1. Using malaria medication is advisable if you don't have access to good doctors and good hospitals. If you permanently live in a malaria area, it's not practical.
2. If you have quick access to a good doctors and good hospitals, it's often better to treat yourself once you are sick. ---> NO this is not travel advice <---. The malaria medications have a lot of side effects to use permanently; the expensive ones have less side effects and I believe pilots generally use such ones since risking getting sick has the potential side effect of a plane crashing.
3. The key is detection and treatment. You can easily die in an top EU or US or Singapore hospital if the doctor doesn't ever see malaria and you happen to have it. You have to test until you get a positive---even if it is a false positive, and then you test again. I personally know people who's parent died of malaria in a good hospital in South Africa, but in an area that is far from the malaria areas, and hence has doctors who don't test for it. I am not a doctor so I am not sure how one is treated once tested positive, but I do know many people who recovered very quickly due to the doctors being acutely aware of how to treat malaria.
4. Taking into account said things above, malaria is not a major threat. If you read stories about game rangers in the KNP of South Africa, many of them died from malaria in their later life because they were somewhere deep in the bush/lowveld and far from hospitals and couldn't be bothered with having malaria, yet again, and stopping their fun bush activities to go to the hospital 200km away.
5. My grandmother had malaria 6 or 7 times and died rather healthy in her mid 90s. My family actually actively avoided the malaria areas in the summer back in the late 1800s and early to mid 1900s by living on the higher escarpment. You could also read about Dr. Annecke and the efforts back then to combat malaria.
6. The countries to the north of South Africa don't have the facilities to treat malaria, generally, and with proper treatment and selective DTT application, you should be able to limit the ranges of the parasite. Yes, DTT is a bad chemical.
7. On that topic, malaria is caused by a parasite, so in terms of vaccines it's not clear what the mechanism behind it should be.
8. If you think about the Panama worm exclusion line that featured a while ago on HN, something like that would have made sense if Africa were a more developed continent. But in any case, the point is that the poor state of many things in Africa is part of the malaria problem.
9. Many other things about Africa is way cooler than the other continents. We still have lion and rhino, for one. There were many large predators on the other continents. So, "development" is something of a complicated word.
10. South Africa generally manages malaria well, so it is possible to contain it through holistic management. And no, holism is a word that belongs to Jan Smuts and you cannot steal it for your magic peanut oil business.
11. Yes, a silver bullet would be nice.