Malaria keeps people poor, but so does government.

Richard Tren
Africa Fighting Malaria
September 01

Malaria and Poverty

Malaria is arguably the most devastating disease in the history of mankind. Annually around 300 million cases of malaria occur and the disease accounts for over 1 million deaths each year, mostly children under the age of 5. This is an equivalent of crashing seven Boeing 747s packed full of children into the ground every day. More than 90% of cases occur in Africa, the worlds poorest continent.

While malaria is associated with some of the world's poorest nations in tropical regions, this was not always the case. Malaria was wide spread throughout southern Europe, the southern states of the US and cases of malaria were even recorded in the Arctic Circle. These countries and regions all managed to eradicate malaria after the Second World War by using DDT. The insecticide, which is so reviled by environmentalists, is enormously effective in killing the malaria vector, the Anopheles mosquito.

Economic growth in those countries that eradicated malaria was significantly higher once they were rid of the disease. Greece, Italy and Spain all managed to achieve growth rates of between 1.3% and 4.0% higher than the rest of western Europe once the burden of malaria was removed. (Gallup & Sachs).

In a study into the economic burden of malaria, Gallup and Sachs estimate that those countries with intensive malaria grew by 1.3% less per person per year between 1965 and 1990, compared with those countries without the disease. A 10% reduction in malaria is associated with a 0.3% higher economic growth. In South Africa, which has comparatively few malaria cases, the disease imposed a cost of approximately R270m (approximately US$32m) for the year 2000. (Tren, 2001) This conservative estimate is made up of the direct costs of treating and controlling the disease and the indirect costs of lost productivity.

Malaria ensures that patients are unable to work in factories or in agricultural fields. The disease has serious impacts on the cognitive development of children, so that not only are they kept out of school during bouts of malaria, but their entire education could be compromised, seriously affecting their chances of gainful employment in the future. Perhaps the most dramatic economic cost (and the hardest to estimate) is the opportunity cost of investment and tourism that is driven away due to perceptions of the risks that the disease imposes.

Controlling or even eradicating malaria and ensuring that the population is healthy and able to work will improve the conditions for economic growth and development. That said, controlling malaria is a necessary, but not sufficient condition for economic development. Government policies that create a stable economic climate, that protect private property, lower trade barriers and ensure the rule of law all go far further to ensuring that economic growth will occur, than simply controlling malaria.

The countries that eradicated malaria did not increase their economic growth and improve the standard of living of their citizens simply by removing the disease. Post war democracy and sensible economic policies were the engines of prosperity in the previously malarial countries. The world's most malarial countries are not only the worlds poorest, they also happen to be those countries with the least economic freedom. (Economist, 2001)

Mauritius had several catastrophic outbreaks of malaria up until 1963 when it finally managed to eradicate it. The country's economic growth remained negative however until 1973 when the country opened its economy to international trade and focussed on increasing its exports. (Gallup & Sachs) 1 On the flip side, the ruination of Zimbabwe's economy has had little to do with malaria or any other disease. Government policies that drive away investors, restrict markets and disregard private property are far more effective at creating poverty and destroying wealth than any disease.

Anti-Malaria Action

Malarial countries in Southern Africa face numerous difficulties in controlling malaria. Drug resistance is increasing and many countries will be forced to use multi-drug therapies, as has been introduced in Kwa-Zulu Natal. Resistance has been recorded to many of the insecticides that are used in vector control. Difficulties persist in ensuring that malaria patients obtain medical treatment in time and that the disease is accurately diagnosed and correctly treated.

More can be done though. As mentioned above, one of the most effective (and cheapest) weapons against the disease is residual spraying of DDT. Many countries however have halted DDT use because of demands from environmentalists. Donor agencies have argued that they are unable to support the use of DDT as it is not permitted in their home countries. Ignoring sound scientific and medical studies, which support the use of DDT where appropriate, and pandering to greens within their organisations and at home not only results in unnecessary deaths and illness, but also compromises any ability to develop economically and reduce poverty.

Developing country governments can do more to improve the incentives of drug and insecticide developers to invest in research and development. Protecting intellectual property rights, easing the regulatory process and engaging in a more cooperative manner with drug companies would assist greatly to produce new anti-malaria technologies.

The proposed Global Fund, which aims to raise over $9 billion for the purchase of drugs and vaccines, could also assist. While it is likely that over 80% will be directed towards HIV/Aids, the fund could provide the much-needed funds for the purchase of anti-malarials and perhaps a malaria vaccine if and when it is developed. The structure of the fund has not been finalised, however it is vital that the transfer of funds goes directly to those providing medical services on the ground. The transfer of money should avoid the bureaucratic machinery of organs such as the UN, which could block funds and only release a fraction of the amount needed. Direct grants to governments with dubious track records when it comes to the disbursement of funds and corruption should also be avoided.

Conclusion

While malaria keeps people poor, donor agencies and governments do have it within their capacities to reduce the burden of the disease significantly. Donor agencies can stop their piecemeal anti malaria projects that might provide good photo opportunities for their brochures, but do nothing for long term malaria control. If these agencies are committed to malaria control, they should engage with the scientific community and fund activities that will work and will save lives (such as DDT spraying) despite the protestations from the greens in their safe malaria-free hometowns.

Governments can introduce sensible and stable economic policies that will foster investment, growth and trade. All they need do is note what President Mugabe is doing and then do the complete opposite.

Economist (2001), Pocket World in Figures, 2001, Edition, The Economist Books, London.

Gallup, J.L. & Sachs, J.D (2001), "The Economic Burden of Malaria," The American Journal of Tropical Medicine and Hygiene, Vol. 64, No. 1,2, pp. 85-96.

Tren, R. (2001), "DDT, Malaria and the POPs Convention," Conference Paper, Southern Africa Malaria Conference, July 2001.

Tren, R. & Bate, R (2001), Malaria and the DDT Story, Institute of Economic Affairs, London.