While today's malaria research focuses on P. falciparum, there is also need to study the P. vivax strain—what Wellcome Trust's director of technology transfer Ted Bianco calls "the neglected of the neglected." NITD is currently searching for genes shared by the two parasites to help find drugs that might work for both—and reduce R&D costs in the process.

Funding Today more money is flowing in for malaria programs than ever before, with the Global Fund and the Bill and Melinda Gates Foundation as the two biggest engines driving attack on this global killer. But a growing number of organizations have smaller programs: WHO, USAID (which upped its malaria spend from $1 million in 1997 to $30 million in 2005), UNICEF, Doctors Without Borders, the Presidential Malaria Initiative, the World Bank, and UNITAID, which leverages innovative financing mechanisms like taxes on airline tickets to raise money for HIV, tuberculosis, and malaria.

Yet outside assistance, however necessary, is not always forthcoming or predictable. "Even with the Global Fund, there are problems with transfers, procurement, and tendering," says Bosman. "It all results in delaying the drug to the port of entry."

A World Without Malaria

When did the world stop believing in the eradication of malaria in Africa? After all, the disease used to be endemic in the United States. It stemmed down the eastern seaboard, along the Gulf Coast, and blanketed the entire midwest. And when the US conquered malaria, it did so with instruments that, by today's standards, would be considered crude: drainage, removal of mosquito breeding sites, spraying of DDT, and chloroquine.

Eliminating malaria in Africa is certainly harder than in, say, South Carolina. Climate, poverty, and the AIDS epidemic conspire to make the project an immense challenge. Still, governments and nonprofits can balance that with what's now in their favor: more than half a century of experience controlling the disease, more effective surveillance, prevention, and treatment, and better-financed strategies.

It may be a long fight—and one that cannot be won without pharma's support. Industry's participation will ensure the arsenal of weapons so that global health organizations can finish what they started. "If industry can join private–public partnerships to tackle malaria, it will be our generation's response to what other generations did with smallpox and polio," says John Bridgeland, CEO of the nonprofit Malaria No More.

In many ways, Ripley Ballou's lifelong search for a malaria vaccine personifies the wider fight against the disease: uncertain success in the face of ever-growing challenges. "I have to keep in my own heart the reality that there are vaccines that fail in Phase III," he says. "The sobering side to this is that not everything works. But that's my personal challenge out there, to see that we cross the goal line."