The global community has made impressive strides in malaria control and elimination, but progress has stalled. To reach eradication, we must rethink our approach.
The global effort to control malaria, starting with the first concerted actions at the end of the 19th century, has resulted in a major public health success. A disease transmitted and feared in nearly every country on the planet has been successfully eliminated in Europe, North America and much of Asia and Latin America. However, malaria transmission remains intense and devastating in some parts of the world, particularly in sub-Saharan Africa.
"Clearly, a change is required to reach the ultimate goal of malaria eradication."
In 2015, an influential paper in the journal Nature summarized the impressive successes of malaria control from 2000-2015 in endemic countries like Tanzania and Senegal. Sadly, 2015 is also known as the year in which the global malaria control efforts stopped making progress, as reported in the latest World Malaria Report. Clearly, a change is required to reach the ultimate goal of malaria eradication. This frank assessment was long overdue. Fortunately, the same report also presented the most recent figures on prevented cases and deaths, and the numbers are stunning. From 2000-2021, 1.5 billion malaria cases and 7.6 million malaria deaths have been averted. This should be a strong motivator to up our collective game.
The road ahead for malaria elimination was well summarized by the now-former Director of the Global Malaria Programme, Dr. Pedro Alonso, in his farewell message. He highlighted the need for new control tools, more resources and stronger political commitment. Here, I would like to add two additional points. First, global excellence in analytical skills and planning ability, through sophisticated computer modelling or other approaches such as risk stratification, should be matched by excellence in implementation and problem solving on the ground. Second, a major strengthening of health systems is required to reduce disease burden and support preventive efforts down to the last mile.
"Many small improvements in the health system will also have a strong positive effect on malaria control efforts."
Developing new “magic bullets” such as the next generation of antimalarial drugs and vaccines and genetically engineered mosquitoes is very important. However, we should also recognize that many small improvements in the health system will also have a strong positive effect on malaria control efforts. Fortunately, health system strengthening has received a major boost during the COVID-19 pandemic, as exemplified through enhanced laboratory services and improved clinical management. This positive development should be harnessed to further improve malaria control, leading eventually to the eradication of this preventable and treatable disease.