thoughts on elimination

Sarah Boseley of the Guardian has opined that, “not to say that elimination should no longer be contemplated. It’s just more possible in some countries than in others.” Some comments we added to her blog follow:

When Melinda Gates used the ‘E’ word, she did add the caveat that eradication would not be in the immediate future, and as we have learned, the Gates Foundation has invested a lot in vaccine research.  Even with the addition of a vaccine, malaria elimination will continue to require multiple tools adapted and adopted according to the epidemiological situation of the area. Surveillance will continue to be the foundation tool for any effort to eliminate a disease.

The overall question of when can we start seriously talking about elimination requires a quick look back in history. Medical News Today in reviewing Feachem’s recent Lancet article, notes that, “Up to 1945, about 178 nations had endemic malaria. Since then 79 countries have eradicated the disease.” (Technically they have eliminated malaria since eradication only occurs when elimination country-by-country has occurred worldwide).  So 44% achievement in elimination over 65 years means _____ (your guess – fill in the blank).
There has been massive scale-up of malaria control activities over the past 5 years, but even with this, ensuring that an insecticide treated nets are inside a household does not guarantee that people will use them according to recent Demographic and Health Surveys and Malaria Indicator Surveys.

The danger of targeting a specific year is that once that year passes, donors and the public lose interest.  This is why it might be logical in the near term to ensure that appropriate malaria control and elimination activities are integrated into basic and universal primary health care services – which hopefully will not go out of style.

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