Climate change futures: health, ecological and economic dimensions

A MALARIA SUCCESS
The New York Times, 27 March 2005
In 1998, the Australia-based mining company BHP Billiton began building a huge aluminum smelter outside
Maputo, the capital of Mozambique. The company knew that malaria plagued the region. It gave all its
workers mosquito nets and free medicine, and sprayed the construction site and workers' houses with insecticide.
Nevertheless, during the first two years of construction there were 6,000 cases of malaria, and at least 13
contractors died.
40 | INFECTIOUS AND RESPIRATORY DISEASES
To deal with the problem, the company did something extraordinary. It joined an effort by South Africa,
Mozambique and Swaziland to eradicate malaria in a swath of the three countries measuring more than
40,000 square miles. The project is called the Lubombo Spatial Development Initiative, after the mountains that
define the region. In the three years since house-to-house insecticide spraying, surveillance and state-of-the-art
treatment began, malaria incidence dropped in one South African province by 96 percent. In the area around
the aluminum smelter, 76 percent fewer children now carry the malaria parasite. The Lubombo initiative is probably
the best antimalaria program in the world, an example for other countries that rolling back malaria is possible
and cost-effective.
In its first years, financing came from BHP Billiton and the Business Trust, a development organization in South
Africa financed by more than 100 companies there. They decided to fight malaria not only to save children
and improve health, but also to encourage tourism and foreign investment. Governments should make the same
calculation, and should follow the Lubombo example. Malaria kills some two million people a year, nearly all
of them children under 5. A commission of the World Health Organization found that malaria shrinks the
economy by 20 percent over 15 years in countries where it is most endemic.
The Lubombo initiative hires and trains local workers, who spray houses with insecticide once or twice a year,
covering their communities on foot. People who get malaria are cured with a new combination of drugs that
costs about USD 1.40 per cure for adults, abandoning the commonly used medicines that cost only pennies
but have lost their effectiveness. While it is still the largest antimalaria project started by business in Africa,
there are other successful ones, run by Marathon Oil, Exxon Mobil and the Konkola copper mines in Zambia.
Fifty years ago, Africa did use house spraying widely, with good results, but such projects vanished as the
money dried up. Today money is available again, from the Global Fund to Fight AIDS, Tuberculosis and
Malaria, and the Lubombo initiative's managers are beginning to get calls from other parts of Africa. Malaria,
unlike many other diseases, is entirely preventable and curable. The challenge for health officials is to fight
malaria in very poor countries on a large scale, and now they have the Lubombo initiative to show them how.
Copyright 2005. The New York Times Company
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