pregnancy. Thus the burden of the disease in highly endemic areas falls mainly on young children and pregnant women. Malaria also significantly increases the risk of childhood death from other causes (Snow et al., 2004).

The amount spent worldwide on malaria research and development is not commensurate with its contribution to the global burden of disease. The Malaria R&D Alliance (2005) estimated that in 2004, malaria accounted for about 46 million DALYs lost but that only US$288 million was spent worldwide for research and development. This amounts to only about US$6.20 per DALY. This is significantly lower than the amounts spent per DALY on tuberculosis (TB) ($10.88) and human immunodeficiency virus/ acquired immunodeficiency syndrome (HIV/AIDS) ($24.26) in 2004.

This will be a long war, if for every division I have facing the enemy, I must count on a second division in the hospital with malaria, and a third division convalescing from this debilitating disease.

—General Douglas MacArthur, 1943

Malaria has persisted as a formidable problem—indeed a veritable scourge—for the U.S. military throughout its history. Tables 2-1 and 2-2 show lists of major U.S. military actions, deployments, or overseas exercises in which malaria posed a meaningful threat. Some actions involved