Not long ago, an experimental malaria vaccine made newspaper headlines. Over six months, it more than halved serious episodes of malaria in 2,000 children in rural Mozambique. The only trouble is that it will take at least 10 years to come to market.

Fortunately, there are new, effective drugs already available that could start to loosen malaria's stranglehold on many impoverished countries. With a modest global investment, these drugs could be mobilised today.

Malaria is one of the world's greatest threats to life and human performance. Each year, it kills more than 1m people, mainly children in sub-Saharan Africa, and triggers some 500m debilitating attacks in people of all ages throughout the tropics. The toll in lost productivity is a big contributor to Africa's poor economic performance.

All concerned with malaria know that new drugs are needed. After the second world war, a drug called chloroquine became standard. Until about 20 years ago, it worked well in Africa. In addition, it was cheap, averaging 10 cents per treatment. However, chloroquine-resistant strains, which first emerged in south-east Asia, are now rife throughout Africa. The death toll from malaria is rising once again.

What makes this situation more distressing is the existence of an effective alternative. When the first signs of drug-resistant malaria appeared in Asia during the Vietnam war, Chinese scientists developed a family of drugs from sweet wormwood, a common shrub that had been used for centuries in traditional medicine. These "artemisinin compounds" are now standard components of malaria treatment in Asia, where they have proved to be the best ever anti-malarial drugs. To circumvent future drug resistance, however, the time has come to partner artemisinins with other anti-malarial drugs, creating artemisinin combination therapies (ACTs) - the same strategy that underlies the treatment of HIV and tuberculosis. In 2002, the World Health Organisation went on record urging governments to adopt such therapies rapidly in order to provide more effective malaria treatment and slow the spread of drug resistance.

Now the only remaining obstacles to these treatments in Africa are economic. At present, ACTs cost about $2 a treatment, not 10 cents. Subsidies are needed - probably in the region of $500m a year, a small amount on any global scale. The other challenge is how this money enters the drug supply chain.

To overcome the need for a new system of delivery, a recent report from the Institute of Medicine, the US-based health advisory organisation, recommended that ACTs be bought at competitive prices by an international organisation such as Unicef, then resold at a deep discount to governments and private wholesalers in countries where malaria is endemic. The main condition underlying access to subsidised ACTs would be that they flow freely through public and private channels - just as chloroquine does now. This approach would accomplish two objectives: it would allow the existing private market to support the switch to ACTs and it would keep the treatment's cost to consumers down to about the price of chloroquine.

Centralised purchasing has other advantages. It would assure a market for producers, and in particular would encourage the planting of sweet wormwood to overcome the existing reported shortage of artemisinin. It would also facilitate quality control. Moreover, the scale of any international subsidy of combination therapy would discourage the distribution of any solo drug whose use might encourage new resistance down the line.

Above all, in the case of anti-malarial drugs, centralised purchasing would provide the impetus for a swift change in the way the world treats malaria. Without a co-ordinated programme, the change is far more likely to be gradual and incomplete, the scenario most likely to jeopardise the effectiveness of artemisinins over the next few years.

There can be no excuse for delay. Resistance is overwhelming the usefulness of existing drugs, and deaths due to drug-resistant malaria are accelerating daily, especially among the poor of Africa. The IOM has proposed a feasible plan to introduce ACTs quickly. All that remains is for the international donor and finance communities to embrace the logic, allocate funds and take action once and for all against malaria.

President Bush has claimed a renewed mandate, and has begun to reshuffle his national security team. Condi Rice will move to State; Steve Hadley will move up at the NSC. Rich Armitage and Jim Kelly, who have borne much of the day-to-day responsibility for U.S. policy in Asia, are leaving along with Colin Powell. What might we expect of the Bush administration in its second term?

Generally speaking, continuity rather than change is likely to be the watchword in foreign policy. Above all, the Middle East and South Asia are likely to remain the principal preoccupations of American concerns. In Iraq, Washington will seek to acquit its commitments - to hold elections, train Iraqi security forces, and accelerate reconstruction projects - with whatever measure of dignity and honor it can muster in the face of excruciatingly difficult choices. With Yassar Arafat's death, American engagement in Israeli-Palestinian issues is destined to increase. And Iran's bid for nuclear weapons will continue to challenge the United States and Europe.

Thus Asia will not have pride of place on the Bush agenda. Yet it will continue to command Washington's attention. Why? Because it is in Asia that the interests of the great powers intersect most directly. Asia is the world's most dynamic economic area, and it is becoming more tightly integrated. Washington cannot afford to neglect South and Southeast Asia, for in these areas Islam presents a relatively moderate face. And North Korea, of course, poses a direct and growing challenge to the administration's nonproliferation policy.

Fortuitously, the United States is better positioned in Asia than in most other regions. Our military presence remains sizable and retains mobility and flexibility. Our economy continues to generate solid demand for Asian exports and is a robust source of direct investment. While criticism of American policy is widespread in the region, it is not expressed with the virulence that is seen in Europe and the Middle East. Above all, Washington has cultivated the Asian great powers assiduously, and has managed to improve relations with Tokyo, Beijing, Moscow, and New Delhi - a substantial accomplishment. It remains to be seen whether it can work in concert with others to ameliorate the sources of discord on the Korean Peninsula and over the Taiwan Straits.

The United States, to be sure, confronts some daunting challenges in Asia. If the U.S.-Japan alliance is in excellent condition, defense cooperation with Seoul remains troubled by the sharp divergence in U.S. and Korean perspectives on North Korean aims and strategy. Nor have we found a solid basis for pursuing with Pyeongyang's neighbors a coordinated approach to the six-nation talks. Regional economic cooperation is taking shape along pan-Asian rather than trans-Pacific lines. Developments in the Middle East threaten to "Arabize Islam" in Southeast Asia. And the "Johnny One Note" quality of American diplomacy - i.e. its preoccupation with international terrorism - often plays poorly against Beijing's more broadly based effort to provide regional leadership.

Nor is America unconstrained in its policy efforts in the region. Our military forces are stretched thin globally, impelling some downsizing of deployments in Asia. Huge fiscal deficits loom, and with growing bills falling due in both Iraq and Afghanistan, resources available for policy initiatives elsewhere are likely to be tight. The president has succeeded in pushing negotiations with North Korea into a multilateral framework, yet Washington is being pressed by its negotiating partners to adopt a more conciliatory posture. The democratization of Asian nations, while welcome, does not automatically facilitate U.S. diplomatic objectives. Recent elections in South Korea and Taiwan were decisively shaped by a new generation of voters. Governments in Seoul and Taipei are increasingly accountable, yet viewed from the United States, they are not extraordinarily sensitive to Washington's views, let alone deferential to its lead.

With these considerations in mind, one should expect President Bush and his foreign policy team to continue cultivating close ties with the Asian powers. Whether Washington can effectively utilize those relationships to roll back North Korea's nuclear program and avert crises in the Taiwan Straits will depend heavily on its relationships with the governments in Seoul and Taipei. And at the moment South Korea appears determined to expand economic ties with the North virtually without reference to Pyeongyang's nuclear activities. Taipei remains preoccupied with efforts to assert its own identity while counting on American protection.

In the end, of course, foreign policy rarely sees carefully laid plans bear fruit. Someone once asked a new British prime minister, Harold MacMillan, what would drive foreign policy in his government. He answered without hesitation, "Events, dear boy, events." I expect the same may be true for Mr. Bush.