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Originally published Thursday, September 25, 2008 at 12:00 AM

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Gates Foundation links with $3 billion global effort to eradicate malaria

Today, the goal of wiping out one of the world's deadliest diseases got a boost from the Gates Foundation — part of an overall $3 billion in funding and a detailed plan of action signed by 65 global institutions. The Gates money is its latest grant to Seattle-based PATH, which is working on a vaccine. The news was announced at the U.N. Summit in New York, where progress on reducing extreme poverty and disease is the focus.

Seattle Times staff reporters

An ambitious goal was set in Seattle last year when Bill and Melinda Gates stood in front of a crowd of malaria experts and uttered the "e" word — eradication.

Today, the goal of wiping out one of the world's deadliest diseases got a boost of $3 billion in funding and a detailed plan of action signed by 65 global institutions. The news was announced at the U.N. Summit in New York, where progress on reducing extreme poverty and disease is the focus.

The malaria funding includes the largest grant ever for Seattle-based PATH, $168.7 million from the Gates Foundation to expand the quest for a malaria vaccine.

"We're excited about the grant we're receiving as the Gates Foundation's commitment to research and development makes eradication ultimately feasible," said PATH Chief Executive Chris Elias. The new grant validates nearly a decade of sustained progress, he added.

The Gates Foundation initially funded PATH's vaccine initiative with $50 million in 1999, and then renewed it in 2004 with $100 million. Developing just one vaccine can cost between $250 million and $500 million, Elias said.

The $3 billion package of funding will go toward implementing a Global Malaria Action Plan, which seeks to cut malaria deaths by more than half, saving 4.2 million lives in the next seven years.

"This plan is the first step on the road to eradication," Elias said. "The first thing we needed was a business plan that everyone agreed on that would show how to do that."

A malaria "Woodstock"

Last year's malaria summit in Seattle helped set the stage for the U.N. forum and raise malaria's profile worldwide, said malaria expert Kent Campbell. Cambell, who called the Gates meeting a malaria "Woodstock," runs a Gates-funded program at PATH that works with African nations to improve distribution of bed nets, increase mosquito spraying, and make anti-malarial drugs more widely available.

"The event last October in Seattle, with the notoriety and the challenge around elimination and eradication, has energized the community," he said. "Malaria has moved to center stage."

Besides the Gates Foundation's grant to PATH, the commitments announced today include $1.62 billion by the Global Fund, $1.1 billion by the World Bank, $83 million by the U.K.'s Department for International Development, and $28 million by a coalition of global businesses.

One pledge in question

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One health expert questioned how much of that money represents a new commitment, at least from the World Bank.

Some of that is "taking old money and re-announcing it as if it were new," said Amir Attaran, associate professor of population health and law at the University of Ottawa and associate fellow at the UK's Royal Institute of International Affairs.

"Far from there being $1.1 billion of new and forthcoming pledges," Attaran said, the World Bank's malaria funding for 2008 has a "paltry $19 million in the pipeline to be spent."

One major challenge in the future will be reaching funding targets over the next 12 years to fully control malaria. Doing that will take at least $57 billion, according to Roll Back Malaria, the Geneva-based umbrella organization that leads the effort. The plan calls for $5.3 billion in 2009, $6.2 billion in 2010 and $5.1 billion each year from 2011 to 2020 to fully control malaria in all endemic countries, according to Roll Back Malaria.

$400 million in Gates money

Malaria affects half the world's population and kills nearly a million people a year, most of them African children.

The Gates Foundation has thrown its weight behind the drive for a malaria vaccine, devoting more money to the cause than other any single organization. The new $168.7 million grant brings the total Gates funding for the PATH Malaria Vaccine Initiative to more than $400 million.

The new cash will allow testing of more vaccine candidates and development of methods to boost vaccine potency, said MVI Director Dr. Christian Loucq.

"In a nutshell, we are going to fill our pipeline with a lot of very interesting new initiatives and combined strategies."

One promising vaccine, developed in cooperation with the pharmaceutical company GlaxoSmithKline, is currently being tested in 16,000 African children and could be ready for distribution by 2012. But early tests show it is only partially effective.

Two other candidate vaccines, including one developed by scientists at Seattle Biomedical Research Institute, will also be moved into human trials soon.

With the new goal of worldwide malaria eradication, MVI has expanded its work to include vaccines against the form of malaria that is dominant in Asia and South America. Development of a dual-purpose vaccine, that would protect against disease while also stopping the transmission cycle in mosquitoes, has also been added to the agenda.

Loucq said he's confident MVI will deliver one or more effective vaccines.

"It will take time, but we have the science and we have the projects to make it happen."

Other helpful steps

In the meantime, the first goal is to reduce deaths and illness from malaria by half from 2000 levels, by scaling up access to bed nets, indoor spraying, diagnosis and treatment, including preventive treatment for pregnant women, in the next two years.

The plan then calls for bringing down the number of malaria deaths to near zero by 2015, through sustained efforts. In the longer term, the goal is to maintain near-zero deaths worldwide while eliminating malaria transmission in key countries and ultimately eradicating malaria completely with new tools and strategies.

Several African countries have made progress against the disease using low-tech methods like bed nets and indoor spraying. In Ethiopia, for example, 70 percent of households in high risk areas now have at least one insecticide treated bed net and indoor spraying, and effective medicines are available nationwide to treat malaria.

In less than three years, Zambia has seen a 50 percent drop in the number of children infected by malaria parasites and a 29 percent drop in overall child mortality, which experts say is almost certainly due to the wider distribution of insecticide treated bed nets.

"That's a little miracle," said Gina Rabinovich, who directs infectious disease programs at the Gates Foundation. "We always new that would happen, but it's never been done in sub-Saharan Africa."

Even Burt and Ernie helping

There has also been a spike in the number of churches, businesses and other groups supporting the fight against malaria, Campbell said.

While many of these players don't bring much money to the table, they do help shine a spotlight on malaria — like the PBS program "Sesame Street's" decision to include malaria information in its programming.

""They are taking malaria to the popular culture," Campbell said. "You've got Burt and Ernie talking about malaria now."

Campbell also credits the Gateses call for eradication and their convening of the Seattle forum for helping emphasize the need for a detailed road map d to push progress forward. Roll Back Malaria's new plan, which is the work of virtually everyone in the malaria community, provides that direction.

The question is whether the goals are realistic, Campbell pointed out.

"The answer is: They're ambitious," he said.

Progress in countries like Zambia show that it is possible to meet ambitious goals. Success there is inspiring other African nations to take up the challenge of reducing malaria's toll on their people and economies.

But much more money will be needed, along with sustained leadership, to get the job done, Campbell cautioned.

"The onus is on the malaria community to see if we can make that happen."

High return on investment

The malaria cause has attracted a diverse coalition from business leaders to celebrities like U2's Bono to heads of state. Even U.S. presidential and vice presidential candidates are taking notice of global health as a major issue.

"If you tried to tell me five years ago, that five years later I would be listening to the word malaria come out of both president and vice president and the candidates," said Rabinovich, "I would have said you were in an altered state of consciousness."

Business leaders link reducing disease to long-term economic development.

"As a businessman, I firmly believe that no other cause offers the same potential return on investment as malaria," said Peter Chernin, president of News Corp and chairman of the nonprofit Malaria No More. "The support committed by the public and private sectors today will go a long way to defeating this disease and unlocking the potential of Africa."

However, as the U.N. meets in New York, the financial crisis hitting Wall Street and spreading globally could affect government foreign assistance budgets, Elias of PATH acknowledged.

"I think there's a real sense of momentum," he said, citing the recent reauthorization of funds by Congress to expand the President's Malaria Initiative. "We need to be vigilant and continue to make the case that these are good investments," he said.

Recent progress in places like Ethiopia and Zambia show that money spent has been effective. "Especially in tight budget times, we have to help governments understand how these investments have, in fact, paid off in lives saved," Elias said.

Kristi Heim: 206-464-2718 or kheim@seattletimes.com

Copyright © 2008 The Seattle Times Company

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