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Despite Challenges, Malaria Eradication Is Practical Policy Option

In a post in The Lancet Global Health, Jenny Liu of the University of California, San Francisco’s Global Health Group and colleagues examine malaria eradication efforts, highlighting progress made against the disease and writing, “This progress is encouraging, but is worldwide eradication of human malaria possible? If so, is it a worthwhile goal and should we commit to it?” They write that eradication is “probably” possible, “however, substantial challenges exist.” They highlight six major challenges: “[T]he burden of malaria is still great and it is widespread”; “drug and insecticide resistance are on the rise”; “increased mobility of people not only makes containment of resistance difficult, but also threatens the introduction or reintroduction of malaria parasites to receptive areas”; “Plasmodium vivax, the second major human malarial parasite species, “is harder to diagnose and failure to successfully treat its dormant liver stage results in relapses that can fuel onward transmission”; “extreme events, such as wars or natural disasters, greatly disrupt malaria control and elimination activities, and can lead to substantial resurgence”; and “as malaria becomes rare, persuasion of governments to allocate finances to maintain effective elimination or post-elimination programs is increasingly difficult.”

“These six factors present notable challenges on the road to eradication,” Liu and colleagues note, adding, “However, all have potential solutions resulting from substantial international collaborative efforts that range from basic research to improvements in policy and financing arrangements.” They write, “Is eradication worth it? Probably yes, but the answer is dependent on the temporal and spatial perspective,” and continue, “Should we eradicate malaria? Yes, because the alternative policies are untenable.” They state, “Imagine a world in which the goal was merely to control malaria — i.e., reduce it to a level at which it is no longer a major public health problem,” and write, “Such a situation will be expensive, unstable, and is an unappealing policy option for the 21st century.” They add, “The practical policy option, and the one that will be less costly in the long term, is to pursue a global policy of progressive elimination, aggressive control in the high-burden areas, and eventual eradication.” The authors conclude, “With adequate and sustained commitment, the task can be achieved” (July 2013).