Low-Cost, High-Impact Solution to Save Millions in Africa

Apr 29 , 2023
By Bjorn Lomborg

Most people think malaria is a problem faced only by humid and hot countries. But over a century ago, the disease thrived as far north as Siberia and the Arctic Circle. It was endemic in 36 states of the United States.

Much of the developed world eliminated malaria in the 1950s through increased prosperity, housing and breakthroughs in medication and insecticides. As people became wealthier, mosquito breeding ground marshes were drained, and increased livestock meant mosquitos had animals to bite instead of humans. Improved nutrition made people healthier and less vulnerable, while increased incomes afforded better homes and insect screens.

Quinine and then synthetic chloroquine gave developed countries affordable treatment, and insecticides wiped out many mosquito populations.

Outside of sub-Saharan Africa, annual deaths plummeted from more than three million in 1930 to fewer than 30,000 today. Yet, much of the malaria problem has stubbornly remained in Africa, killing more than half a million people yearly. Ethiopia had almost 3.8 million malaria infections in 2021 and 8,000 deaths from it.

There are two key reasons.

The malaria parasite found in Africa is the deadliest, and strains have developed resistance to the common medicine chloroquine. The prevalent malaria-spreading mosquitos in Africa almost exclusively bite humans. There was progress against malaria in Africa at the start of the 2000s, but that was halted by Covid, which disrupted basic medicine and caused around 60,000 more deaths.

The world has long promised to get rid of malaria for good. The Global Malaria Eradication Program was established in 1955, before it was abandoned in 1969 because the goal was deemed unachievable. In 2015, world leaders renewed the pledge. In the UN's global promises known as the Sustainable Development Goals (SDGs), all countries undertook to fix almost every global problem by 2030, including malaria.

Progress has been glacial, meaning the malaria goal will be achieved some 400 years later. This is just one of many spectacular failures of the big UN promises. Politicians promised too much: the global priorities include an impossible 169 promises, which is indistinguishable from having no priorities at all. This year, the world will be at halftime for its 2030 promises, yet it will be nowhere near halfway.

It is time to identify and prioritize the most crucial goals. The Copenhagen Consensus, a think tank, is doing that; together with several Nobel laureates and more than 100 leading economists, we have been working for years to identify where each dollar can do the best.

Our new research on malaria, written by Rima Shretta and Randolph Ngwafor at the University of Oxford, proposes a 10pc point scale-up and use of bednets in the 29 highest-burden countries in Africa alongside insecticide resistance management strategies between now and the end of the UN's promises.

Ensuring people sleep under an insecticide-treated bednet is one of the most effective ways to prevent malaria. Mosquitoes are blocked by the netting and killed by the insecticide. Bednets each cost less than four dollars, yet result in a dramatic reduction in transmission by ensuring mosquitos die before parasites can mature and spread.

It is important that budgets are not just distributed but actually used correctly, which requires social behaviour change and communications and information sharing. Even allowing for this — and for the higher price tag of responding to resistant strains of malaria — the cost across this decade is about 1.1 billion dollars a year. To put this into context, it is one-third of what the US population spends on lipsticks each year.

This investment would save 30,000 lives this year. By the end of the decade, the number of malaria deaths will be halved, saving  1.3 million lives in total.

Bednets also mean many fewer infections with malaria. The research shows that 242 million fewer people will get sick in 2030, drastically reducing healthcare costs. Reducing the number of sick people means adults can go to work, and children to school. Caregivers are not stretched, which increases productivity at a country level.

Putting all these factors together, every dollar spent on this campaign would yield societal benefits worth 48 dollars — a phenomenal return on investment.

We have allowed malaria to turn into a disease of poverty in Africa. And while we cannot deliver on all the global UN promises, we ought to deliver on the smartest things first. Distributing and using insecticide-treated bednets would cost little but save 1.3 million lives.

PUBLISHED ON Apr 29,2023 [ VOL 24 , NO 1200]

Bjorn Lomborg is President of the Copenhagen Consensus and Visiting Fellow at Stanford University's Hoover Institution. His new book is "Best Things First", which The Economist named one of the best books of 2023.

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