The Malaria Eradication Pipedream

Is eradicating malaria a pipedream? Some think it is. A thoughtful discussion of the possibility, or impossibility–take your pick–of doing so appears in today’s Science Times.

The goal of eradicating the disease was presented by Bill and Melinda Gates at a Forum on Malaria the Gates Foundation hosted last year in Seattle. Before hearing Melinda Gates call for eradicating the disease the scientists in attendance had spoken skeptically about the “E” words–eliminate or eradicate. Ms. Gates issued the challenge the second morning of the event and the tone of the meeting changed.

There is good reason for skepticism. The parasite has shown extraordinary adapatability. As writer Donald G. McNeill, Jr. points out, the best chance to eradicate the disease came in 1955 when chloroquine and DDT had reduced the number of cases to a mere 500,000. The near success, however, was the undoing of eradication. Young scientists chose other fields of research, the parasite adapted to the pesticide and the medication, and the use of DDT came under suspicion and was halted.

The parasite roared back even stronger than before. The world has been nowhere near as close to eradication since. This history makes for sobering reflection.

But considering malaria a medical issue apart from other important circumstances in life is to miss the point. A key issue that begs attention is the connection of malaria to poverty. MacNeill quotes a veteran malaria scientist who says malaria won’t be ended until Africa ends civil strife and poverty. Malaria is a disease of poverty. It’s occurrence cannot be separated from poverty. Poverty is a cause of and a result of social instability. Where war rages people suffer economically. Where poverty exists social instability is likely.

Those who are still afflicted with malaria live in areas that are infested by poverty as they are infested with mosquitoes. Given this reality, the effort to eradicate malaria is also connected with the effort to eradicate poverty and social stability. The disease cannot be separated from the social realities in which it afflicts and kills. Economic development and community organization are directly related to public health. It is no pipedream to seek a better life for all. It is necessary for survival.

We would do well to recognize that life is interconnected and the diseases of poverty are not going to be conquered by medical interventions alone. These are obviously important. But if they are not accompanied by environmental improvements, better economic opportunities, effective community services and responsible governance, we know the hope of eradication will be a pipedream. But we can dream a different future and set about making it happen.

It’s a matter of which dream we choose to make real.

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