metric tones in 2006 to 1,310,000 mt in 2012. So the amount of rice produced per capita went from 56 kg/cap in 2006 to 94 kg/cap in 2012. Clearly Mali won the Malthusian race.
The Malaria Initiative has also been working in Liberia, another country dependent on rice for food. From 2007 to 2012 the number of people went from 3.8 million to 4.7 million.
During those same years rice production went from 100,000 mt to 170,000 mt, and thus the per capita food production went from 27 kg/cap to 36 kg/cap. So Liberia won this one too.
In Tanzania maize or corn is the principal food. The population rose from 38 million to 43 million between 2005 and 2012, and maize production rose from 3.5 million mt to about 5.5 million mt during that same time. So the amount of food per person went from 93 kg/cap to 128 kg/cap. Again Tanzania beat Malthus.
The Good News
Thus the Good News about suppressing malaria in Africa – which we must celebrate enthusiastically – is that the additional population created by saving children’s lives will be fed by the increased agricultural productivity of their healthier parents. Isn't that Good News?