Should we commit to eradicate malaria worldwide?
For Bruno Moonen, Deputy Director for malaria at the Global Health Program, eradication is the only equitable and sustainable solution.
He points out that the world has already committed to malaria eradication, albeit without a target date—and that malaria endemic regions "are setting ambitious elimination targets, showing a clear demand for, and commitment to, regional elimination and, eventually, global eradication."
He believes the alternative, indefinite control, is not sustainable, saying this "would require constant investment in research and development to stay ahead of an ever evolving parasite and vector."
Countries that eliminate, on the other hand, are more likely to remain malaria-free," he writes. And he calls for a recommitment by the World Health Assembly to malaria eradication as "a strong sign of support for the regional elimination ambitions."
However, he argues that "this should not be a commitment to a campaign that is based on a single tool, effected through an all-in global effort that needs to continue everywhere until the last parasite is exterminated.
Instead, it should be "a global commitment to support parallel regional elimination efforts combined with sustained investments in research to develop the necessary tools and to tackle the yet unknown challenges of the future."
But Clive Shiff, Associate Professor at Johns Hopkins Bloomberg School of Public Health in Baltimore, believes the necessary huge investment could be better spent.
"We should promote the management of health services rather than commit massive funds to attempt to eradicate malaria in the near future," he writes.
His reasons include the fact that governments of many endemic countries have other priorities, while local wars as well as unstable, reluctant, or impoverished administrations, "mean many cannot commit the concerted effort necessary to achieve eradication."
He questions whether eradication efforts could be properly integrated and funded, and whether national health ministries could manage and coordinate the resources necessary for eradication.
Eradication requires elimination of all cases, even of subclinical infection, he explains, meaning that however implemented, eradication would be costly.
"Proper management of malaria seems the sensible route. Investing to integrate malaria control into functional local public health systems would be sustainable at a manageable expense. It would also help bolster local infrastructure and the local public health service as well as ensuring that malaria is kept under control and no longer of public health importance," he concludes.