Public Health Economics
Fighting Malaria
How malaria harms health and economies, the cost-effective tools that cut deaths, and debates about free versus paid bed nets.
Malaria, spread by mosquitoes, killed around 600,000 people in 2023, according to the WHO, most of them young children in sub-Saharan Africa. India has made major progress in reducing malaria cases.
Economic effects
Malaria reduces economic output by making workers sick, keeping children out of school, and affecting cognitive development. Research by economists including Hoyt Bleakley found that malaria eradication campaigns in the Americas in the twentieth century raised the adult earnings of people who were children when malaria was eliminated in their areas.
Cost-effective tools
- Insecticide-treated bed nets: nets protect people while they sleep, when many mosquitoes bite.
- Indoor spraying of insecticides.
- Rapid diagnosis and treatment with effective drugs.
- Seasonal malaria chemoprevention: giving preventive medicines to children during high-transmission seasons.
- Vaccines: the WHO recommended the first malaria vaccines, RTS,S in 2021 and R21 in 2023, the latter developed with the University of Oxford and manufactured by the Serum Institute of India.
The bed net debate
Should bed nets be given free or sold at a subsidised price? Some argued that charging a small price would ensure nets went to people who valued and used them. A randomised study in Kenya by Jessica Cohen and Pascaline Dupas found that even small prices sharply reduced take-up, while people who received free nets were just as likely to use them. This evidence supported free distribution.
Cost-effectiveness
GiveWell, which evaluates charities using evidence, has consistently rated malaria prevention programmes, such as the Against Malaria Foundation and seasonal chemoprevention, among the most cost-effective ways to save lives.
India’s progress
India’s malaria cases and deaths fell substantially over the past two decades, and India set a goal of eliminating malaria by 2030.
A child sleeping under an insecticide-treated net is protected from mosquito bites through the night. Across a village, widespread net use also reduces mosquito numbers. The nets cost only a few dollars each, yet can prevent deadly infections, making them one of the most cost-effective health tools available.
For bed nets in Kenya, small prices greatly reduced take-up without improving use. The best pricing approach depends on evidence, not assumptions.
- Malaria killed around 600,000 people in 2023, mostly young children in Africa.
- Eradication campaigns raised later earnings of children who were protected.
- Bed nets, spraying, treatment, chemoprevention and new vaccines cut deaths cost-effectively.
- Evidence from Kenya showed free bed nets reached more people without reducing use.
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