Malaria Eradication: Necessary and Possible
In 2007, Bill and Melinda Gates stated that it would be unacceptable not to aim for malaria eradication as "Any goal short of eradicating malaria is accepting malaria; it’s making peace with malaria; it’s rich countries saying: ‘We don’t need to eradicate malaria around the world as long as we’ve eliminated malaria in our own countries."
In addition, we believe that the counterfactual, sustained control, is neither a technically nor financially feasible alternative as it will require indefinite investments to counter the inevitable emergences of parasite and vector resistance and will lead to resurgences when programs are not adequately financed.
However, the necessary tools to eliminate malaria everywhere are currently not available and financing is still falling short to achieve maximum impact with current tools and strategies. The Bill & Melinda Gates Foundation’s investments therefore aim at developing new tools that would allow for complete detection (more sensitive point of care tests), complete cure (Single Dose Radical Cure and Prophylaxis) and complete prevention (Vaccines and/or Vector Control Tools).
In addition, in the Greater Mekong Region, Southern Africa and Meso-America our investments and partnerships aim at using current tools in the most effective and efficient way to rapidly achieve regional elimination. Elimination strategies in those regions will need to be based on a robust understanding of the underlying epidemiology and topology given the increasing mobility of the human host.
Surveillance will need to be the backbone of any elimination program and novel approaches will be required to help define interconnectedness of parasites and parasite flows, detect resistance faster, and predict rebound and potential epidemics. While the resources might not be as single-donor dependent as during the Global Malaria Eradication Program in the 19502 and 60s, after 10 years of amazing gains, the world is again facing drug and insecticide resistance.
Our product development pipeline is more robust both for drugs for treatment and active ingredients for vector control and are cause for optimisms. Now is the time to recommit to eradication unless we are willing to be faced with those challenges over and over again.