The greatest threat to Uganda’s future? The mosquito

KAMPALA, Uganda – This week marks the 50th anniversary of Uganda’s independence, and the capital of Kampala has been noisy with celebration. My country has overcome a violent past, but hope is daily threatened by a force more deadly than any warlord or civil unrest.

The greatest threat to Uganda’s future is the common mosquito. 

Infected mosquitos spread malaria in the same way as the dreaded West Nile virus that has hit the US so hard this year. But unlike West Nile, which preys upon the elderly with weakened immune systems, malaria is much more deadly and disproportionately attacks children. Malaria is the leading cause of death in Uganda, killing more than 100,000 people each year, most of them under the age of five. 

Uganda has the highest incidence of malaria in the world according to the World Health Organization – approximately 10 million cases in a country of fewer than 36 million people. Malaria is endemic in over 95 percent of my country. In the northern Apac district, known as “the malaria capital of the world,” each person is bitten four times a day, on average, by an infected mosquito. 

My country’s economy is deeply affected by the disease. Ugandans, many of whom live in extreme poverty, spend 25 percent of their paltry incomes to prevent and treat malaria. Most struggle in vain. Children suffer disproportionately, and the disease forces young students to miss countless school days. By 2016, malaria will leave 13 million Ugandan children developmentally impaired, rendering them unable to learn and work to their full potential. 

As a result of these tremendous losses, African economists estimate that, if unchecked, malaria’s toll on Uganda’s annual GDP will rise over the next five years to as much as $3.2 billion.

I have witnessed malaria’s toll every day as a pediatrician, hospital administrator, and now Uganda’s minister of health. As a young child, I suffered several bouts with malaria, and I vividly remember the crushing headaches, high fevers, vomiting and pain. I saw the fear of malaria that would grip my parents every time one of us children felt unwell.

When Ebola struck my country in July of this year, it killed 17 people in one month and created a panic, but it was quickly contained through a collective response of the Ugandan government and partners around the world. In contrast, malaria kills an average of 191 people daily in my country, yet it has not received nearly the same attention. Malaria’s unbearable toll on Uganda should be considered a national emergency, and its eradication should be an effort that galvanizes significant national and international resources. 

Malaria can be defeated with a combination of mosquito control, mass screening and prompt diagnosis, treatment, research, and public education. We’ve seen that this can work. The Ugandan organization Pilgrim Africa ran a pilot project using this strategy in the eastern district of Katakwi in 2008. Malaria rates in that district dropped by 92 percent in less than one year. We know that a nationwide scale-up of this type of intervention would dramatically reduce malaria transmission. 

The political will to tackle malaria is stronger than ever in my country. Ugandan President Yoweri Musevani has made a public commitment to defeat the disease, and our political party, the National Resistance Movement, states malaria eradication as a policy goal. To encourage imports, the president removed tariffs on medicines, diagnostics, medical equipment, and other goods, and he has encouraged the use of tools like larvicides, indoor spraying and bed nets.
Despite our increasing national drive and ability to tackle malaria, we cannot do this alone. International partnerships to increase operational capacity and provide funding are critical. In an uncertain global economy, many people are concerned that international funding for malaria control will stagnate or decrease. That would have huge negative impact on countries like Uganda. 

In contrast, funding bold action against malaria would be money well spent. The current malaria burden costs Uganda $600 million each year. Spending a healthy fraction of this amount on proven interventions to combat the disease would be a smart investment in Uganda’s future. It would drive down health costs, strengthen the economy, and decrease the need for international aid. Most importantly, it would dramatically improve the health of our children.
In her next 50 years, Uganda we will either conquer or be conquered by malaria. By scaling up the right mix of proven health interventions, I know that we can be victorious. 

Dr. Christine Ondoa is the health minister of Uganda.