Six Experts, Six Answers

Interview by Jackie Powder

Will it be possible to eliminate or eradicate malaria?

For 30 years, the malaria “E” words were not discussed in polite company. (Elimination is the interruption of local mosquito-borne malaria transmission; eradication is the permanent reduction to zero of worldwide incidence of malaria infection.) Those who raised the possibility of country-by-country elimination, let alone global eradication, would quickly be branded as naïve dreamers and insufficiently knowledgeable about the complexities of malaria.

All that changed dramatically on October 17, 2007, when Bill and Melinda Gates called for nothing less than global malaria eradication.

However, this renewed attention does not mean that elimination in the short-to-medium term is an advisable goal for every country battling the disease. It is a worthwhile goal for countries located on the endemic margins, which have already greatly reduced malaria within their borders. We identified 32 of these countries in the recent series of papers on malaria elimination in The Lancet, published on November 6, 2010.

Achievement and maintenance of controlled, low-endemic malaria is the natural goal for the remaining 67 malarious countries in the malaria heartland. The task for them is to massively scale up the effective interventions and thereby reduce transmission to low levels, bring malaria mortality close to zero and greatly reduce malaria morbidity rates. When this is achieved, a discussion about elimination can begin.

We expect to see a gradual shrinkage of the malarious zone to a final battleground in the lowland, humid and tropical parts of Africa. The speed of progress will depend on the development and deployment of better drugs, better diagnostics and a series of increasingly effective vaccines.  These new tools, combined with continued international support and effective program management, will propel us towards global eradication, which I believe will be achieved by roughly 2060.

Sir Richard Feachem, DSc(Med), PhD, is the director of the Global Health Group at the University of California, San Francisco, and professor of Global Health at UCSF and UC Berkeley.