Economic aspects of suppressing malaria in Africa.

Background: Suppressing malaria in Africa is costly, but is it a good way for international agencies to use their funds, or alternatively, for the African nations that are the direct beneficiaries? Unfortunately, the current ephemeral methods in the malaria strategy of the World Health Organization have required continuous and rising expenditures by international donors who were beginning to lose interest by 2010. To avoid becoming hostage to international economic limitations, African countries might want to consider suppressing malaria themselves, and might want to add permanent and lasting methods to the WHO strategy. The purpose of this study was to determine whether investments in suppressing malaria might produce significant benefits for African nations.

Materials and methods: Two epidemiologic analyses were used in parallel to evaluate data from Africa: a before-after comparison of countries treated under the US President's Malaria Initiative for Africa (PMI), and a simultaneous comparison of treated-untreated countries.

Results: From 2007 to 2012, relative increases in population and gross domestic product (GDP) were greater in 14 countries treated as part of PMI than in 9 similar, but untreated countries. In the treated countries the relative increase in the GDP of 0.61 before malaria suppression rose to 0.64 afterwards; whereas in the untreated countries it fell from 0.67 to 0.56. The increase in GDP in the 14 treated countries that was attributable to malaria suppression over the 5-year interval was about $4.77 billion. During that period, the mean cost of suppressing malaria had been about $1.43 billion, indicating a return on the investment of 3.4 to 1. However, the costs began rising steeply in 2012.

Conclusions: Malaria suppression might be worthwhile for African countries to undertake themselves, as long as the biocides and drugs in current use remain effective.