Towards Malaria Elimination

Infectious diseases are the leading cause of death globally, particularly among children and young adults. The spread of new pathogens and the threat of antimicrobial resistance pose particular challenges in combating these diseases. Major Infectious Diseases identifies feasible, cost-effective packages of interventions and strategies across delivery platforms to prevent and treat HIV/AIDS, other sexually transmitted infections, tuberculosis, malaria, adult febrile illness, viral hepatitis, and neglected tropical diseases. The volume emphasizes the need to effectively address emerging antimicrobial resistance, strengthen health systems, and increase access to care. The attainable goals are to reduce incidence, develop innovative approaches, and optimize existing tools in resource-constrained settings.

Towards Malaria Elimination - A Leap Forward was started to mark the occasion for renewed commitment to end malaria transmission for good (the WHO's call for "Malaria Free World" by 2030). This book is dedicated for the benefit of researchers, scientists, program and policy managers, students and anyone interested in malaria and other mosquito-borne diseases with the goal of sharing recent information on success stories, innovative control approaches and challenges in different regions of the world. Some main issues that emerged included multidrug-resistant malaria and pandemic risk, vaccines, cross-border malaria, asymptomatic parasite reservoir, the threat of Plasmodium vivax and Plasmodium knowlesi, insecticide resistance in Anopheles vectors and outdoor malaria transmission. This book is one little step forward to bring together in 17 chapters the experiences of malaria-expert researchers from five continents to present updated information on disease epidemiology and control at the national/regional level, highlighting the constraints, challenges, accomplishments and prospects of malaria elimination.

Admittedly, the world and the nature of forced migration have changed a great deal over the last two decades. The relevance of data accumulated during that time period can now be called into question. The roundtable and the Program on Forced Migration at the Mailman School of Public Health of Columbia University have commissioned a series of epidemiological reviews on priority public health problems for forced migrants that will update the state of knowledge. Malaria Control During Mass Population Movements and Natural Disasters- the first in the series, provides a basic overview of the state of knowledge of epidemiology of malaria and public health interventions and practices for controlling the disease in situations involving forced migration and conflict.

The World Health Organization's Global Technical Strategy for Malaria 2016- 2030 has been developed with the aim to help countries to reduce the human suffering caused by the world's deadliest mosquito-borne disease. Adopted by the World Health Assembly in May 2015 it provides comprehensive technical guidance to countries and development partners for the next 15 years emphasizing the importance of scaling up malaria responses and moving towards elimination. It also highlights the urgent need to increase investments across all interventions - including preventive measures diagnostic testing treatment and disease surveillance- as well as in harnessing innovation and expanding research. By adopting this strategy WHO Member States have endorsed the bold vision of a world free of malaria and set the ambitious new target of reducing the global malaria burden by 90% by 2030. They also agreed to strengthen health systems address emerging multi-drug and insecticide resistance and intensify national cross-border and regional efforts to scale up malaria responses to protect everyone at risk.

Towards Malaria Elimination - A Leap Forward was started to mark the occasion for renewed commitment to end malaria transmission for good (the WHO's call for ""Malaria Free World"" by 2030). This book is dedicated for the benefit of researchers, scientists, program and policy managers, students and anyone interested in malaria and other mosquito-borne diseases with the goal of sharing recent information on success stories, innovative control approaches and challenges in different regions of the world. Some main issues that emerged included multidrug-resistant malaria and pandemic risk, vaccines, cross-border malaria, asymptomatic parasite reservoir, the threat of Plasmodium vivax and Plasmodium knowlesi, insecticide resistance in Anopheles vectors and outdoor malaria transmission. This book is one little step forward to bring together in 17 chapters the experiences of malaria-expert researchers from five continents to present updated information on disease epidemiology and control at the national/regional level, highlighting the constraints, challenges, accomplishments and prospects of malaria elimination.

The main purpose of this manual is to raise awareness of the sorts of technical, operational, and financial resources that would be required to reduce and eventually eliminate malaria, the timelines over which such reductions are likely to be achieved, and how they can be sustained. This knowledge is essential in order to plan strategically for long-term success. More detailed, context-specific planning will be an important next step after working through the general approach set out in the document. This document aims to assist malaria programs in evaluating whether elimination, or other reductions in malaria, represents a feasible and appropriate goal in a defined area, based on careful consideration of what reductions in transmission are likely to occur given the intrinsic malaria burden, the levels of program coverage that can be reached, and the financial investment available.

In 2016, at the request of the WHO Director-General, a group of scientists and public health experts from around the world were brought together to advise WHO on future scenarios for malaria, including whether eradication was feasible. Over three years, the members of the Strategic Advisory Group on Malaria Eradication (SAGme) analysed trends and reviewed future projections for the factors and determinants that underpin malaria. Our analysis and discussions reaffirmed that eradication will result in millions of lives saved and a return on investment of billions of dollars. We did not identify biological or environmental barriers to malaria eradication. In addition, our review of models accounting for a variety of global trends in the human and biophysical environment over the next three decades suggests that the world of the future will have much less malaria to contend with. However, even with our most optimistic scenarios and projections, we face an unavoidable fact: using current tools, we will still have 11 million cases of malaria in Africa in 2050. Under these circumstances, it is impossible to set a target date for malaria eradication, to formulate a reliable operational plan for malaria eradication or to give it a price tag. Our current priority should be to establish the foundation for a successful future eradication effort. At the same time, we need to guard against the risk of failure, as such failure might lead to the waste of huge sums of money, frustrate all those involved (national governments and malaria experts alike), and cause a lack of confidence in the global health community's ability to rid the world of this disease. We need a renewed drive towards research and development (R&D) on vector control, chemotherapy and vaccines in order to develop the transformative tools and knowledge base necessary for achieving eradication in the highest burden areas. We need political leadership that makes effective and efficient use of increased domestic and international funding. We need bespoke national and subnational strategies guided by improved use of data and stronger delivery systems to provide the appropriate mix of services to all those in need, without financial hardship. We need strengthened cross-border, regional and international cooperation on malaria control and elimination efforts worldwide. When these critical foundations are laid, we believe that the world will be in a much stronger position to make the final and credible push for eradication. As we complete our work in 2019, we recognize that the world stands at a crossroads in the fight against malaria. Despite huge progress in reducing malaria cases and deaths between 2000 and 2015, in the last five years, we have witnessed the stalling of global progress. The world is not on track to meet the 2020 milestones that will lead us to lower case incidence and mortality by 90% by 2030 (from 2015 levels) (5). Without massive concerted and coordinated action, we are unlikely to meet these targets. While we are certain that eradication by a specific date is not a promise we can make to the world just yet, there is a clear agenda - beginning with getting back on track to achieve the goals of the GTS - that should immediately be pursued to make eradication possible.