Dr. Richard Feachem, Executive Director of the Global Fund to Fight AIDS, Tuberculosis and Malaria, warns that malaria has become more difficult to control over the past two decades, as drug-resistant forms of the disease have spread across tropical Africa and even reappeared in some regions where it had been virtually eradicated.

“Paradoxically,” Dr. Feachem adds, “effective tools are now available to control malaria and to reduce dramatically malaria-related mortality among vulnerable groups such as children under five and pregnant women. It’s not that we can’t do it,” he says. “We’re just not doing it.”

However, “doing it” requires political will in the form of well managed malaria control programs in countries where the disease is endemic. It also requires ample donor funding, such as the multi-million dollar grants now beginning to flow from the Global Fund, to pay for effective malaria treatment and prevention programs. They cover everything from drugs and rapid diagnostic tests to insecticide-treated bednets.

In a financial lifeline to developing countries, Novartis and the World Health Organization (WHO) are making Coartem available at cost under a unique public-private partnership. Moreover, Novartis and Medicines for Malaria Venture, a not-for-profit health organization, are jointly developing a pediatric formulation of Coartem which will be easier for children to take and could make

The WHO now recommends that countries adopt artemisinin-based combination therapies (ACT), such as Coartem, “when there is strong evidence that existing conventional medicines are no longer working.”

Several countries in sub-Saharan Africa are following that advice. Zambia revised its national malaria-control policy during 2002, adopting Coartem as first-line treatment. Other countries, from Mozambique and Burundi to Swaziland and Sudan, have added ACT options to their national malaria policies, or are considering use of Coartem in emergency settings, such as refugee camps, where drug-resistant malaria is often rife.

In addition to the agonizing death toll, malaria costs sub-Saharan Africa an estimated USD 12 billion a year in lost economic growth. Preliminary health-economic analysis of the KwaZulu-Natal data suggests that while Coartem therapy is more expensive than the older treatments (USD 2.40 per adult treatment course at the preferential WHO price for Coartem, versus 10–20 cents for sulfadoxine pyrimethamine (SP) or chloroquine), total treatment costs with Coartem are significantly lower, due to the dramatic reductions in the overall number of patients needing treatment and in the number of complications requiring hospitalization.

“The Coartem approach has clearly been cost effective. Even if the unit costs are more, total costs are less,” Professor Green-Thompson explains. “But the ultimate equation is not in currencies but in human lives.”