Malaria: Equipping partners to end the disease

By the turn of this century, malaria had been eliminated in wealthy nations yet still killed nearly a million people a year – mostly young children – in poorer countries. So we joined with other organizations working to reduce the burden of this preventable disease, dedicating billions of dollars to the effort. This past September, the foundation announced a US$912 million commitment over three years to the Global Fund to Fight AIDS, Tuberculosis and Malaria.

Our biggest contribution over the years, though, may not have been the money. In 2007, Melinda posed a challenge to the global health community: Rather than merely reduce the threat of malaria, why not totally eradicate it? From there, we plotted backwards: What actions would get the world to zero cases? Of those, which would be unlikely to happen if we didn't play a role?

Our influence hasn't really been about what we can make happen. (Our contribution to the Global Fund, after all, is only about 6% of what it raises from all donors.) It's about how we help others make a huge impact.

We have funded R&D for and gotten private-sector companies to focus on not just the next generation of diagnostic tools, bed nets, and medicines, but also the generation after that. That includes work agreements we've reached with pharmaceutical companies so they produce drugs that benefit low-income populations, even though those products don't have high profit margins. We've helped some countries export their knowledge – like China, which eliminated malaria within its borders and now lends its expertise to African countries – and helped others strengthen measurement systems and analytic capacity so they can use data to tailor malaria interventions to local needs. And we fund the training of African entomologists and national malaria program staff, so that there will always be a vibrant community of experts to see the fight to the end.

All along, Bill, Melinda, and I have spent a lot of time trying to convince leaders to dedicate more money to fighting malaria and other diseases that disproportionately affect people living in poverty.

By all accounts, the fight has been a big success. While malaria deaths have increased during the pandemic, from 2000 to 2020 the death rate dropped by nearly 50%. We're optimistic that cases could fall even more over the next few years, thanks to several promising innovations in the works, including a preventive therapy that uses monoclonal antibodies and ways to rid areas of the most deadly mosquitos (by killing them with sugar bait traps or using genetic technology to stop disease transmission).

Despite this progress, people have raised good questions about our work. They ask whether resources spent on specific diseases would be better spent on improving overall health systems. They suggest that eradication is an unrealistic goal. And they critique the foundation for playing what they see as an outsized role.

We agree that funding health systems is important, so we do that too, in Ethiopia, India, and other countries. We agree that calling for malaria eradication is audacious, but we knew that any lesser goal would mean continued suffering.

On the size of our role, I agree, in a way: It's not right for a private philanthropy to be one of the largest funders of multinational global health efforts. Countries should fully fund them. But consider the example of the World Health Organization. Where we share common goals, like eradicating malaria, we fund WHO programs. As countries have decreased their contributions, we've become the second-largest donor. I'd love it if many more governments would pass us on that list – because that would mean more lives saved.