Divergent Goals and Commitments in Global Malaria Intervention

As we ride a wave of renewed awareness of and investment in malaria prevention and treatment, it is tempting to believe that the era of neglect lies behind us. Although malaria's comparatively high profile excludes it from the World Health Organization's list of " neglected tropical diseases " (http://www.who. int/neglected_diseases/diseases/en/), this technicality should not deceive us into thinking that malaria receives sufficient attention. The neglect of malaria persists, as uncovered by an analysis of malaria spending in this month's PLoS Medicine [1]. Robert Snow and colleagues detail the alarming gap between the funds needed to meet internationally agreed goals and the resources thus far allocated [1]. Their comprehensive audit of malaria funding shows that the world invests only about $US1 billion per year, billions short of what several independent estimates suggest is necessary to achieve basic international goals for reducing malaria burdens [2,3]. Because need estimates may undershoot actual needs, the true gap may be far wider. In a climate rife with calls to revisit the goal of global malaria elimination and eradication, the magnitude of this gap is worrying. Target 8 of Goal 6 of the Millennium Development Goals is to " [h]ave halted by 2015 and begun to reverse the incidence of malaria and other major diseases " (http:// www.mdgmonitor.org/goal6.cfm). It is unlikely that Target 8 will be met unless malaria resource commitments can be made. In a field often informed by glimpses and guesswork, Snow and colleagues [1] provide a comprehensive and rigorous analysis of global malaria financing. Funds made available for malaria interventions both domestically and internationally were compiled from a diverse array of sources. Missing data were approximated using dummy figures based on conservative, region-specific averages. These total investments were then applied to a geographic model of populations at risk of " stable " transmission (PfPAR) [4]. This model interpolated clinical observations across a population density map, and then subtracted areas that climatically or topographically fall beyond the biological limits of malaria's distribution. This distribution provided the denominator for calculating investments per person at risk. The sheer range of per capita investments in malaria control is startling. While the Republic of the Congo, Côte d'Ivoire, and Pakistan apply only $US0.11 annually per person against malaria, Suriname spends about 1,500 times more: $US167 per person per annum. Most countries spend much less than what is necessary. In Nigeria, where more than 100 million people live at …