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At the same time, efforts to control anopheles mosquitoes have been more or less abandoned. Part of the problem was the realization that malaria could never be completely eradicated from tropical regions the way it had been in the U.S. and other countries in temperate zones. There was also a growing backlash against DDT, a pesticide that is highly effective at attacking mosquitoes but whose indiscriminate use in agriculture killed many fish, beneficial insects and birds. Although only small amounts of DDT are needed to control malaria--usually in indoor-spraying campaigns--its toxic reputation made cash-strapped governments in Africa, which often must rely heavily on international donors, hesitant to use it.
So much for how things got so bad. The silver lining to all this heartache is that the outlines of a workable solution have at long last emerged. No one is promising an end to all deaths from malaria. But doctors estimate that hundreds of millions of people could be spared the illness and the mortality rate could be cut in half. The catch: although astonishingly inexpensive (at least by the industrial world's standards), an effective response is still beyond the financial resources of the poorest nations of the world, particularly those in Africa. There simply can be no progress without help from the developed world.
To be successful, any antimalaria campaign must do two things: treat the illness and prevent the transmission of parasites. Several pilot studies conducted in Africa have proved that combination therapy, in which at least one of the medications is derived from a plant called Artemisia annua, or sweet wormwood, easily destroys drug-resistant malarial parasites in the bloodstream. Using several drugs at once, often in the same pill, greatly decreases the risk that the parasites will become resistant. As an added bonus, artemisinin, the active ingredient in Artemisia annua, acts very quickly, further decreasing the chances of drug resistance.
The full three-day course of treatment with artemisinin-based combination therapy costs from $1 to $10 a person, depending on whether it is purchased in the public or private sector. Unfortunately, that's at least 10 times the price of current, albeit ineffective, treatment programs. Most impoverished African governments simply cannot afford to foot the entire bill for combination therapy and the training required to give it, and the same holds true for the majority of their private citizens, many of whom already spend a third of their income on malaria treatment.
Although nearly every developed country and most major international aid organizations have said they are ready to help finance artemisinin-based treatment in Africa, that support has not always been forthcoming. Some health experts believe a report on artemisinin-containing therapy due out from the U.S. Institute of Medicine this week will dissolve any lingering reluctance.