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A doctor tests a child for malaria at the Ithani-Asheri Hospital in Arusha, Tanzania, May 11, 2016. REUTERS/Katy Migiro

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By Katy Migiro

ARUSHA, Tanzania (Thomson Reuters Foundation) - Jakaya Kikwete, the former president of Tanzania, recalled arriving at his cousin's house to find the family arguing about taking their feverish teenage daughter to hospital.

"They were saying: 'No, no, no, it's not malaria'," he said, describing how the family had sought advice from a traditional medicine man who said a jinni, or spirit, had invaded her body.

"They said: 'If you take this girl to the hospital, if she gets an injection, then that jinni (spirit)... will... suck all her blood'," Kikwete said.

Ignoring their protests, he took the girl to hospital but it was too late. She died from malaria.

Kikwete, who also lost his brother to malaria as a child, is committed to eradicating the disease, which killed an estimated 438,000 people globally in 2015 - making the mosquito, which transmits it, the world's deadliest creature.

He and his wife even appear in television adverts, urging Tanzanians to prepare their bednets before they sleep.

"We are looking at 2040 as the most probable date for a malaria-free Africa," Kikwete, who stepped down as president in November, told reporters at a recent dinner in Dar es Salaam.

"If we continue with the interventions that we have been doing here relentlessly, we should be able to get there."

THE "E-WORD"

Global plans to eliminate malaria were abandoned in 1969 as the goal was seen as prohibitively complicated and expensive, despite success in eradicating the disease in the 1950s in parts of Europe, North America and the Caribbean.

The "e-word" has been revived in recent years, with support from the world's richest couple Bill and Melinda Gates and U.S. President Barack Obama, who called malaria a "moral outrage".

Bill Gates, who Kikwete describes as a "good friend", aims to eradicate malaria by 2040 and has called for a doubling of funding by 2025.

His goal of permanently ending transmission of the disease between humans and mosquitoes is more ambitious than the Sustainable Development Goal of ending epidemic levels of malaria by 2030.

Spending on malaria, mostly by the United States, surged to $2.7 billion (1.8 billion pounds) in 2015 from $130 million in 2000, while death rates in Africa have fallen by 66 per cent, according to the World Health Organization (WHO).

The most important investment was the roll out of one billion free bednets. Some 68 percent of malaria cases prevented since 2000 were stopped by these bednets, according to a study by the University of Oxford.

Money was also poured into improved diagnostic tests, better drugs, indoor spraying with insecticide and educating the public to use these tools - rather than blaming witchcraft or buying medication blindly over the counter every time they got a fever.

EVERYTHING IS FREE

In the Tanzanian town of Arusha, overlooked by the dormant volcano Mount Meru, donor-funded bednets and free tests and medicines have made a significant impact.

In a country with a powerful faith in witchcraft and traditional medicine, health officials have worked hard to persuade people to adopt proven methods of preventing and treating the disease.

"There are very few cases of malaria nowadays," said Pius Dallos, the officer in charge of Kijenge Dispensary, where women sat on wooden benches, cradling their babies.

"Previously... if you didn't have money, you could die from malaria. But nowadays, everything is free."

But donors' ability to maintain - and increase - funding is by no means certain given sluggish global growth and uncertainties over U.S. funding under a new administration.

"The political will to go that final mile may be hard to sustain because it will remain expensive until the end," Dyann Wirth, a tropical disease expert at Harvard T.H. Chan School of Public Health, told the Thomson Reuters Foundation.

"It's a question of priority."

It is unlikely that Africa, which accounted for nine out of 10 of the 214 million cases of malaria in 2015, according to the WHO, could foot the bill itself.

On the edge of Arusha, Africa's largest bednet manufacturer, A to Z Textile Mills, has been the main source of 50 million free bednets given to Tanzanians between 2009 to 2016.

Giant, noisy warehouses produce insecticide-treated fibres which are woven into round and square blue bednets. Women in green T-shirts work in fast-moving pairs, folding and cutting panels ready for stitching.

Donor funding drives production of the much-needed nets, as many ordinary Tanzanians cannot afford them.

"Demand is not driven by the need (but) by the funding," said factory director Kalpesh Shah, sitting in front of framed photographs of visits by celebrity campaigners like Bono and Will Smith on the boardroom wall.

Commercial customers account for less than one percent of sales, he said. The Gates-funded Global Fund To Fight HIV, Tuberculosis and Malaria is their main buyer, followed by the U.S. President's Malaria Initiative.

"The question of sustainability is on everyone's mind," said Daniel Moore, acting mission director for the U.S. Agency for International Development (USAID) in Tanzania.

"Right now, we are carrying the load."

RISK

The failure of the global eradication programme that began in the 1950s casts a shadow over the latest campaign.

As mosquitoes and parasites developed resistance to insecticides and drugs in the 1960s, malaria rebounded in countries like Sri Lanka where once it had been virtually eliminated.

Resistance is becoming a major problem again. But greater efforts are being made to invest in new products that will keep humans one step ahead of evolution.

New tools are also required to eliminate the parasite from 'asymptomatic carriers' - people with a few parasites in their blood who don't fall sick but can act as reservoir and spread the disease when they get bitten again by mosquitoes.

As the number of malaria cases falls, it will become harder to maintain the momentum among donors, governments and ordinary people in endemic regions.

"Without the long term investment of funds and the political commitment to continue the fight, we risk wasting the entire investment," said Wirth.

"We are going to go back to the situation where we are losing one million children a year in Africa."

The International Center for Journalists and Malaria No More provided a travel grant for this report

(Reporting by Katy Migiro; Editing by Ros Russell; Please credit the Thomson Reuters Foundation, the charitable arm of Thomson Reuters, that covers humanitarian news, women’s rights, trafficking, property rights and climate change. Visit http://news.trust.org to see more stories.)

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