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Head To Head

Should we commit to eradicating malaria worldwide?

BMJ 2017; 356 doi: (Published 02 March 2017) Cite this as: BMJ 2017;356:j916
  1. Bruno Moonen, deputy director for malaria1,
  2. Clive Shiff, associate professor2
  1. 1Global Health Program, Bill & Melinda Gates Foundation, Seattle, WA, USA
  2. 2W Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
  1. Correspondence to: B Moonen Bruno.Moonen{at}, C Shiff cshiff1{at}

Bruno Moonen cannot accept the iniquitous alternative, but Clive Shiff believes the necessary huge investment could be better spent

Yes— Bruno Moonen

The World Health Organization,1 the Roll Back Malaria Partnership,2 and the United Nations3 all have a vision of a malaria-free world. The world has already committed to malaria eradication, albeit without a target date. More importantly, malaria endemic regions are setting ambitious elimination targets, showing a clear demand for, and commitment to, regional elimination and, eventually, global eradication.456

Equitable and sustainable

For malaria, eradication is the only equitable and sustainable solution. Half of the world has already eliminated malaria,7 and, as Melinda Gates put it in 2007: “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.’ That's just unacceptable.”8

The alternative, indefinite control, is not sustainable. Maintaining financial commitment, especially when the burden becomes low, is challenging, and history has shown that when programmes are not adequately funded malaria will resurge.9 Indefinite control would require constant investment in research and development to stay ahead of an ever evolving parasite and vector. Countries that eliminate, on the other hand, are more likely to remain malaria-free.10

The challenges in the polio endgame, operationally and financially, are obvious reasons for pause. As Chris Whitty, chief scientific adviser to the UK Department of Health, noted: “Trying and failing [to achieve] eradication is costly, pulls resources from other priorities, breeds cynicism, and may destroy good control programmes. The key, therefore, is not to call for it where we cannot achieve it, and, for most diseases, we cannot.”11

However, failures in control because of inconsistent funding are equally expensive,9 and …

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