Barack Obama. Picture: REUTERS/EVAN VUCCI
President Barack Obama has made the eradication of malaria a key mission of his final year in office. Picture: REUTERS/EVAN VUCCI

TWO days before delivering his last State of the Union address, US President Barack Obama called a top adviser into the Oval Office and said he had decided to add a major pledge to the speech that his team had neither discussed nor vetted: to rid the world of malaria.

"It was his belief that we were nearing a kind of tipping point when we should set a major goal of eradicating malaria," says the aide, Benjamin Rhodes, a deputy national security adviser.

He was given 48 hours to make sure Obama could follow through on his commitment. The result was two sentences about how, in part through US commitment, the world could soon "end the scourge of HIV/AIDS".

"And we have the chance to accomplish the same thing with malaria — something I’ll be pushing this Congress to fund this year," Obama said.

The pledge excited researchers and philanthropic organisations focused on malaria, one of the top killers of children around the world.

"What the president said in the State of the Union really matters," says Martin Edlund, CE of Malaria No More. "It’s a really big deal."

Other experts are sceptical. Dyann Wirth, director of the Harvard Malaria Iniiative, is one of many who doubt that the disease can be eradicated soon.

"I do not believe that we have the arsenal that could lead to eradication," Wirth says. "But it is true that the disease is interruptible. That’s been done in many places, and that is not trivial."

Obama’s fight against malaria builds on that of former president George W Bush, who began the President’s Malaria Initiative with a $1.2bn five-year plan that received $30m in its first year to distribute insecticide-treated mosquito nets in Africa.

Under Obama, the initiative has grown into a $618m programme that works in 19 African countries and the Mekong River region of southeast Asia. The programme accounts for a big slice of global spending on antimalaria efforts, which reached $2.5bn in 2014. The US government is responsible for about half the total, and about half of US spending comes from the president’s initiative.

Despite progress, serious challenges remain. Malaria deaths have fallen by about two-thirds since 2000 — in large measure because more than half of Africa’s population sleep under mosquito nets, compared with 2% in 2000 — with 6.2-million lives saved.

Even so, last year the world had an estimated 214-million new malaria cases and 438,000 deaths, 91% in Africa.

But nets wear out, and resistance develops to pesticides and drugs. There is no malaria vaccine, although several are in development. Some experts believe a vaccine will never be made.

But Obama’s antimalaria pledge is optimistic, perhaps influenced by the recent success of efforts to fight Ebola and climate change.

Rhodes says that somewhere in the stack of books and briefing documents Obama took on vacation to Martha’s Vineyard in August is the reason he became aware of antimalarial successes.

Yet Obama’s relatives in Africa gave him "a human understanding of the toll that malaria takes on communities".

Obama mentioned malaria in his speech to the United Nations (UN) General Assembly in September, calling it "a moral outrage" that "many children are just one mosquito bite away from death". But his focus on achieving a climate deal in Paris last month left him little room for a new major international commitment.

Once that was done, along with the Iran nuclear deal and the Trans-Pacific Partnership trade accord, Obama "wanted to set out the next areas where we have a sense of mission, and malaria was ripe to take that place", Rhodes says.

Interestingly, while Obama made his malaria pledge in part because he had finished a global climate accord, one of Bush’s advisers said he had tackled malaria in part because he had renounced one.

Michael Gerson, a White House adviser to Bush, says that in preparations for a 2005 summit meeting of industrial nations in Scotland, Tony Blair, then British prime minister, listed two priorities for the talks: climate change and Africa. Having renounced the controversial Kyoto Protocol in 2001, Bush knew he could not do anything on that issue to mollify the Europeans, Gerson says. So that left Africa.

Gerson, who had travelled extensively in Africa to oversee the Bush administration’s fight against HIV/AIDS, said that on his return, "I would have lunch with the president and talk with him about malaria as part of the discussion of what I saw and found." Bush, looking for something to take to Scotland, decided to attack malaria.

For Obama, the success of the campaign against Ebola was an additional inspiration, says Gayle Smith, the administrator of the US Agency for International Development.

The UN last week declared an end to the Ebola epidemic in West Africa, although the World Health Organisation said the next day that someone in Sierra Leone had tested positive.

Smith says Obama had "looked at malaria and concluded that if we combine the continued progress, our leadership and another big international push, we can actually get to the point of eradication".

One challenge is to get new money from Congress, but some, including Senator John Boozman, are supportive.

New York Times