This supplement, The Intolerable Burden of Malaria: A New Look at the Numbers, published under the auspices of the Multilateral Initiative on Malaria (MIM), takes on the difficult but necessary task of defining the burden of malaria more precisely. Without accurate and timely information, strategic planning to counter this scourge will suffer. For these reasons, I welcome this collection of papers which identifies and quantifies the many ‘‘burdens’’ due to malaria. The consensus of scientists and public health workers is that malaria kills up to 2.7 million persons each year. Nine out of ten of these cases and deaths occur in Africa and the vast majority of them are in children under the age of five years. More than 15% of those who survive an acute attack of cerebral malaria are left with severe neurological damage, and lesser degrees of brain damage that may impair learning and development. Conservative estimates suggest that at least 300 million clinical attacks of malaria occur each year in the African region. The true figure is likely to be greater than three times higher. Up to 40% of children who attend clinics and dispensaries in tropical Africa have febrile illness considered to be malaria, and numerous other such attacks are treated at home. Malaria is especially dangerous during pregnancy since it causes severe anemia in the mother and low birth weight of the baby, which impairs its survival.

The direct economic costs of malaria are enormous and weigh particularly heavily on poor countries with few resources. Recent research has shown a close correlation at the country level between the rate of economic development and the burden of malaria, even after adjustment for potential confounding factors, indicating that malaria is an important constraint on economic progress. The loss of growth in countries with endemic malaria is estimated to be as high as 1.3% per year—up to US$12 billion in lost productivity due to malaria occurs in Africa annually.

A historic event in the on-going fight against malaria took place on April 25, 2000, when an unprecedented number of African Heads of State and governments gathered in Abuja, Nigeria, to attend the ‘‘Summit on Malaria.’’ It was the first time that African Heads of State have gathered in such numbers to discuss malaria and to devise effective strategies to fight it and thereby alleviate the malaria-induced physical and economic suffering of their people. Delegates were able to demonstrate the political will that is vital for the Roll Back Malaria (RBM) movement, and enumerate the actions that need to be taken for its success. Those present pledged to improve health services and, with the support of partners, insure that effective malaria control tools become available to all, including people living in the poorest, smallest, and most remote townships and villages.

In line with the African Regional Health for All Policy, RBM in the African region focuses on partnerships for strengthening the entire health sector and on the enhanced role of communities in the development and implementation of malaria control activities. Roll Back Malaria will carry out its activities within the primary health care system, thus strengthening the performance of health services, insuring their wider accessibility, and promoting increased equity of services among all populations. Such actions will respond to malaria within the local sociocultural milieu and the economic context in which local populations live.

Within malaria control activities in the African region there is a need to continue building capacity for research at all levels, particularly operational research, and for the scientific and malaria program infrastructure and management to respond to the new challenges that we are certain to face. To succeed, it will be necessary to employ and evaluate an appropriate mix of 1) proven cost-effective technical interventions such as early diagnosis of malaria with prompt effective treatment at home; 2) preventive measures (e.g., insecticide-treated bed nets and other materials); 3) forecasting and early detection, prevention, and control of epidemics; and 4) discovery and development of drugs from traditional medicines. The development of improved methodologies for monitoring and evaluating program activities will be an integral part of the research-operational interface, as will achieving better understanding of the various manifestations of the disease. The importance of research in support of malaria reduction activities is exemplified by the 23 multi-country African research projects supported by the MIM and the Tropical Diseases Research and Training Program (TDR/WHO) in conjunction with RBM. These projects, all led by African scientists and institutions, address among other themes: surveillance and control of drug-resistant malaria, vector biology and insecticide resistance, pathogenesis and immunology, malaria transmission and mortality, and bio-prospecting for new antimalarial drugs.

Roll Back Malaria, MIM, and several other important initiatives, all aimed toward reducing the burden of malaria, have created a positive momentum. This is admirable and affords us an important opportunity to work together for malaria control in Africa—which our combined efforts should both accelerate and intensify.