I’ve had plenty of near-death experiences, but malaria ranks near the top. I got it when I was living in the Democratic Republic of the Congo nearly 20 years ago. Fortunately, the only reason I am still around to talk about my alley fight with malaria is because it hit me while I was back home in Kinshasa, not out in the middle of nowhere.
Doctors still struggled to keep me alive as my fever spiked to 105 degrees Fahrenheit and my resting heart rate hovered around 175. I had multiple intravenous bags of quinine dripped into me, a routine treatment that brought with it the unfortunate risk of sudden cardiac arrest due to my infection while on Larium, a controversial and, in hindsight, ineffective antimalarial drug.
It’s a massive understatement to say malaria sucks, but I am among the lucky ones who get to say it at all. Malaria remains one of the greatest public health threats facing humanity, infecting 241 million people each year and inflicting incalculable damage on the economic prospects of endemic countries. If my description of malaria sounded bad, how could a 4-year-old kid battle the disease without most of the resources I had in Kinshasa? Most of the 500,000 people killed yearly by malaria are children under 5 – a vicious toll on future generations.
That’s why this week’s announcement by the WHO approving the use of a second malaria vaccine is astoundingly good news. Since the introduction last year of Mosquirix, the first-ever malaria vaccine brought to market by GSK last year, health officials have been trying to balance the limitations of the vaccine – both in efficacy and supply – with the high cost and urgency to get it distributed. With the approval of R21/Matrix-M, developed by the Serum Institute of India and Oxford University, comes the potential for greater price competition and sufficient supply.
The news couldn’t come soon enough. As climate change expands the habitat of malaria-carrying mosquitos, two issues are rapidly emerging. First, regions that have been malaria-free for decades – or have never experienced malaria – will be in the projected range of vector-borne diseases within a matter of years. These include North America and parts of Europe. At the same time, the overuse of prophylactic medications, such as chloroquine-based drugs, is fueling increased resistance in regions such as Southeast Asia.
Second, malaria primarily afflicts rural communities in many areas where malaria is endemic. No longer. Researchers are now tracking new forms of malaria that are settling in densely populated urban areas. This is a potential tectonic shift in the threat that vector-borne disease poses to sustainable economic development and health system resilience. Seasonal outbreaks may crash worker productivity, shutter universities, and overwhelm hospitals.
The two approved malaria vaccines may help prevent the worst-case scenario looming in our future, but they are not solutions by themselves; they are part of a Swiss Army knife of tools that public health officials are deploying to contain malaria. Some, like insecticide-treated bed nets, provide trusted, low-cost and accessible interventions for low-income populations worldwide. Other theoretical options, such as genetically modifying male mosquitos or making humans “invisible” to the insects, may prove more effective in grabbing headlines than protecting communities. But with more volatile weather patterns and increased resistance fueling a surge in malaria mosquitos, nothing should be off the table or dismissed out of hand.
Why is malaria prevention more than a feel-good development story? The answer to that question lies in a simple calculus. Most of the potential for future economic growth will come from markets in the Global South. Several countries in Africa, Latin America and Southeast Asia represent a surge in young, increasingly educated and upwardly mobile consumers. The rise of megacities and other large urban centers can focus economic productivity, but such concentration also dramatically increases the impact of widespread, uncontrolled disease outbreaks.
The implications for the business community are clear. As we saw with COVID-19, the potential for disease outbreaks to cause prolonged economic disruption is high. And the ripple effects are extensive. Vector-borne diseases such as malaria are not the same as the next pandemic threat, of course. Thankfully we have a variety of tools to prevent and treat malaria.
The imperative now is to make sure we apply a greater sense of urgency and policy support to fund the research and mitigation programs that are necessary to protect vulnerable populations today, as well as the growth markets of tomorrow. This requires the global business community to become vocal champion for public health initiatives that help blunt a future where disease-carrying mosquitos can derail the economic vitality of the next generation of consumers.
