A Malaria Success

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.

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 $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.