Science        
22 February 2013 vol 339, issue 6122, pages 873-1000
http://www.sciencemag.org/current.dtl

Policy Forum – Infectious Disease
The Stability of Malaria Elimination
C. Chiyaka, A. J. Tatem, J. M. Cohen, P. W. Gething, G. Johnston, R. Gosling, R. Laxminarayan, S. I. Hay, and D. L. Smith
Science 22 February 2013: 909-910.

Eradication may not be necessary before countries can eliminate, scale back control, and rely on health systems.
Summary
When the Global Malaria Eradication Programme (GMEP) was launched in 1955 (1, 2), all malaria-endemic countries outside of Africa were (or would soon be) eliminating malaria (3). The GMEP’s design was based on a theory of malaria transmission dynamics and control that has become the standard for malaria elimination decisions today (4–6). When financial support for the GMEP collapsed in 1969, participating countries were caught at different stages of progress toward elimination (1). Examining their fate in the decades that followed provides a natural experiment that tests the theory. With a rise in funding (7) and renewed interest in eradication (8, 9), there is now a need to revisit the lessons learned from the GMEP. We identify changes in the epidemiology of malaria when elimination is reached that could explain its stability and discuss how this calls for a reassessment of strategies for eradication.