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Are we winning the war on malaria or not?

Some experts are talking about the path to eradication. Others warn things are getting worse. They’re both right.

A woman sits in front of mesh cages of mosquitos.
A researcher feeds mosquitos in Rio de Janeiro, as part of a trial of a program to reduce mosquito-borne disease.
Mauro Pimentel/AFP via Getty Images

Last month, the Lancet commission released a report on our prospects of eradicating malaria forever. Its conclusion: no longer a sci-fi dream, malaria eradication is now possible in our lifetime.

“Malaria can and should be eradicated by 2050,” report co-chair Richard Feachem said in a press release accompanying the study. The Lancet’s research, funded by the Bill and Melinda Gates Foundation, outlines how that can be done.

Malaria is a deadly mosquito-borne disease that kills hundreds of thousands of people each year — mostly children and pregnant women. It’s one of the deadliest diseases in human history, with some researchers arguing that it may have killed half of all people who ever lived. (The most likely death toll is lower than that, but still staggering.)

But much of the developed world has now eradicated malaria, and through treatments, insecticide-treated bednets, and efforts to develop vaccines, its toll in the developing world has been reduced, too. Will we someday destroy it?

The Lancet report was optimistic, perhaps surprisingly so. To be sure, the approaches to malaria eradication it outlines are all scientifically and politically plausible. We’ve seen major advances in the last few years in the use of gene-editing techniques for safe, ecologically responsible pest control. New drugs have been developed and found to be effective. Studies have seen good results for mass administration of antimalarials.

In short, there are lots more tools in our toolbox — enough tools to bring an end within sight.

But the optimism felt out of step with recent communications on malaria from the Gates Foundation, the funder of the Lancet report. Malaria is a key focus for Bill and Melinda Gates, and they’ve spent years making the case that the disease can be eradicated.

But Bill Gates has taken a more pessimistic tone in his recent public statements about the future of the fight against malaria. In June, he warned us that progress was slowing thanks to drug and insecticide resistance, and in July he wrote about how infection rates have plateaued or increased.

So, what gives? Does the new Lancet report contradict those earlier pronouncements? Are things going better than we thought?

Two ways to look at the fight against malaria

The answer: not really. The difference between the new report and Gates’s most recent statements about malaria is a difference in emphasis, not differing views of the realities on the ground.

The fact of the matter is that right now, the progress we’ve been making against malaria has been slowing even as we’ve developed new tools for the job and even as new treatments and ambitious ideas like gene drives have advanced through the clinical research stage. Both the Lancet report and Gates’s more pessimistic statements reflect this fundamental reality. The different emphasis doesn’t reflect different facts, but two different philosophies about how to talk about progress in global health.

One philosophy is that we should keep all our attention focused on ambitious, but achievable, long-term goals, like ending malaria in a generation. It’s goals like those that inspire researchers and people, after all. And at least anecdotally, lots of people are moved to contribute to an effort to end malaria in a way that they wouldn’t be if the mission was framed as an effort to stem this year’s losses from the disease.

Donors find something compelling about solving a problem once and for all — and since, as the Lancet report acknowledges, donor backing will be essential to continued progress against malaria, it is important to clearly communicate a vision that they are moved by.

But the other philosophy is that it’s critical to keep at least some of our communications focused on the here and now, not on long-term ideas that still rely on untested technology. This year, hundreds of thousands of people will die of malaria. They’ll die because international aid has not been swift in following up on earlier gains. They can be saved if we commit more resources, now. Surely, it’s not a good idea to obscure that story in favor of an encouraging, but more distant, story about our eventual triumph.

To some extent, the Lancet report tries to bridge this gap — discussing both technologies that are on the horizon, like gene drives, and the tremendous gains that can be realized immediately by expanding use of technologies that already exist.

That seems to me to be the right way to go. We need to know where we’re going in the long term, and realize there’s a solid vision to end the fight forever instead of just endure it year after year. But we also need a concrete grasp of the realities of the fight against malaria this year, for the millions of people — mostly pregnant women and children — who will die from it. So it’s not confusing that Gates has tried to straddle both messages, speaking at once of how we’re losing ground and of how we’re closer to winning the war against a deadly disease.

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