Twenty five years ago, I went to western Kenya as a Centers for Disease Control and Prevention (CDC) Epidemic Intelligence Service (EIS) officer to study an outbreak of severe anemia. No one was sure of the cause. Was it parvovirus, or exposure to an environmental toxin, perhaps? In the hospital there were five or six sick children to a bed, and they were so anemic that their blood looked more like a pinkish fluid than the rich red to which we are accustomed. As it turned out, there was no exotic cause. I was seeing the ravages of drug-resistant malaria at a time when chloroquine, the routinely used antimalarial drug, was failing globally.

That kind of grim hospital scene is much rarer these days, thanks to the enormous investment in malaria programs in Africa over the past decade and the improvements these investments have made possible. Programs that provide proven interventions—artemisinin-based combination therapies (ACTs), insecticide-treated bed nets (ITNs), and indoor residual spraying (IRS)—have achieved a 33% reduction in malaria deaths in the African region and 1.1 million lives saved globally. We have much more to do, but this is a reason to celebrate. As we celebrate, however, we must realize that we are also in the midst of a very fragile situation for three major reasons.