Director's Corner: Paving the way for global malaria eradication by doubling down on regional elimination

Ten years ago, I—along with a small team at the UCSF Global Health Group—started the Malaria Elimination Initiative (MEI) with a bold vision: countries can eliminate malaria. Having seen remarkable but under-appreciated success throughout decades of work with ministries of health, I knew that this was possible. Since the MEI’s inception, seven countries—most recently Sri Lanka—have done just that, and for the first time, a whole region—the European Region—has been declared malaria-free.

The MEI, along with other forward-thinking partners, supported these elimination success stories by researching the most stubborn problems and providing malaria programs with the tools and strategies to overcome them. But ultimately, it was the countries and regions themselves that applied the necessary leadership, commitment, finance, and aggressive strategies to cross the finish line.

Building on our unique action-tank approach, the MEI has doubled down on an ambitious program of work that embraces a renewed vision for what is possible: malaria can be eradicated globally, country by country, region by region.

Our portfolio today emphasizes a regionally-led approach to elimination and aims to build global consensus and leadership to eradicate malaria, ending it for good.

In southern Africa, we are supporting the Elimination Eight (E8) Regional Initiative and its Secretariat based in Windhoek, Namibia. The E8 is a coordinated, eight-country effort to achieve the historic goal of eliminating malaria in southern Africa by 2030. Led by member countries and supported by the E8 Ambassador and former Minister of Health of Namibia, Richard Kamwi, and the Director of the E8 Secretariat, Kudzai Makomva, the E8 works to strengthen coordination, data-sharing, and joint action against malaria in southern Africa.

The recent heavy rains across southern Africa, and the resulting surge in malaria cases and deaths in most of the E8 countries, is undoubtedly a setback.  But during a recent trip to the region, I saw that the malaria outbreaks are demonstrating the unparalleled value of the E8’s collaborative approach.  At an emergency meeting last month, the eight countries discussed the latest developments, shared learnings, and developed a joint action plan for a regional early warning system.

As a partner to the E8, the MEI is supporting leadership and regional coordination to strengthen a harmonized approach to malaria elimination. The MEI is also conducting innovative operational research to find near-term strategies that work in the region, including targeted mass drug administration, improvements to reactive case detection, and new techniques to control vectors.

In Asia Pacific, our focus is to fully support the new joint-Secretariat of the Asia Pacific Leaders Malaria Alliance (APLMA) and the Asia Pacific Malaria Elimination Network (APMEN), based in Singapore. Supported by the APLMA Envoy and former Minister of Health of Indonesia, Nafsiah Mboi, and APLMA Executive Director, Ben Rolfe, this joint platform successfully solicited commitment by regional leaders to eliminate malaria throughout Asia Pacific by 2030.

As a partner to the Asia Pacific, the MEI is conducting research which includes supporting national malaria programs to develop and execute plans to mobilize adequate financial resources to finish the job and find new and effective surveillance strategies that target high-risk populations. The MEI also has a particular focus in helping Laos PDR eliminate malaria.

Some countries, including Bhutan, China, and Malaysia are on track for elimination by 2020 or sooner. Other countries are not. Some of these, such as Papua New Guinea, are plagued by a combination of high transmission rates and poor capacity to deliver effective programs to remote communities. Others, such as India, where we held the most recent Malaria Elimination Group (MEG 1.0) meeting, will need state-level leadership, solid data, and adequate financing to effectively deploy elimination strategies. Alongside these well-recognized challenges is another alarming trend: the spread of drug resistance in the Greater Mekong Sub-Region which threatens to reverse progress in the region and could derail malaria efforts globally.

On the global stage, we reached what I call the elimination tipping point in 2015. Once a dirty word, ‘elimination’ has become not only an acceptable word, but also a desirable goal. The WHO included an elimination target in its Global Technical Strategy for Malaria, and a visionary report, From Aspiration to Action, sparked a debate about whether eradication is possible in a generation. This year, the End Malaria Council was established—with the likes of Bill Gates, Ellen Johnson Sirleaf, and media mogul Peter Chernin at the helm.

In this new context, the MEI will focus on working with WHO and others to build robust global consensus on both the feasibility and desirability of global malaria eradication. Is it possible to eradicate malaria? We are convinced the answer is “yes”, but not everybody shares this opinion. Some will argue that other priorities should come first, and that the opportunity costs of malaria eradication are not justified. The MEI will soon convene the Malaria Eradication Group (MEG 2.0), a group of eradication experts and malaria ‘outsiders’ who will review, debate, and generate the evidence that will underpin the eradication agenda.

I have never before seen such remarkable momentum towards a world free from malaria. Our unwavering commitment is to work with global, regional, and country-level colleagues to eradicate this ancient disease. Do we have the tools today to eradicate? Likely not. But the commitment will ensure that the research enterprise to develop new tools remains ambitious and well-funded, and that once these tools emerge successfully from the R&D pipeline, they are rapidly put to work in communities affected by malaria. Together we can end malaria, but only if we believe in it and commit to it.

Professor Sir Richard Feachem, KBE, FREng, DSc(Med), PhD
Director, The Global Health Group
University of California San Francisco