No other disease in the course of human history has had as profound an effect on human development and well-being as malaria. Africans in Neolithic times, ancient Chinese and Greeks, Roman emperors, and hundreds of millions of other people—rich and poor— have died from this disease. For centuries, Africa was known as the White Man's Grave because so many Europeans who went there lost their lives to malaria. During the early stages of World War II, General Douglas MacArthur lost more soldiers in the Pacific arena to malaria- carrying mosquitoes than to the Japanese. Today, up to 7,000 people, primarily children in sub-Saharan Africa, die from this disease every day. "There is no doubt that malaria has caused the greatest harm to the greatest number," notes Sir Frank Macfarlane Burnet, a Nobel Prize-winning immunologist.

Malaria is still known as the King of Diseases in Hindi, and with good reason: for each person who dies from malaria itself, another three who have it succumb to more mundane problems such as malnutrition, anemia, or diarrhoea. The death toll from malaria and malaria-related illnesses exceeds that of AIDS, which now kills about 3 million people annually.

Despite its unrelenting grip on humanity and the fact that about 2.5 billion people are at risk of contracting the disease, malaria is a relatively low public health priority on the international scene. It rarely makes the news. Between 1975 and 1999, only 4 of the 1,393 new drugs developed worldwide were anti- malarials.

The low priority assigned to malaria would be easier to understand if the threat were static. Unfortunately, it is not. Although the geographic range of the disease has contracted substantially since the mid-twentieth century, over a few decades malaria has been gathering strength in several different dimensions. The parasites now resist most anti-malarial drugs, making treatment vastly more complicated and expensive. Poverty, war, and civil strife make it hard for governments to implement preventive and curative measures. Environmental change and human migrations have always exacerbated the potential for this disease to spread, but the global scale of these factors today makes malaria even more difficult to contain.

Like so many problems that are especially acute in developing countries, malaria costs more to ignore than to treat. Malaria costs Africa some $3-12 billion a year, but it could be controlled with available prevention and treatment measures for much less. By 2007, about $2.5 billion a year will be needed to control malaria globally, according to recent estimates. Although such an investment would pay off in human and economic terms, it is not being made. International funding for malaria research currently comes to about $150 million annually, only about 5 percent as much as proposed U.S. government funding for AIDS research in 2003.

The reality is that malaria is a disease of poor countries. If it were a constant threat in industrial countries, the story would be completely different. Although the funding situation looks much better today than it has in years, the newly created Global Fund to Fight AIDS, Tuberculosis & Malaria and the Medicines for Malaria Venture are still vastly underfinanced compared with the scale of the problem. Moreover, money alone is not enough to fight malaria. It will take political will and concerted international cooperation to confront this global threat. And it will take a change in mindset: people must appreciate that human and environmental health are intimately linked on a local and global scale. Adopting this thinking is perhaps the greatest challenge—and the greatest opportunity—for curbing malaria.