When the Bill and Melinda Gates Foundation announced in 2007 that global eradication of malaria was a goal they would like to see within their lifetimes, some commentators thought their proposition was naïve. But WHO Director-General Margaret Chan immediately endorsed their challenge.
In the years since this announcement, malaria experts have been divided about their objective. Many of those experts have now combined to produce this Lancet Series, which puts malaria elimination under the microscope. The team of authors behind it include Professor Richard Feachem, and many others from the Malaria Elimination Group (MEG), which is part-funded by the Gates Foundation. The Series provides provides detailed information about today's malaria-eliminating countries, summarises the risks, benefits, and challenges of elimination, and examines the technical, operational, and financial feasibility that countries must assess before they embark on elimination.
The Series concludes that one practical way forward is continuing the work of the past 150 years by further shrinking the malaria map—starting at the outer ring of endemic countries and working inwards (paper 1). The challenges today are different to those faced in the distant past. Many malaria endemic countries have high levels of intrinsic transmission, poor health systems, and high levels of population movement within and across their borders. Such concerns lead Andy Tatem and colleagues (paper 2) to conclude that malaria elimination is most feasible in the Americas and least feasible in sub-Saharan Africa. Or, put another way, elimination is currently much easier to achieve in some countries than others.
Previous assumptions are also challenged in the Series. Oliver Sabot and colleagues (paper 4) show that in terms of dollar cost, elimination is unlikely to be cost saving compared to continuing the status quo of control in malaria-endemic countries. But the other benefits of malaria elimination—increasing investment and tourism among others—are currently unquantifiable, and much more research needs to be done in this area. Malaria elimination will not be a quick win, and, like immunisation, will require long-term repeated investment to ensure the disease does not return, even after the intense activity of actual elimination has subsided.
In the Comment introducing The Lancet Series on Malaria Elimination, Lancet Editor-in-Chief Dr Richard Horton and Executive Editor Dr Pamela Das discuss the prospects for elimination, saying that leadership in malaria control has been absent in recent years and that WHO has so far failed to rise to their responsibilities to give the malaria community essential direction. The two Lancet editors conclude that malaria elimination (or eradication) will only truly be possible with the advent of a widely available and effective vaccine.
Drs Horton and Das say that WHO has an important but unfulfilled part to play in malaria strategy, saying that the organisation "should be the convener of global health expertise, synthesising the appropriate strategies that are consistent with the best evidence worldwide, including the voices of national malaria control programmes and policy makers. So far, WHO has yet to rise to this role and responsibility."
They also highlight that the Gates Foundation's aims, while noble, could lead to dangerous swings in funding and political commitment, in malaria and elsewhere. They say: "If existing control efforts were indeed scaled up, by 2015, 1•14 million children's lives could be saved in sub-Saharan Africa alone. This finding is important. The quest for elimination must not distract existing good malaria control work."
They conclude: "When confronting malaria, elimination is worthy, challenging, and just possible. But it must be pursued with balance, humility, and rigorous analysis. Malaria will only be truly eliminable (or eradicable) when an effective vaccine is fully available."
Press conference audio: http://press.thelancet.com/malelim.mp3
Presentation: http://press.thelancet.com/MALARIAELIMSLIDES.ppt
(PowerPoint 2003)
Presentation: http://press.thelancet.com/MALARIAELIMSLIDES.pptx
(PowerPoint 2007)
Lancet Press Office T) +44 (0) 20 7424 4949 E) tony.kirby@lancet.com
For full Comment, see: http://press.thelancet.com/malelimrhpd.pdf
NOTE: THE ABOVE LINK IS FOR JOURNALISTS ONLY. IF YOU WISH YOU CAN PROVIDE A LINK TO THE DEDICATED SERIES PAGE ON THE LANCET.COM, WHERE ALL USERS CAN DOWNLOAD PAPERS FOR FREE ONCE THEY HAVE REGISTERED (ALSO FREE). THE LINK TO USE IS BELOW (NOTE THIS WILL GO LIVE WHEN EMBARGO LIFTS): http://www.thelancet.com/malaria-elimination
Journal
The Lancet