We think malaria is a problem faced only by humid, hot countries. But just over a century ago, the disease thrived as far north as Siberia and the Arctic Circle and was endemic in 36 U.S. states. Back then, malaria is estimated to have killed 80,000 people yearly in Europe and North America.
Much of the developed world countries eliminated malaria in the 1950s through increased prosperity, housing and breakthroughs in medication and insecticides. As people became wealthier, mosquito breeding ground marshes were drained, and increased livestock meant mosquitos had animals to bite instead of humans.
Improved nutrition made people healthier and less vulnerable, while increased incomes afforded better homes and insect screens. Quinine and synthetic chloroquine gave developed countries affordable treatment, and insecticides wiped out many mosquito populations.
Outside sub-Saharan Africa, annual deaths plummeted from more than 3 million in 1930 to fewer than 30,000 today. Yet, much of the malaria problem has stubbornly remained in Africa, killing more than half a million people annually.
There are two key reasons. First, the malaria parasite found in Africa is the deadliest, and strains have developed resistance to the common medicine chloroquine. Second, the prevalent malaria-spreading mosquitos in Africa almost exclusively bite humans. There was progress against malaria in Africa at the start of the 2000s, but that was halted by COVID, which disrupted basic medicine and caused 60,000 more deaths.
The world has long promised to get rid of malaria. The Global Malaria Eradication Program was established in 1955, then abandoned in 1969 because the goal was deemed unachievable. In 2015, world leaders renewed the pledge. In the United Nations’ global promises known as the Sustainable Development Goals, all nations undertook to fix almost every global problem by 2030, including malaria.
Progress has been glacial, meaning the malaria goal will be achieved 400 years late. This is just one of many spectacular failures of the big U.N. promises. This is because politicians promised too much. The global priorities include an impossible 169 promises, which is indistinguishable from having no priorities.
This year, the world will be at halftime for its 2030 promises, yet it will be nowhere near halfway. It is time to identify and prioritize the most crucial goals. The Copenhagen Consensus think tank is doing precisely that. With several Nobel laureates and more than 100 leading economists, we have been working for years to identify where each dollar, rupee or shilling can do the most good.
Our new research on malaria, written by Rima Shretta and Randolph Ngwafor at the University of Oxford, proposes a 10 percent point scale-up and use of bednets in the 29 highest-burden countries in Africa alongside insecticide resistance management strategies between now and the end of the U.N.’s 2030 promises.
Ensuring people sleep under an insecticide-treated bednet is one of the most effective ways to prevent malaria. Mosquitos are blocked by the netting and killed by the insecticide. Bednets each cost less than $4 yet result in a dramatic reduction in transmission by ensuring mosquitos die before parasites can mature and spread.
It is important that bednets are not just distributed but actually used correctly, which requires social behavior change and communication and information sharing. Even allowing for this — and for the higher price tag of responding to resistant strains of malaria — the cost across this decade is about $1.1 billion a year. To put this into context, that is one-third of what the U.S. population spends on lipstick each year.
This investment will save 30,000 lives even in 2023. By the end of the decade, malaria deaths will be halved, saving 1.3 million lives.
Bednets also mean many fewer infections with malaria. The research shows that 242 million fewer people will get sick in 2030, drastically reducing healthcare costs. Moreover, reducing the number of sick people means adults can go to work, children can go to school and caregivers are not stretched, which increases productivity at a country level.
Putting all these factors together, every dollar spent on this campaign would yield societal benefits worth $48 — a phenomenal return on investment.
We have allowed malaria to turn into a disease of poverty in Africa. And while we cannot deliver on all the global U.N. promises, we ought to deliver on the smartest things first. Distributing and using insecticide-treated bednets will cost little but save 1.3 million lives.
