Analysis

Tackling malaria today

BMJ 2008; 337 doi: http://dx.doi.org/10.1136/bmj.a869 (Published 19 August 2008) Cite this as: BMJ 2008;337:a869

This article has a correction. Please see:

  1. Jo Lines, reader in vector control and malaria biology1,
  2. Allan Schapira, senior researcher2,
  3. Tom Smith, professor of epidemiology2
  1. 1London School of Hygiene and Tropical Medicine, London WC1E 7HT
  2. 2Swiss Tropical Institute, 4051 Basel, Switzerland
  1. Correspondence to: J Lines jo.lines{at}lshtm.ac.uk
  • Accepted 25 May 2008

In most countries where malaria is endemic, elimination is still not feasible, and the best strategy is steady progress towards universal coverage with key interventions

Once again, after an interval of 40 years, local elimination and global eradication of malaria (see box for definitions) is a focus of international health.1 In 2007, the African Union called for elimination of malaria from the continent,2 and the Bill and Melinda Gates Foundation challenged partners to adopt the goal of eradication.3 In this article, we draw on lessons from the first global malaria eradication campaign to argue that in most countries, time limited elimination remains unfeasible with existing tools, and we argue that for these countries it is better to consider how to achieve sustained progress in reducing the burden of malaria.

Definitions4

  • Control—Reduction of disease incidence, prevalence, morbidity, or mortality to a locally acceptable level as a result of deliberate efforts. Continued intervention measures are required to maintain the reduction

  • Elimination of disease*—Reduction to zero of the incidence of a specified disease in a defined geographical area as a result of deliberate efforts. Continued intervention measures are required

  • Elimination of infection—Reduction to zero of the incidence of infection caused by a specific agent in a defined geographical area as a result of deliberate efforts. Continued measures to prevent re-establishment are required

  • Eradication—Permanent reduction to zero of the worldwide incidence of infection caused by a specific agent as a result of deliberate efforts. Intervention measures are no longer needed

  • Extinction—The specific infectious agent no longer exists in nature or in the laboratory

  • *WHO has defined malaria elimination as “the interruption of local mosquito borne malaria transmission.”5

Why the first global eradication campaign could not achieve its goal

The global malaria eradication campaign of 1955-69 relied on indoor spraying with insecticide as the main tool, and failed …

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