National Geographic : 2007 Jul
of the population survives on less than a dollar a day. So people buy other drugs, for as little as 15 cents. They provide temporary relief, reduc ing the malarial fever, but may do little to halt the parasites. Then there are widespread traditional beliefs. One of the posters plastered across Zambia reads: "Malaria is not transmitted by witchcraft, drinking dirty water, getting soaked in rain, or chewing immature sugarcane." When children suffer from seizures-a symptom of advanced cerebral malaria-some parents interpret it as a hex and head straight to a traditional healer. By the time they make it to the hospital, it's too late. Even the gift of a bed net can backfire. There's no question that the nets can save lives, especial ly the latest types, which are impregnated with insecticide. But first they need to reach the peo ple most in need, and then they must be prop erly used. "Distributing nets to remote villages is a nightmare," says Malama Muleba, executive In Zambia, a country that was steadily losing 50,000 children a year to malaria, early indications are that deaths have been cut by more than a third. director of the nonprofit Zambia Malaria Foun dation. "It's one thing for me to convince Bill and Melinda Gates to donate money, it's quite another to actually get the nets out." The Zambian army has been employed to help, but even after delivery, people can be reluctant to sleep beneath nets, which make a hot and stuffy part of the world feel hotter and stuffier. If a leg pops out at night or the fabric is torn, mosquitoes can still reach the skin. And the nets are sometimes misused, as fishing gear. Theater troupes are spreading out into the Zam bian countryside, emphasizing the proper use of bed nets through stage productions in settle ments large and small. Despite the difficulties, Zambia's campaign 58 NATIONAL GEOGRAPHIC * JULY 2007 has started to produce results. In 2000, a study showed that fewer than 2 percent of children under the age of five slept under an insecticide treated bed net. Six years later, the number had risen to 23 percent. The government of Zam bia says an ACT known as Coartem is now avail able cost free to the entire population. In a country that was steadily losing 50,000 children a year to malaria, early indications are that the death rate has already been reduced by more than a third. But what if donor money dries up? What if Zambia's economy collapses? What about polit ical instability? Both Angola and the Democratic Republic of the Congo, which flank Zambia, have a history of war. In the 1970s, during a civil war in Angola, six bombs landed near Kalene Mission Hospital; in the Congo war years, some of the nearby roads were mined. "This is a critical moment," says Kent Camp bell, program director of the Malaria Control and Evaluation Partnership in Africa. "There are no national models of success with malaria con trol in Africa. None. All we've seen is pessimism and failure. If Zambia is a success, it will have a domino effect. If it's a failure, donors will be dis couraged and move on, and the problem will continue to get worse." No matter how much time, money, and energy are expended on the effort, there still remains the most implacable of foes-biology itself. ACTs are potent, but malaria experts fear that resistance may eventually develop, depriv ing doctors of their best tool. Before the ban on DDT, there were already scattered reports of Anopheles mosquitoes resistant to the insecti cide; with its return, there are sure to be more. Meanwhile, global warming may be allowing the insects to colonize higher altitudes and farther latitudes. Drugs, sprays, and nets, it appears, will never be more than part of the solution. What's required is an even more decisive weapon. "When I look at the whole malaria situation," says Louis Miller, co-chief of the malaria unit at the National Institute of Allergy and Infectious Diseases, "it all seems to come down to one basic idea: We sure need a vaccine."