Two years ago the Bill and Melinda Gates Foundation sought to start an ambitious project – to wipe malaria from map during their lifetimes. Despite negative responses from various quarters, Margaret Chan, World Health Organization General Secretary embraced their challenge enthusiastically. Various malaria experts, including Professor Richard Feachem and others from the MEG (Malaria Elimination Group) have helped created this new Lancet Malaria Elimination Series, partly sponsored by the Gates Foundation.
The Series has detailed data on the current situation on malaria-eliminating countries, as well as explaining the pros and cons, and challenges of elimination. It also explains the technical, operational and financial realities faced by nations striving or aiming to strive for malaria elimination.
The authors conclude that wiping out malaria completely may work by further shrinking the malaria map, starting with the outer ring of countries where the disease is widespread and then moving inwards – an approach that started 150 ago.
Andy Tatem and team believe that eliminating malaria is much more achievable, by far, in the Americas than in sub-Saharan Africa, where levels of intrinsic transmission are extremely high, and health systems are severely lacking.
Oliver Sabot and team do not think that the eradication of malaria will be cost saving compared to a continuation of the current status quo of control in nations where malaria is endemic. However, the elimination of malaria brings with it other economic benefits, such as increased tourism and investment in general. Sabot says more research is required to quantify these benefits.
Only through long-term immunization and continuous investment to make sure the disease does not come back is there any chance of wiping out malaria once and for all. “It is not a quick win situation”, the authors stress.
Dr. Richard Horton, Editor-in-Chief of The Lancet, and Dr. Pamela Das, Executive Editor of the same journal write about how they see the prospects for eradication. They point out that the World Health Organization’s (WHO’s) response and assumption of responsibility to give the malaria community crucial direction and has been poor – there is a lack of leadership in malaria control, they write.
WHO’s role is vital, but sadly unaccomplished in the malaria strategy, Horton and Das add.
They write:
(WHO) 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.
The Gates Foundation’s noble aims have the risk of leading to dangerous funding variations and political commitments in malaria and other issues, the authors write.
Horton and Das 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.
The authors 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.
Pam Das, Richard Horton
The Lancet, Early Online Publication, 29 October 2010
doi:10.1016/S0140-6736(10)61551-6
Written by Christian Nordqvist