The Lancet Commission on malaria eradication

The Lancet
Apr 21, 2018 Volume 391 Number 10130 p1549-1636

The Lancet Commission on malaria eradication
Ingrid Chen, Rebecca Cooney, Richard G A Feachem, Altaf Lal, Winnie Mpanju-Shumbusho
… The malaria community is reaching consensus that eradication is the only acceptable end goal. If we aim for anything short of eradication, the parasite and vector will become increasingly resistant to the drugs and insecticides available to combat the disease.8 Without eradication, sustained effort would also be needed indefinitely, as the disease would be able to return with a vengeance, particularly in tropical areas with high anopheline vectorial capacity. There is also a strong ethical imperative to eradicate malaria, a disease mainly affecting poor and marginalised people. Malaria eradication offers a massive return on investment: every dollar spent returns up to US$60 for the wellbeing of countries and their populations.9

With malaria eradication emerging as a pragmatic, ethical, and economically advantageous investment, the global health community needs more evidence to guide eradication strategies at national, regional, and global levels. To address this, The Lancet and the Malaria Elimination Initiative at the Global Health Group, University of California, San Francisco have convened the Lancet Commission on malaria eradication, designed to complement and supplement the WHO Strategic Advisory Group on malaria eradication. The Commission will elaborate the scientific, financial, and operational requirements to achieve malaria eradication. Some of the questions to be addressed by the Commission are shown in the panel. The Commission comprises 24 leaders in science, epidemiology, policy, finance, economics, and implementation (appendix). The Commissioners will meet two or three times over the next 12 months with the aim of publishing the Commission’s report in 2019.

Questions to be addressed by the Lancet Commission on malaria eradication
The Lancet Commission on malaria eradication will develop a comprehensive roadmap for the eradication of malaria. Questions to be tackled by the Commission include:
:: Why should we eradicate malaria and what return on investment can we expect?
:: What are the costs of eradication and who will pay?
:: How will global megatrends (eg, urbanisation) facilitate or impede malaria eradication?
:: In which countries will malaria eradication prove most difficult and where will the last battlegrounds be?
:: Which new game-changing technologies are likely to be essential to complete the eradication task?
:: How will malaria eradication support universal health coverage and vice versa?
:: How can programme implementation be strengthened at the national and subnational levels?

The Commission’s work will emphasise the dual imperative to shrink the malaria map, while intensely reducing the burden of disease in high transmission areas. The Commission will pay special attention to the endgame: the last battle that will probably play out in high transmission countries in equatorial Africa. The comprehensive synthesis developed by the Commission will be intended to propel continued progress towards elimination using available tools in parallel with the development of future innovations, including the potential use of CRISPR-Cas9 gene drive technology to modify parasites or mosquitoes.10, 11

While the task of malaria eradication will be formidable, 20 years of progress have brought us more than halfway there. This month is an important time for the malaria community. MIM reconvenes in Dakar, Senegal, after 21 years at the 7th MIM Pan African Malaria Conference on April 15–20, 2018, where researchers will share the latest research findings and agree on new strategies to advance elimination and eradication. Today the pace of scientific advance and innovation continues to accelerate with pilot studies to evaluate the first malaria vaccine underway.12 At the same time, leaders gather in London, UK, on April 16–20 at the Commonwealth Heads of Government Meeting where malaria is firmly on the agenda. The 53 Commonwealth countries are home to 60% of all malaria cases and 52% of all malaria deaths.2, 13 A bold commitment by the Commonwealth could greatly increase the prospect of malaria eradication within a generation.

The fight against malaria has made exceptional progress in the past decades. We are now poised to embark on a journey towards eradication. Building on this momentum and harnessing the combined energy and commitment of politicians, scientists, implementers, and the public and private sectors, we have both the opportunity and responsibility to create a world free of malaria.5