New Antimalarial Drugs: Biology and Economics Meet

• Author: Kenneth J. Arrow
• Position: Professor of Economics Emeritus at Stanford University
• Pages: 20-21

A global public goods commission looks at ways to stop or slow the spread of drug-resistant strains of malaria.

Page 20

Malaria has been and remains one of the greatest scourges of humanity. Its geographical range is wide, even today. It is a particularly devastating health problem in Africa, especially between the Sahara Desert and South Africa. At one time, malaria was a major illness in the southern United States and southern Europe and was much more widespread in Latin America. Although figures are far from reliable, malaria deaths are estimated at over one million children a year-about 9 percent of all childhood deaths. However, with malaria more than many other killer diseases, mortality is a small fraction of morbidity. In the highly epidemic regions of Africa, the approximately 650,000,000 inhabitants are infected, on average, more than once a year.

The economic implications of a frequently sick population are evident. To some observers, the economic retardation of sub-Saharan Africa can be substantially explained by the prevalence of malaria. In addition to its direct effects on productivity, the presence of this devastating disease scares off foreign investors and traders.

There are several strategies other than drugs for controlling and reducing the incidence of malaria: draining standing water, spraying pesticides on potential breeding grounds for mosquitoes and on houses, and using netting to protect people from mosquito bites at night. Vaccine development continues but offers no medium-term prospects. These strategies are all important, but none is likely to eliminate malaria, especially in sub-Saharan Africa. Drugs remain our best hope. In this article, I focus on the use of drugs to combat malaria and the need for those currently in use in Africa to be replaced by new and much more expensive ones-the subject of a study by a committee, which I chair, of the Institute of Medicine of the U.S. National Academy of Sciences.

Alternative drugs

A synthetic variation of quinine, called chloroquine, was introduced into general usage around 1950. It was effective and, at about 10 cents a treatment, remarkably cheap. Cost was no obstacle to its use, even in the poorest countries. Chloroquine was and still is widely used in Africa, Southeast Asia, and India, where it has contributed greatly to the control of malaria. But as a result of...