BioEd Online

The Bill and Melinda Gates Foundation is backing an ambitious project with the Zambian government to reduce deaths from malaria by three-quarters in just three years. They plan to use existing controls such as bednets, drugs, and house spraying on a much wider scale than ever before.

"We think that this partnership can establish the value of scaled-up, national malaria control as the gold standard in Africa," says Regina Rabinovich, director of the Gates Foundation's Infectious Diseases Program. The world needs "a blockbuster success against malaria," she says to "encourage both donor countries and developing countries to devote greater resources to fighting it."

The new project is known as Malaria Control and Evaluation Partnership in Africa (MACEPA), and will be run by the Seattle-based non-profit organization PATH with a nine-year US$35 million grant from the Gates Foundation.

Brian Chituwo, Zambia's health minister, says his government has pledged to provide insecticide-treated nets for 90% of households, and to ensure that 60% of patients get treated with antimalarial artemisinin drugs within 24 hours. It also hopes to provide prophylactic drugs for 90% of pregnant women, who lose their naturally acquired immunity to severe malaria during pregnancy.

MACEPA will also work with the UN-led Roll Back Malaria Partnership; the Global Fund to Fight AIDS, Tuberculosis, and Malaria; and the World Bank. Roll Back Malaria, established in 1998, has pledged to cut malaria deaths worldwide by 50% by 2010, but it is far off track because international efforts have been too fragmented.

"In the past there wasn't a global or governmental commitment," Chituwo told news@nature.com. "There was much rhetoric, but in terms of actual resources, we did not do well."

Measuring success

Monitoring the effectiveness of its campaign will be a high priority, says Carlos Campbell, MACEPA programme director at PATH, and former head of malaria at the US Centers for Disease Control and Prevention in Atlanta, Georgia. He hopes that clear evidence of their success will guide large-scale efforts in other nations.

More money has recently become available to tackle the disease, and a flagship campaign like MACEPA could help to make best use of the funds, Campbell adds. The Global Fund has currently pledged $949 million over two years for malaria control, for example, and this may rise to $1.83 billion over five years. Of this, Zambia has been allocated $38 million over two years, and may get as much as $83 million over the next five years.

The project will also measure the economic impact of reducing deaths. Given that disease is a major cause of poverty, the partnership hopes its figures will prove to governments that public health improvement can substantially boost a nation's economic performance. Malaria is estimated by the World Bank to cut the economic growth of African countries by at least 1.3% annually.

Chituwo adds that it was the social and economic impact of malaria, which is responsible for 40% of child deaths in Zambia, that had prompted his government to make malaria control a priority.