Net benefit

IT IS a ubiquitous scene in east Africa’s coastal villages: hung from trees or big bushes, bed nets shelter families sleeping outside in search of a semblance of night-time cool. Treated with synthetic insecticides, the nets repel mosquitoes and kill those that alight on their surface. Thanks to a surge in money for nets and other interventions, death rates are 26% below their level in 2000, according to the World Health Organisation (WHO), though the global toll in 2010 was still a shocking 655,000. A report promoted among others by Ray Chambers, the UN’s special envoy against the disease, says a new push will bring a huge return. But raising the cash will be tricky and getting the promised result harder still.

The latest assault on malaria is unprecedented. Last year an array of organisations, including the Roll Back Malaria Partnership, based at the WHO and founded in 1998, the Global Fund to Fight AIDS, Tuberculosis and Malaria, founded in 2002, and the President’s Malaria Initiative, founded under George Bush in 2005, spent a record $2 billion fighting it.

The Roll Back Malaria Partnership has set goals for 2015 that include the heroic aim of cutting malaria deaths to near zero. This would mean more than doubling spending, to $5 billion a year. Mr Chambers is trying to rally the troops. The report he is to present estimates the benefits of fighting malaria in sub-Saharan Africa, which is reckoned to have accounted for nine-tenths of worldwide deaths from the disease in 2010.

Universal deployment of good treatment, diagnostics and preventive measures, including bed nets, would—in theory—prevent 640m malaria cases and 3m deaths by 2015, the paper explains. This would cost at least $6.7 billion between 2012 and 2015, says the African Leaders Malaria Alliance, a regional lobby. But, says the report, it would be a brilliant investment, yielding an astonishing $231 billion-$311 billion, counted in lives saved and malaria cases averted, if you factor in productivity gains and savings in the cost of treatment.

That $6.7 billion is not likely to materialise in its entirety soon. Nor does it include the cost of training health workers and improving surveillance. Problems of counterfeit or substandard medicines are particularly worrying. Tanzanian regulators recently seized 155 containers of fake anti-malarials. Since 2010 the Global Fund has subsidised the private market for the best anti-malaria drugs, known as artemisinin-combination therapies (ACTs). But Roger Bate of the American Enterprise Institute, a think-tank, found that 8% of subsidised ACTs in his sample had too little of the active ingredient. Moreover, those mosquitoes are beginning to resist ACTs and popular insecticides. The battle is far from over.