The InterDependent

MONROVIA--Malaria is by far the biggest killer in Liberia. The entire country-from the capital's city center to the border regions-is considered endemic in the parasitic disease. Prevention and treatment of malaria are understandably among the country's most pressing public health challenges.

Late last month, I joined a delegation visiting Liberia from UNITAID, a World Health Organization-affiliated program that gives grants to governments and NGOs to implement HIV/AIDS, malaria, TB and other health projects in the developing world. Through a small tax on plane tickets in a handful of countries, UNITAID is able to raise billions of dollars to finance health projects in countries like Liberia. In the era of flat-lining foreign aid budgets, those billions go a long way.

There is good news and bad news in Liberia's fight against malaria. Malaria is spread by infected mosquitoes, and the ministry of health and international partners reported in 2011 that they had reached 100 percent net coverage, meaning that every household in Liberia had been given at least one insecticide-treated bed net. The scale-up has been rapid; in 2005, that figure was under 10 percent, and in 2009, about 50 percent of households were covered. During those years, the ministry of health reports that morbidity declined from 66 percent to 33 percent of the population. That is still a huge number, but it represents real progress.

Unfortunately, it's not as easy as simply getting bed nets into every home. Receiving a bed net and actually using it are two different things. I visited several homes in one community where no one had much interest in using a bed net. Public information and awareness campaign signs are visible everywhere, but I do wonder about how effective their messages are.

Another explanation for the significant drop in malaria deaths in Liberia since 2005 is that treatment options for the disease have become much more accessible. This is thanks in part to UNITAID financing schemes, which have helped bring down the price of artemisan-based control therapy (ACTs)-the gold standard for malaria treatment. UNITAID has used the $2.5 billion from airline taxes in 14 countries to make long-term purchasing commitments with drug manufacturers, which has helped to dramatically reduce the price of ACTs. In 2006, a treatment course cost about $10, making it well beyond the reach of the public health sectors in poor countries like Liberia. UNITAID has helped bring that price down to 33 cents per treatment. Thus, a patient who visits a public hospital today for malaria will receive the top-of-the line ACT therapy at no cost, providing the drugs are in stock.

Still, the system has weaknesses. The hospitals reach only a fraction of the population, particularly in rural areas. Rather than walk several hours to the nearest government clinic, patients often opt for the local pharmacy. The pharmacist won't necessarily sell the patient ACTs; they may instead opt for traditional cures. And even if the pharmacist has ACTs, the cost may be too pricey for the patient.

Given this dynamic, encouraging the private sector to offer ACTs to patients properly diagnosed with malaria is among the most urgent treatment priorities. According to the ministry of health, the public system treats about 54 percent of malaria cases and the private sector treats about 46 percent.

Real as the challenges are, malaria eradication is not some pie-in-the sky dream. According to the World Health Organization, malaria rates have been reduced by 25 percent globally since 2000 and by 33 percent in Africa over the same timeframe. The key is keeping up the fight and the pressure in the midst of a global economic turndown. Donor funds are drying up, which is why innovative sources of global health funding like UNITAID's airline ticket scheme are more necessary than ever.

Interventions in prevention and treatment work. They just need a little funding and a lot of political will. That's more than evident in Liberia's case, where there is no shortage of challenges to tackle and it would be easy for malaria to fall through the cracks. This country is still on the road to recovery after a decades-long civil war that finally ended in 2005. President Ellen Johnson Sirleaf, Africa's only female head of state, won the Nobel Peace Prize for her efforts at reconciliation so far. But this fall, the country held a contentious presidential election. There are still about 10,000 peacekeepers in the country.

The international community rallies behind Liberia like no other country in the region. In part, that may be because of its historic ties to the United States. President Sirleaf is much liked among western colleagues and donors. The Nobel Peace Prize, of course, is a powerful symbol of her international support. On malaria, the support can't be strong enough.