Last week, as the world commemorated the sixth annual World Malaria Day, I was struck by the tremendous progress we have made against this disease -- progress that, at the outset, many would have thought impossible. Malaria mortality rates in Africa have decreased by one-third, and more than one million lives have been saved over the last decade. Amazingly, we are now in a place few of us could have imagined: eliminating malaria in Africa is a real possibility.
To succeed, however, the global malaria community must recognize that our mission, and what it demands of us, has changed. Now we need to work together and bring every tool we have -- our communities, technologies, talent, and commitment -- to reach our goal. A world free of malaria is within our sights. We cannot afford to hesitate.
No treading water
In Africa, many of the countries hit hardest by malaria are calling for elimination and have included aggressive goals in their national health plans. A few countries, including Zambia, Swaziland, Senegal, and Rwanda, already are piloting successful strategies to stop transmission, creating and expanding large areas that are completely free of the disease. This expression of national aspiration poses both an enormous opportunity and challenge for the malaria community.
There are some who contend that eliminating malaria in Africa is not possible with currently available tools; however, there is no evidence to support this contention. As researchers develop additional tools, the current alternative -- trying to maintain high levels of malaria control by keeping transmission at low levels indefinitely -- is not sustainable. It would require us to constantly inject money and effort into keeping the disease at bay with no end in sight, all while battling the ever-present threat that the disease will resurge or become resistant to the few drugs we have to treat it. Meanwhile, funding to fight the disease has slowed over the last two years, the result of a challenging economic climate that has led to a notable decrease in support for global health programs and development assistance worldwide.
The bottom line? There is nothing sustainable about sustained malaria control. Lessons learned in our ongoing battles to eradicate polio and guinea worm have taught us that there can be no treading water when it comes to fighting malaria -- we must keep pushing the envelope or risk losing the progress we have made.
Elimination is possible
Globally, more than 90 countries today are malaria-free, with an additional 26 en route to achieving that status. Still, eliminating malaria in Africa is a challenging goal. The continent is home to 90 percent of all malaria deaths, and the hard truth is that the disease has never been eliminated in a single country in malarious, contiguous sub-Saharan Africa. What also is true, however, is that we have better tools to meet this challenge than ever before. We have better diagnostics and treatments, a better understanding of how to fight the disease, new and improved technologies and strategies, interest from both the public and private sectors, and a decade of progress and experience to build on. Simply put, we shouldn't decide something can't be done simply because it's never been done before.
What it takes
So, what will it take to eliminate malaria in Africa? We must continue to expand our work to control the disease in the areas with the highest burden, while working to stop transmission altogether in areas where the parasite is losing its foothold. That means developing robust surveillance and response systems to track where the disease is occurring to stop transmission. This includes identifying individuals who have acquired immunity through repeated exposure to the disease, but still carry the parasite and are vectors for transmission, despite not having any symptoms. Progress in eliminating malaria also will require optimizing targeting and uses of existing tools and strategies to fight the disease, while developing, piloting, and testing new ones.
As our goals change, we'll need to develop new ways of measuring success: in areas with low malaria transmission, we soon may mark our progress not by a dramatic decrease in illnesses and deaths, but by the absence of disease and the economic and societal benefits of healthy, malaria-free communities and countries. Documenting progress is critical, as is advocating for sustained and diversified funding and supportive policies, and renewing our commitment to major players who support this lifesaving work, including the Global Fund to Fight AIDS, Tuberculosis and Malaria and the President's Malaria Initiative.
A defining moment
The malaria landscape as we now understand it is changing. To continue to make progress in fighting the disease, we must keep pace. We cannot continue to use the same approaches to fight an evolving battle. We have good reason to be optimistic and aggressive in our approach -- and must be as smart and adaptive as the malaria parasite itself to achieve our ultimate goal: a world free from malaria.
Dr. Kent Campbell is the director of PATH's Malaria Control Program, which is focused on developing evidence-based national malaria control programs in Africa.
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