Is eradication really forever?

Spain has reported a case of indigenously transmitted malariaP. vivax. Although there are up to 500 ‘imported’ cases annually, it is believed that the local vector, Anopheles atroparvus, was responsible.

The last such case in Spain occurred in 1961. “Malaria was officially declared eradicated in Spain in 1964,” according to the Examiner. Technically the term for removing malaria from one country is elimination, while eradication is reserved for worldwide cessation of transmission, but whatever one calls it, the situation in Spain shows that we cannot be complacent once we think malaria might be gone from a country.

A similar experience occurred in Virginia in the USA in 2002. “Two cases of Plasmodium vivax malaria near the US capital seem to have been acquired locally from indigenous malaria carrying mosquitoes breeding in the area, not from malaria carrying mosquitoes escaping from Dulles international airport.”

Malaria shows a penchant for moving with its human hosts. In observance of the 400th anniversary of the settlement of Jamestown in the USA, National Geographic Magazine (2007) made the claim that, “Colonists carried the plasmodium (vivax) parasite to Virginia in their blood. Mosquitoes along the Chesapeake were ‘infected’ by the settlers and spread the parasite to other humans.”

botdistributiongrad.jpgMany countries on the frontline of malaria elimination such as Botswana and Namibia should be concerned. First more attention is being paid to high burden countries than those close to elimination. Secondly, opportunities to learn how to achieve elimination are not receiving donor attention. This attention needs to include strategies for keeping malaria out once elimination has been declared.

For example, in its Roadmap to universal coverage Botswana documents …

  • No specific govt allocation towards LLINS
  • National requirement for universal coverage is 400,000
  • Need to re-orient the program towards pre-elimination
  • Inadequate resources for malaria focal persons

Malaria is a moving target. Are we ready to keep up the chase?

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