Bill and Melinda Gates held an important malaria summit this week, where Melinda Gates stressed , “A goal of anything short of eradication would be unethical and a bad business decision, despite unsuccessful efforts to stamp out the disease in the 1950s and 1960s.” She stressed that scientific advances since those early eradication days make it worthwhile to revisit the idea of eradication. Truly there are vaccines on the horizon, new malaria treatments, long lasting insecticide nets, a variety of insecticides for IRS and strategies like IPTp to prevent malaria in pregnancy that did not exist before.
Bill Gates also pointed to the relatively large infusion of funding into malaria control: “The new initiatives have committed 3.6 billion dollars to control malaria.” Though of course this is still below amounts needed for control, let along eradication. This raises the issue of national and health systems support, not only in terms of financially matching donor funds but also in guaranteeing a system that is capable of long term sustainability of gains and concerted prompt effort to really achieve eradication.
A veteran in the efforts to eradicate smallpox and guinea worm, Donald Hopkins of the Carter Center, did raise a note of caution. “We have a very complicated disease with a history of failure in eradication,” he said. Simply striving to control the disease is a difficult enough task, he pointed out.” Experience has shown that eradication needs to rally strong human, organizational, financial and technical resources in a relatively short period of time. The lack of the organizational resources was a stumbling block of first effort to eradicate malaria, and one needs to be sure that health systems are up to the task this time. GFATM and World Bank do give resources for health systems strengthening, but other malaria programs do not.
Donors and people lose interest if eradication is promised but not fulfilled. “Bill Gates also called on US politicians running in the 2008 presidential campaign to keep Bush’s 1.2 billion-dollar malaria initiative alive,” according to the Seattle Times, so the advocacy process for eradication has started. Let’s take this as a sign of hope, but remain realistic of the hard work needed by all partners to make eradication happen.