Insidious only begins to describe malaria in the developing world. This horrendous disease kills almost 3 million people yearly, many of them children under 5. The devastation malaria leaves behind is crippling the continent of Africa where the majority of cases occur. Conservative estimates peg yearly global episodes at over 4 billion (that’s right, billion, since many people in endemic areas are infected multiple times during the year) and the economic toll is huge.

Two of the major organizations worldwide to tackle malaria are the World Bank and the Global fund for AIDS, TB and Malaria. The World Bank’s spending on malaria will decrease to around $11 million within the next two years from its current level at around $43 million per year unless there is a dramatic shift in the way the agency deals with the malaria pandemic. According to a recent study by RESULTS Canada, this decrease will occur because the World Bank has no major anti-malaria projects in the pipeline, even though it committed four years ago to spend $300 to $500 million annually to fight the disease.

While much of the world’s attention is focused on the HIV/AIDS pandemic (and rightfully so), the fact that malaria may be responsible for as many deaths every year has been largely ignored. The result has been that, despite commitments by African Governments and the major international development organizations at the Roll Back Malaria Summit in Abuja in 2000, global malaria mortality has increased. This is a major wake up call for all.

The Malaria Supplement of The American Journal of Tropical Medicine and Hygiene, released in August 2004, attributes 3 million deaths per year to malaria by direct and indirect causes. It also states that the percentage of the world’s population exposed to malaria has increased by 10% over the last decade. Africa bears the overwhelming burden of the disease, over 90%. In addition to the profound human suffering it causes, malaria is also crushing Africa’s economy. Development economists Jeffrey Sachs and John Luke Gallup have estimated that malaria costs African countries at least $12 billion annually. Considering that the price tag the World Health Organization places on fighting malaria is only $3 billion per year, there is no reason why the world should not be meeting the challenge, especially considering that effective tools for preventing and curing the disease exist and are inexpensive.

Nonetheless, malaria spending is only around $500 to $600 million per year, despite the recent unprecedented commitment by the Global Fund for AIDS, TB and Malaria. Louis Da Gama of the Massive Effort Campaign underlines the absurdity of the situation: “The funding gap for malaria is around 80%, yet it costs more to maintain malaria that it does to eradicate it. If the world was truly concerned about Africa, malaria would be our first priority. With 40% of countries’ health budgets being spent on malaria, reducing the burden would release huge resources to fight AIDS and other diseases of poverty.”

Mali, where the annual number of reported deaths due to malaria has increased from 102,000 to 121,000 since 1999, provides a poignant example of how malaria has been overlooked: “It doesn’t make any sense that in a country like Mali where the mortality rate of malaria is over ten times that of HIV/AIDS, the World Bank has a $25.5 million project for HIV/AIDS and two other projects worth $100 million where HIV/AIDS is a significant component but there is not one single project that deals with malaria”, said Alexander Soucy of RESULTS CANADA.

There are encouraging signs from the World Bank that more attention will be given to malaria. They are presently undergoing a review of their malaria strategy, indicating a will from within to improve their response to the disease. But with only two staff dedicated to malaria, it will take a substantial shift to address the problem.

“The best possible outcome from this review would be for the World Bank to do for malaria what they have done for HIV/AIDS”, said Soucy. “In the 1990’s, the World Bank was spending an average of $15 million per year on HIV/AIDS until they created a special group – ACTAfrica – mandated to scale up the Bank’s response to the AIDS pandemic. Now their spending on AIDS is around $500 million yearly. It is clear that they need to do the same for malaria.

Early this month, ministers of finance from around the world met in Washington as governors of the World Bank to set future policy for the institution. This is the right time and place for these global policy makers to push for immediate action on malaria. The lives of millions of children and adults depend on it.

Dr. Alec Soucy is the Ottawa based national director of RESULTS CANADA.

Dr. Bob Dickson is a family physician in Calgary and a partner with RESULTS CANADA, a nongovernmental organization dedicated to ending hunger, debilitating diseases and abject poverty in our world.