Out of Africa: a backlash against spending on malaria research

Ten years ago I made a visit to the London School of Tropical Diseases. The British research institute, one of the world's best in its field, had just received it first grant from the Bill and Melinda Gates foundation. The aim: jump-start the then-moribund project to find a vaccine for malaria. One of the Holy Grails in preventive medicine, a vaccine for malaria was by the late 1990s considered impossible, and only pursued -- fitfully at that -- by a branch of the U.S. Department of Defense.

The Gates money, which began as a trickle, became a flood over the past ten years. Today, malaria research is booming and one big pharma company, GlaxoSmithKline, even has a malaria vaccine -- aimed at children and promoted as 50% effective -- ready for field trials. By any narrow measure, the Gates intervention into malaria -- accompanied by many varied programs to treat the disease and to prevent its spread through non-pharma means -- is a smashing success (Disclosure note: I have consulted for the Gates foundation on various African issues, though never on malaria or health generally).

Yet the very revival of malaria research has spawned some curious objections, which I might categorize as a variant of the old "rising expectations" problem. Critics say that the Gates money devoted to malaria is so large that the foundation dominates the field, making an independent assessment of funded work impossible. Others grouse that GSK's vaccine, which hasn't worked in half of the children tested so far, isn't effective enough to justify the costs associated with mass vaccination campaigns in poor African countries. More attractive, in the minds of these pragmatists, are programs like the one in Zambia that emphasize traditional prevention, such as bed-nets and early-detection and treatment of the illness.

The wrangling over malaria is of course ironic. For decades people have complained that Western scientists ignored African problems, from health-care to information technology to energy. At least in one area, malaria, scientists in the U.S. and Europe are now completely absorbed in engineering a solution to one of black Africa's greatest scourges. What could be the problem?

As Nature magazine wrote recently, "For years the global malaria effort has been asking for more resources. Now the field needs to figure out a systematic strategy for spending the money effectively." Yet using money effectively is of course a no-brainer, to invoke a term that Bill Gates himself did much to popularize in his heyday at Microsoft. To urge malaria researchers to use money wisely would seem to be giving voice to a concern beyond debate.

So why the venomous arguments? Critics say that a malaria vaccine isn't enough -- and even might distract attention from the broader need for African countries to monitor diseases more thoroughly. Nature, for instance, insists that Africans need new networks of laboratories, better disease monitoring, and regional -- not just individual country -- approaches to disease-fighting. Nature calls such steps "essential," and without which "the billion-dollar malaria effort is flying blind."

The conclusion from one of the most influential science organs in the world seems too harsh to me. African societies are indeed deeply flawed, but they can only start from where they are -- not from some ideal place that they might never reach. In injecting new technologies into sub-Saharan Africa, we must worry about presenting them as panaceas. A malaria vaccine is surely not. But it is a step forward. And in the debate over how to fight malaria in Africa more effectively, this simple fact should not be forgotten.


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