As Michael Gerson of the Washington Post said today, “It is now possible to set goals in a number of areas — malaria elimination, an AIDS-free generation, the end of extreme poverty — and not be dismissed as a crank.” He was lamenting the fact that with the 17 new Sustainable Development Goals there are 169 targets – too much to get a handle on. Thus focus on something specific like malaria elimination is important for endemic countries to consider.
The New York Times reports that, “Now, the United Nations and the Bill and Melinda Gates Foundation are calling on the world to eradicate the disease by 2040, potentially saving 11 million lives in the next 25 years. They say this goal can be achieved for between $90 billion and $120 billion and would produce economic benefits of $2 trillion.” Even though some experts may question the feasibility of 2040, they are no longer calling Gates a crank.
The challenge has been though that our global malaria programming is largely stuck in the era of scale up of control efforts with a focus on getting more long lasting insecticide-treated nets and increased household spraying out in high burden areas. As recent reports from WHO and partners indicate, the malaria morbidity and mortality map is shrinking, but there do remain high burden areas. It is only that now we need to focus equally on the science and management of the tools needed to eliminate the disease.
The challenges lie in issues like weak health systems and increasing resistance of parasites and vectors to existing tools. These problems can be overcome through research if the international community is willing to provide the funding.
Here is where groups like the Malaria Eradication Scientific Alliance (MESA) come in. They are addressing the following:
- Basic science and enabling technologies
- Insecticide and drug resistance
- Characterizing the reservoir and measuring transmission
- Specific Tools for elimination
- Combining interventions and modelling
- Health systems and policy research
Major donors like the US President’s Malaria Initiative, The Global Fund to fight AIDS, TB and Malaria and the World Bank need to join with groups like MESA and the Gates Foundation and get behind this agenda. Countries, when updating their malaria strategic plans for new funding from the Global Fund, need to be encouraged to include malaria elimination efforts. Opportunities are should not be missed on the frontline in southern Africa including Zimbabwe, Zambia, Angola, Mozambique, Botswana, South Africa, Swaziland and Namibia to study and implement new approaches and document the lessons, which could also be picked up in the countries of the Sahel, the Pacific Islands and South America. Malaria will not eliminate itself!