Is eliminating malaria hopeless?

The real way to get rid of malaria is to reverse the dynamics of rural-to-urban migration and build comfortable, stable rural communities first—something that is probably never going to happen in Africa—and then to attack the disease. The key way the disease is spread is by infecting people without resistance. Rural to urban migration, the kind that dominates in Africa today, promotes the spread of the disease.

…In this sense, Jeffrey Sachs and the Gates Foundation are working against themselves, by pushing development and fighting malaria at the same time.

That is James Pogue writing in Guernica. The tagline for the piece is “Ending malaria in Africa any time soon is nearly hopeless. And in trying, Jeffrey Sachs and Bill Gates may be doing more harm than good.”

Skeptical though I am of massive, idealistic, cash-driven interventions, I have to hope that policymakers regard Pogue’s article skeptically.

First, if there’s one success Big Aid can claim in the 20th century, it’s disease eradication. Western donors and African governments may be crap at generating jobs, but man did they wipe out some persistent sickness.

I’ve just come from Vietnam and Thailand where malaria has not disappeared, but ceased to be a major concern (unless you live astride the border with Burma or Laos). To the public health specialists out there: is this so? And is the goal really so much more elusive in Africa?

Ultimately, what other cure to malaria is there other than development? To run effective eradication campaigns, governments must be staffed with well-educated bureaucrats and backed by stable tax revenues. People must be able to afford treatments and preventions. And citizens and businesses must hold the government accountable for providing this public good. Few of these factors arrive without economic development, and most are going to be tied to population movements away from agriculture.

Governments and businesses across the continent are already taking action. Many capital cities have lower transmission rates in part because they drain swamps. Rural home spraying is increasingly common. Some mines and other private businesses have eradicated malaria in their environs.

I’m all for pursuing scientific advances, but for Africa to sit in poverty and wait for a cure to be discovered sounds like madness.

Pogue’s parting paragraphs suggests even the cure may be overblown, and that malaria isn’t much concern (indeed it’s a source of pride):

For some Africans, resistance to malaria is literally in their blood; for many of the rest, they’ve earned their immunity, without drugs, and without asking for Western help. Guys like me, only there to profit off what’s under the ground, ought to be able to handle a couple weeks of fever.

More than one friend or coworker in Africa has lost a child to malaria. I cannot imagine anything more emotionally painful or antithetical to “development”. There’s very little here to be proud of.