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Special report: The cost of a malaria-free world

Joe Cohen, a scientist tantalizingly close to delivering the world's first malaria vaccine, is on the stump.

After 23 years of painstaking laboratory work and a program of major trials in seven countries, the 67-year-old biologist says the clinical case for the vaccine is almost proved. It's a breakthrough moment that could save hundreds of thousands of lives, but when it comes to public health in the developing world, Cohen knows hard science is only half the job. That's why the softly spoken U.S.-Italian researcher found himself one chilly December evening pitching his life's work to rich-world politicians whose voters will have to foot the bill, and fielding questions over festive mince pies and wine in a leather and oak-clad room in London's Houses of Parliament.

How cost-effective will the vaccine be compared to tried and tested low-tech approaches like mosquito nets and insecticides, one inquirer asks. Is there any evidence that it will bring down the spread of the disease in general, helping those who haven't been vaccinated? How long is a shot likely to stay effective? Is there a danger it might foster a false sense of security? As the session goes on, it's clear that enthusiasm for Cohen's work is coupled with wariness among the experts and well-informed lawmakers. The bottom-line question: is the vaccine -- and the global health community's aim of completely eradicating a disease that kills a child every 45 seconds -- really worth the money?

It may seem an absurd thing to ask. Malaria threatens half the people on the planet and kills around 800,000 people a year, many of them too young to have even learned to walk. The death rate has come down in the last decade, but full-scale eradication will cost billions and drag funds away from other equally, or possibly even more urgent health efforts. As governments in poor countries and donors from wealthy ones weigh up where to put their money, experts have begun a quiet but fundamental debate about whether wiping out malaria is realistic or even makes economic sense.

"With all of the money and human capacity in the world, there is very little doubt that we could eliminate malaria. The question is: What is the best value for our dollar? And this is an increasingly pressing question as we look at the global economic climate," says malaria expert Oliver Sabot, who works at the Clinton Health Access Initiative in Boston.

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