Fatal inaction: there is a silver bullet for Africa's malaria epidemic. Why the Bush administration won't pull the trigger.

• Author: Kurlantzick, Joshua

Ndirande, Malawi, is one of the poorest neighorhoods in one of the poorest nations in the world. At a local health clinic, anxious mothers in brightly colored body wraps and head scarves shove their children's health records at the admissions counter. Inside, another 80 women wait for blood tests in a hot, tiny, windowless room, their babies suckling weakly at their breasts. Several babies lie unconscious or shaking on the ground. Others are so thin that their skeletal structures are plainly visible.

Twenty-three year-old Margaret cradles her 11-month-old son in her arms. When he contracted malaria last week, she gave him Fansidar, a commonly prescribed antimalarial drug here. "He's not getting better," she says. Her voice cracks. Next to her, 25-year-old Innocent, a tall woman with long, wiry hair, has bundled her one-year-old in a heavy sweater to quell the chills that shake his small body. He's had malaria twice in the past two months, and also took Fansidar, with little effect. A physician's assistant moves from mother to mother, distributing pills that he knows are essentially worthless. Most of the children in this room have had malaria before, and most will get it again: An African child dies of malaria nearly every 30 seconds.

Stories about Africa frequently hew to a familiar script: narratives of intractable tragedies ignored by the world with no feasible solutions in sight. This isn't one of those stories. Roger Bate, a malaria-policy expert at the American Enterprise Institute, calls malaria probably the most obviously preventable serious disease in Africa. Although the parasite has grown resistant to drugs that once tamed the disease--including the Fansidar distributed in the Ndirande clinic--it's easily treatable with a powerful drug called artemisinin. Nor has malaria escaped political attention. In 1998, Roll Back Malaria (an alliance of international organizations, including the World Bank and the United Nations) launched a campaign to halve global malaria deaths by 2010. Last year, President Bush called for a "broad, aggressive campaign" to cut malaria deaths in Africa by half--an effort which, he declared, "our nation is prepared to lead."

Yet leadership has been noticeably absent from Washington's main aid-givers: the United States Agency for International Development and the World Bank. Both agencies have questioned artemisinin's effectiveness in the past, and squandered large portions of their malaria budgets. Meanwhile, malaria death rates have not decreased. Although some thoughtful conservatives like Sen. Sam Brownback have pushed USAID hard to address this entirely solvable problem, other conservatives have diverted reform energies by turning the issue into a partisan debate about environmental regulations. And the malaria crisis has received little tangible attention from the man who promised that "aggressive campaign" to fight it. After the president reaped considerable public praise for his declaration of support for Africa, he's shown less inclination to actually deliver the help that he promised.

ACT up

Not that long ago, developed countries viscerally understood the connection between malaria and their own national health. Until the mid-20th century, the disease was a scourge of nearly every continent. The parasite, which travels from mosquitoes to humans, then through human blood to the liver, triggers fevers, nausea, and sometimes, deadly comas. Tellingly, major advances in treatment have often been spurred by economic ambitions. Malaria-control efforts were seen as crucial to the development of the American South, and became a linchpin of FDR's Tennessee Valley Authority Project, leading to the almost total eradication of the disease here by the late 1940s. But the effective disappearance of the disease from the developed world means that malaria, unlike HIV, lacks a vocal or wealthy Western constituency to push for the production of new drugs.

For a while, no new treatments were needed. Beginning in the 1950s, chloroquine halted malaria's march in Africa and Asia. But by the 1980s, the parasite had become resistant to the drug on both continents. The World Health Organization (WHO) termed chloroquine "useless"; other cheap drugs like Fansidar also lost their effectiveness. Now, at least...