New strategy to eliminate malaria

UCSF global health experts have outlined a new strategy and action plan to help countries eliminate malaria and bring the world closer to global eradication of the deadly disease.

The three-part strategy includes aggressive control in the hardest hit areas, progressive elimination in areas where it has already been reduced, and research and development of new interventions and technologies as tools in the effort.

The strategy appears in a series of papers on malaria elimination in the Nov. 5 issue of the leading medical journal The Lancet and will be formally presented at the annual conference of the American Society of Tropical Medicine and Hygiene in Atlanta, Georgia.

The series is led by the UCSF Global Health Group (GHG) and features the work of 36 researchers worldwide, including the Minister of Health of Ethiopia. Those co-authors span a range of disciplines from basic science and mathematical modeling, to economics, epidemiology and health policy, as well as leaders of national malaria programs.

“Progressive elimination, from the endemic margins inwards, has been proceeding steadily over the past century. Today, 32 countries are actively pursuing a goal of malaria elimination,” said Sir Richard Feachem, DSc(Med), director of the GHG. “Malaria elimination will bring numerous benefits to the more than 2 billion people who live in these countries. They will then pass the baton to their neighboring countries and the shrinking of the malaria map will continue.”

The goal of the series was to provide data, strategies and priorities for action to support systematic and effective elimination efforts. Richard Horton MD, editor-in-chief of The Lancet, said there remains an “unacceptable gap” between what we know can be done and what actually is being done to eliminate malaria.

“The quest to eliminate malaria in many countries is entirely possible, but has for too long been a neglected dimension of the global effort to defeat this devastating parasitic disease,” Horton said. “For the first time, leading malaria scientists have brought together the best available evidence to show what can be done, where, and how to make elimination a reality.”

Since 1945, roughly half of the countries that once had widespread malaria have been able to eliminate it completely from their borders. Yet 250 million people still suffer from the disease in the 99 countries in which it remains, killing nearly 1 million people a year, most of them children in Africa.

Malaria elimination – the interruption of malaria transmission within a country – has been a critical, but neglected part of the overall strategy to eradicate the disease, Feachem said. Until recently, the “e” words – elimination and eradication – rarely were mentioned. That changed dramatically in 2007, when Bill and Melinda Gates announced their commitment to eradicate malaria – a statement quickly endorsed by World Health Organization Director-General Margaret Chan, MD.

Feachem, who has dedicated his career to global health, founded the Global Health Group’s Malaria Elimination Initiative in 2007 to gather new evidence to support malaria elimination in Africa, Asia, and Latin America, leading to the current series.

The Lancet series examines the technical, operational, and financial aspects of elimination to address the challenges confronting today’s 32 malaria-eliminating countries. In four papers, the series provides an overview of elimination, quantifies the technical and operational feasibility of doing so, and investigates the challenges, risks, costs and benefits of eliminating malaria as well as preventing its reintroduction.

The series includes a global call to action detailing priorities for malaria elimination in the coming decade to ensure ongoing momentum and calling on specific players to increase their involvement in defined ways. It also addresses the challenges of eliminating all forms of human malaria and critical long-term research priorities, and argues that continued progress in elimination is essential to global malaria eradication.