Can we really eradicate malaria?

Bill Gates and Stephen O'Brien believe we can eradicate malaria within their lifetimes - at least as long as they both live to be 100. Gates needs no introduction. O'Brien is the chairman of the all-party parliamentary committee on malaria in the UK. He is much the same age as Gates, he tells me, though there probably the resemblance ends. He is a health spokesman in David Cameron's party and may well be part of the next government. And he was born in Tanzania, remembers DDT spraying when he was a child, and has been involved in the fight against malaria for the last 30 years.

The point is that there has been for some time a growing sense that malaria could be stamped out - if not across the planet then from much of it. O'Brien credits Bill and Melinda Gates with triggering this in November 2007. "They said we are going to set it as an objective to eradicate malaria within our lifetimes. It was hugely ambitious and radical," said O'Brien. Clearly he wants to believe it. But other people now want to as well.

Today his committee published a report that he describes as "a huge stock-take of the whole approach". Some things are going really well. There are now long-lasting insecticide impregnated bednets, for instance, and 30% of those who need a bednet in malarial regions have them. The artimisinin drug combinations are working well. There is a possible vaccine on the horizon. Against that, there is drug resistance on the Cambodian border, which is where chloroquine first began to fail in the 1950s before it lost effectiveness in Africa, increasing bednet coverage to 100% is going to be hard and that vaccine is probably only around 50% effective.

So there are tools that can work and hopefully there will be more and better ones. The more critical factor is conviction, and what follows from that - money. And the hardest part is keeping that conviction and that money at a high level, even when some regions start to be cleared of malaria. This is what the report says:

Not all commentators are supportive of the attention paid to malaria elimination. There is a real risk that expectations will be raised too high and that support and interest will then wane when targets are missed. Subsequent reduced interest and commitments to malaria could result in overall deterioration in malaria control. In those settings where control improves and malaria transmission decreases, it is inevitable that populations will become less immune to malaria. Any lapse in commitment to full scale control in such settings may lead to devastating epidemics. Yet elimination will never be achieved if this phase is not passed through.

O'Brian talks of the need for political buy-in. That applies also to his own party if Cameron becomes the next UK prime minister. Nobody quite knows what the Tories, in power, will do for international development. It has not usually been a major priority in the past. But if he and Gates and Margaret Chan at the WHO and all the others who have backed this fight continue to spread energy and enthusiasm around, who knows what is possible?

And full marks to Brian Williams, professor of epidemiology in South Africa, for declaring at American Association for the Advancement of Science meeting in San Diego that transmission of HIV could be halted within five years if everybody at risk is tested and every person who is positive put on antiretroviral drugs. Yes - of course he is right. There is no problem with the analysis. We know it makes sense. The G8 is already pledged to "universal access" to HIV drugs. The very much bigger issue is how it is going to be done. At the end of 2008, only 4 million people were on the drugs out of the 9.5 million in urgent need of them to stay alive. But maybe some more front page headlines like those generated by Williams' presentation in San Diego will help.

Posted by Sarah Boseley Monday 22 February 2010 17.34 GMT guardian.co.uk

http://www.guardian.co.uk/society/sarah-boseley-global-health/2010/feb/22/malaria-prevention-health