In a recent paper, the UCSF’s Feachem identified 32 countries that have now controlled the disease to a point where they could move toward wiping it out. They are all on the fringes of the malaria map. “More than 2 billion people live in the 32 malaria-eliminating countries,” he said. “The benefit to these individuals, their countries, their neighboring countries and the world from continuing to shrink the malaria map is clearly large, even if we cannot fully quantify it or express it in terms of U.S. dollars.”

Experts trying to do just that calculate the disease costs African healthcare systems around $12 billion a year. When you add it all up, malaria lops an estimated 1.3 percent off annual economic growth in the worst-hit countries, which include the likes of Democratic Republic of Congo and Nigeria. It may not sound much but that’s around half the total rate of growth in gross domestic product that a typical industrialized country might expect outside recession.

Research shows a firm link between reducing the disease and increasing economic output - because workers are healthier and take less time off work. Unsurprisingly, children without malaria do better at school.

Though hard to measure, there are other ways cutting malaria is likely to help. Tourists may be more attracted to parts of Africa that are malaria-free, for instance - a potential boon to places such as Kenya where tourism is one of the main foreign exchange earners. Foreign investors may also be more drawn to countries that have dealt with the problem.

THE SMELL OF WATER

For the people of Kilifi, the debate is little more than a distraction from life’s daily battles. Tourists bathe on the region’s white sand beaches, but most residents struggle to make ends meet by selling charcoal or picking up casual labor.

“Growing up in an average family with many siblings in the house, we knew when the malaria season came and when one of us in the family had a bout of malaria, we knew it was a question of time before it would be the next and the next and the next,” says Roma Chilengi, one of the doctors working on the vaccine trials in the district. “By the time it hits you, you have these terrible fevers, these headaches, and the mere smell of water makes you want to vomit.”

Chilengi is excited about the prospect of the first malaria vaccine, but wary of hoping for too much after years of seeing other measures like mosquito nets, insecticides and anti-malarial drugs fail to end the disease. As for the price, there’s little to dwell on. “All these things cost a lot of money,” he says. “But this money is nothing compared to the burden that malaria hits us with.”

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By Kate Kelland and Ben Hirschler

LONDON