Total elimination of transmission was slowly achieved. In , the country was declared free of malaria as a significant public health problem. By , CDC gradually withdrew from active participation in the operational phases of the program and shifted its interest to surveillance, and in , CDC participation in operations ceased altogether. The role of CDC became one of surveillance within the U. Distribution of malaria in the United States, The goal of most current National Malaria Prevention and Control Programs and most malaria activities conducted in endemic countries is to reduce the number of malaria-related cases and deaths.
Recent increases in resources, political will, and commitment have led to discussion of the possibility of malaria elimination and, ultimately, eradication. Commercial Availability of Artesunate for Injection. Contact Us. Section Navigation. Facebook Twitter LinkedIn Syndicate. Drainage activities, Virginia, 's. Aircraft spraying insecticide, 's. To receive email updates about this page, enter your email address: Email Address. Malaria Notices.
At present, the WHO considers quality-assured microscopy the gold standard for diagnosing clinical malaria. However, microscopy and RDTs are less sensitive at detecting low-density and subpatent infections, which can contribute a sizable proportion of secondary cases and onward transmission. Nucleic acid amplification techniques such as polymerase chain reaction are more sensitive than microscopy and RDTs and are increasingly being used in epidemiological studies; however, they are not yet field friendly and require considerable start-up costs and staff training.
Lab-based polymerase chain reaction assays through pooling techniques can provide a high-throughput approach for detecting low parasitemias Hsiang and others ; Imwong and others However, they do not provide immediate results, and conducting them is capital intensive. Similarly, loop-attenuated isothermal amplification can detect all species of infection at low density and high throughput, is available at a relatively low marginal cost, and involves less lab equipment, but it still requires staff capacity Surabattula and others The WHO recommends that the use of highly sensitive diagnostic tools should be considered only in low-transmission settings where malaria diagnostic testing and treatment are already widely used WHO b.
ACT is the frontline therapy for uncomplicated P. The WHO currently recommends five ACT combinations, and a few others are in the pipeline, although they are not expected to be available in the near future. Eliminating countries also face significant threat from P. Despite long being regarded as benign, acute cases can have severe consequences.
Primaquine, the only medicine currently available to treat hypnozoites, requires a long course of treatment 7—14 days or even 8 weeks , and poor adherence can lower its efficacy John and others Furthermore, the risk of life-threatening hemolysis in patients with glucosephosphate dehydrogenase G6PD deficiency, a common blood disorder present in about 8 percent of the population in malaria-endemic areas Howes and others , limits its use.
A reliable point-of-care test to detect G6PD deficiency is not yet widely available Baird Tafenoquine, a promising single-dose medicine against hypnozoites and relapses, is likely to be available in Eziefula and others ; Llanos-Cuentas and others , but it has severe side effects in G6PD-deficient patients.
Therefore, solving the problem of G6PD diagnosis and making more sensitive, field-deployable diagnostics more widely available have great potential for eliminating P.
Interest in the empiric administration of a therapeutic antimalarial regimen to an entire population at the same time, otherwise known as mass drug administration MDA , has recently been renewed. Proactive MDA has been successfully deployed against several infectious diseases, including lymphatic filariasis, onchocerciasis, schistosomiasis Hotez , and malaria Bruce-Chwatt ; Newby and others ; Poirot and others The goal is to interrupt transmission by treating all parasitemia in the population.
MDA can potentially reduce malaria mortality and morbidity through its direct therapeutic effect on individuals who receive a treatment dose of antimalarials. It also can reduce transmission rates by reducing parasitemia prevalence and interrupting various stages of the parasite lifecycle, and it can inhibit the sporogonic cycle in the mosquito, reducing its vectorial capacity.
If every member of a given population were treated by antimalarial MDA, the prevalence of asexual parasites in the population would immediately decline. However, knowledge gaps remain, especially regarding optimal size of the target population, methods to improve coverage, selection of drug-resistant parasites, and primaquine safety. Malaria elimination programs will likely use MDA in targeted ways to accelerate the impact of vector control and ongoing diagnosis and treatment.
Current trials use a full course of dihydroartemisinin-piperaquine or artemether-lumefantrine and a single low dose of primaquine Eckhoff, Gerardin, and Wenger ; White A key issue is that medicines such as ACTs and primaquine have been registered by drug regulatory authorities based on a clinical indication and a demonstrated risk-benefit ratio in symptomatic patients.
The evidence base for its use in asymptomatic or noninfected subjects will need renewed attention. In addition, many medicines considered for MDA are not known to be safe in the first trimester of pregnancy, which presents additional problems if the medicines are deployed in Africa, where pregnancies are rarely reported in the first trimester.
The long-term use of MDA in low-transmission settings faces several challenges. The optimum combination of products and the timing, frequency, and duration of use will depend on the endemicity, seasonality, and rate of importation Newby and others For example, MDA, preferably using treatments with a long half-life, is sensible where populations are static and the risk of importation is low Cohen and others ; Gosling and others To minimize drug pressure on ACTs, a complete course of treatment is needed, and the regimen used for MDA should differ from frontline treatment.
Like most interventions, MDA is designed to accompany other interventions, including active surveillance and vector control. Robust and responsive surveillance systems that identify and eliminate transmission foci are critical for the success of malaria control and elimination.
Ohrt and others An ideal malaria elimination surveillance system swiftly collects and transmits data about individual cases, classified by the origin of infection; integrates it with information on program activities; and analyzes the information on an ongoing basis to guide rapid response strategies.
In elimination settings, the WHO recommends investigation of all malaria cases to determine if they are imported or the first- introduced or second- indigenous degree results of local transmission. Passive detection of cases must be complemented with some form of active case detection. Active case detection might take the form of mass screening of high-risk individuals GHG ; Smith Gueye and others ; WHO , targeted testing of specific high-risk groups, or household visits seeking febrile or infected individuals.
Active case detection typically costs more than passive surveillance; however, the relative cost-effectiveness has not been assessed Sturrock and others Less-demanding approaches are being explored, such as surveying children in vaccination clinics, women in antenatal clinics, or children attending school.
Some programs proactively screen at-risk populations on a periodic basis or screen the contacts of index cases for related infections Moonen, Cohen, Snow, and others ; Wickremasinghe and others For example, migrant laborers and returning military may be screened when entering a malaria-eliminating country, or a village may be screened before and during the malaria season to detect cases before transmission begins. Focal screening and treatment of high-risk communities and mass screening and treatment of whole populations may be used, but these approaches miss infected subjects who are not screened Hoyer and others or persons with subpatent infections.
In islands or in countries with few entry points, visitors from endemic areas can be screened to prevent reintroduction; however, such screening is difficult to sustain.
For any of these methods to be effective, diagnostic tests have to be reliable and able to detect low levels of infection, or presumptive treatment treatment without a diagnostic test can be used WHO b. Use of serology to measure past exposure could help identify at-risk populations, especially in low-transmission settings where infections are relatively rare Hsiang and others Combining serology with conventional diagnostic testing in geospatial models to produce accurate risk maps at finer scales can improve the targeting of interventions Corran and others ; Hsiang, Greenhouse, and Rosenthal ; Kelly and others ; Lindblade and others ; Sissoko and others ; Sturrock and others Malaria should be made a notifiable disease required by law to be reported to government authorities once incidence is low enough that malaria surveillance teams can investigate and report every individual case Moonen, Cohen, Snow, and others China and Swaziland have made malaria a notifiable disease to try to increase reporting and encourage more sectors to use the surveillance system Cohen and others ; Hemingway and others Other approaches to capturing cases that present outside the public sector include restricting access to antimalarials and incorporating private health facilities into the surveillance system Moonen, Cohen, Tatem, and others After elimination has been achieved, passive surveillance at health facilities, including in the informal private sector, is needed to detect and treat introduced infections.
Malaria vaccines include pre-erythrocytic vaccines that aim to prevent blood-stage infection, blood-stage vaccines that clear parasitemia and prevent clinical disease, and transmission-blocking vaccines that prevent infection of mosquitoes and interrupt transmission Horton RTS,S, a pre-erythrocytic vaccine to prevent clinical P.
Clinical trials demonstrated a vaccine efficacy for clinical malaria of 28 percent in children ages 5—17 months, but only 18 percent in infants, the target population RTSS Clinical Trials Partnership and 36 percent and 26 percent, respectively, after a booster dose administered 18 months after the primary series. In January , the WHO released a position paper recommending further evaluation of the malaria vaccine in a series of pilot implementations before considering wider country-level introduction WHO b.
An ideal vaccine would be more effective than RTS,S at protecting individuals against infection and at stopping transmission of both P. Such combinations will likely not be commercially available for at least another decade.
Reorienting a program from control toward elimination involves retraining staff, developing strong surveillance capacity, building a data architecture that can monitor and direct activities, instituting managerial practices that ensure a capable and ready workforce, and changing program tasks from curative services to preventive community action. These activities involve securing political and financial commitment for at least 6—10 years after elimination has been achieved, as demonstrated by the experiences of Turkmenistan and Sri Lanka, described in boxes Despite the need for intensified surveillance and response capabilities during the elimination phase, governments and external donors typically reduce funding as incidence declines Cohen and others Program activities are often integrated into the local health system to increase efficiency Liu and others ; Tatarsky and others A review of managerial experiences with disease elimination suggests that dedicated staff should run and oversee some tasks vector control and rapid case investigation , while local health teams could oversee others case management, surveillance, and reporting Gosling and others Regional collaboration can further reinforce collective goals and foster positive cross-border externalities and financing Barclay, Smith, and Findeis ; Gosling and others ; Moonen, Cohen, Snow, and others For a description of regional initiatives, see annex 12B.
One of the strongest arguments against eliminating or eradicating any disease involves the costs associated with finding and treating a decreasing number of cases Lines, Whitty, and Hanson These final few cases will likely require an outlay of resources that appear to be disproportional to the marginal return. Maintaining a high level of financial support when transmission has been reduced to low levels remains a challenge. Policy makers have to decide whether to maintain control activities indefinitely or whether to actively pursue elimination.
Articulating the costs of elimination and the relative benefits of investment in elimination versus control will help inform these decisions. Three methods can be used to assess the incremental costs and associated benefits of malaria elimination:. Since the conclusion of the GMEP in the s, several studies have reported the costs and consequences of malaria elimination and control, but few benefit-cost analyses have been conducted table Beyond the direct benefits on health, the main economic benefit considered in the studies is increased labor productivity resulting from reductions in absenteeism.
Other benefits include gains from the migration of labor into previously malarial areas and lower treatment costs.
Most studies assume a year elimination campaign, and only two Ortiz ; Ramaiah used empirical data. All studies showed positive benefit-cost ratios, indicating sizable benefits relative to costs. Benefit-cost ratios ranged from 2. Of these countries, Greece continues to report outbreaks as a result of imported cases, despite having eliminated malaria, and Sri Lanka is in the process of seeking WHO malaria-free certification Samaraweera Many of the economic benefits associated with malaria interventions extend beyond health to include larger macroeconomic and demographic effects.
Lower child mortality may reduce fertility Aksan and Chakraborty , increase literacy and human capital Lucas , and eventually increase labor productivity. Domestic and foreign investment may be channeled to formerly malarious areas, contributing to fiscal growth. Comparing the marginal benefits of control to those of elimination is difficult.
Elimination can improve health equity because the last remaining foci of infection are often concentrated within poor or marginalized populations Feachem, Phillips, and Targett Prevention of reintroduction also protects against resurgences. Furthermore, eliminating malaria within a single country may confer substantial regional externalities and global public good, fostering collaboration.
Elimination may also confer threshold benefits by permanently reducing the receptivity of an area to the reestablishment of local transmission Chiyaka and others ; Sabot and others ; Smith Gueye and others , but methods to measure the value of the diminished resurgence risk have yet to be established.
Some studies have examined the relationship between elimination and tourism demand in the Dominican Republic, Mauritius, and South Africa, but with little success because of confounding factors such as the overall increase in global travel Maartens and others ; Modrek and others As benefits become less tangible, they are more difficult to measure.
Gaining an understanding of the larger set of economic benefits will require better macroeconomic models that quantify the links between elimination and other outcomes Mills, Lubell, and Hanson However, programmatic costs are only part of the picture—individuals, households, and employers also incur costs for treatment and prevention. From a programmatic perspective, costs increase as control interventions are scaled up, because interventions are often provided for free to increase coverage and to shift costs from individuals to programs.
Analyses of program expenditures are limited to a few studies primarily in Africa and Asia. A systematic literature review identified 21 studies on the costs of malaria elimination with known data sources Shretta and others Program expenditures were divided by the cost per capita to account for differences in intended coverage and benchmarked to the first year of data for each country.
Only Mauritius seeks to prevent reintroduction by screening passengers at ports of entry and using targeted vector control, which may account for the high costs.
Costs for elimination have varied but have generally been low. These estimates are lower than those from more recent studies, and it is unclear how directly comparable they are because of variable inputs and the availability of new and more costly tools as well as the rise of new challenges, such as insecticide and artemisinin resistance and human migration figure To generate results most relevant to policy, malaria elimination requires a comparison of cost with a counterfactual scenario of malaria control, the costs of which vary substantially with the level of control.
In practice, while an abundance of literature examines the costs of comprehensive control, studies comparing the costs of elimination to the costs of control to determine the financial cost savings of an elimination program relative to control or resurgence are scarce.
Nevertheless, once malaria is reduced to a level at which it is no longer a public health threat, reorienting the program from control to elimination is likely to require a significant one-time investment Sabot and others One study that projected costs to a to year timeline for Hainan and Jiangsu provinces in China and in Mauritius, Swaziland, and Zanzibar found that elimination is likely to be more costly than control in the short term and is likely to remain more expensive than control at substantially longer timeframes depending on the inputs of the post-elimination program.
Programs can also be integrated, making disease programs more efficient as well as creating a platform for mobilizing resources, even if malaria is no longer considered a priority. For example, in Singapore, integrating dengue and malaria surveillance facilitated interagency collaboration and reduced transmission of both diseases Luckhart and others When transmission decreases and eventually ceases, costs are likely to decline and eventually stabilize as efforts turn to preventing reintroduction primarily through surveillance, vector control, and emergency response.
Private out-of-pocket expenditures are also likely to become negligible as the number of cases declines. Two studies figure Elimination should therefore not be justified on the basis of short-term cost savings alone. A focus only on relative cost savings ignores many other factors for example, population growth, economic development, reductions in malaria in neighboring countries that could permanently alter the epidemiology of the area, reduce transmission, accelerate the elimination timeline, and decrease costs Smith and others Several studies have explored the association between malaria and economic productivity Audibert, Mathonnat, and Henry ; Badiane and Ulimwengu ; Girardin and others and can be used to build the investment case.
Many costs of malaria, such as the long-term effects of chronic malaria infection on lowering educational attainment, have yet to be estimated Chen and others Economic modeling using data from Ghana Asante and Asenso-Okyere , Uganda Orem and others , and across several countries Gallup and Sachs ; McCarthy, Wolf, and Wu ; Okorosobo and others found that malaria is associated with losses in gross domestic product GDP growth.
Using cross-country regressions, Gallup and Sachs demonstrated that countries with intensive malaria lost 1. GDP losses of between 0. However, many of these historical studies are not population based and use secondary sources or expert opinion to calculate the burden of malaria, limiting their contemporary use. Exposure to malaria in childhood has been associated with lower incomes and a greater likelihood of poverty in adulthood in South America Barreca ; Bleakley , ; Hong Development assistance for malaria quadrupled between and However, the proportion of development assistance directed toward malaria-eliminating countries declined more than 80 percent and continues to decline figure Securing funding for a disease that occurs infrequently is challenging.
Malaria-eliminating countries typically have lower disease burdens and are often middle-income countries; therefore, they are a lower priority for donors. The Global Fund to Fight AIDS, Tuberculosis, and Malaria has historically allocated about 7 percent of its portfolio to malaria-eliminating countries but, under its new funding model, now allocates about 5 percent, representing a projected decrease of 31 percent in national funding allocation—a serious shortfall at a time when maintaining national gains and advancing the elimination agenda are essential GHG ; Zelman and others Overseas Development Assistance Commitments for Malaria, — Eliminating countries finance about 80 percent of their malaria programs CEPA , and this spending has been increasing steadily since Greater emphasis is being placed on building the capacity of countries to fund their own programs through increased government spending as well as innovative financing mechanisms.
Box Efficiency in the portfolio and delivery of interventions will ultimately increase cost-effectiveness. More efficient deployment of resources, however, requires a robust surveillance platform in which high-quality data can be collected and analyzed so that measures of response can be adjusted in a timely manner box The benefits of achieving and maintaining elimination include a strong public good component—an incremental contribution to global malaria eradication.
While many argue that eradication is unlikely given existing tools Greenwood ; Tanner and de Savigny , particularly for high-burden countries in Africa, the global pipeline for new products has never been stronger, supporting the mounting optimism that global eradication is plausible.
The technical and operational feasibility of eradication, the operational complexity, and the political appetite need to be considered when assessing the prospects for eradication. Determining feasibility involves assessing both the technical challenge—the transmission intensity and the effectiveness of the tools available to reduce it—and the operational capacity to complete the task. Other disease eradication campaigns suggest that eradication has only been considered after many countries have eliminated the disease.
For example, when the goal of smallpox eradication was announced, the disease had been eliminated in all high-income countries and was endemic in only 59 low-income countries Barrett ; Henderson Similarly, the poliomyelitis eradication initiative was launched in only after polio had been eliminated in the Americas and all high-income countries, with indigenous transmission remaining in countries Aylward and others ; Bart, Foulds, and Patriarca ; Khan and Ehreth Malaria has been eliminated within many local borders, but the overall burden remains high and widespread.
As burdens of P. The true burdens of these species are largely unknown because identification by microscopy or rapid diagnostic tests is not reliable Baltzell and others ; Oguike and others ; Steenkeste and others Eradication of any species only succeeds if the last carrier of disease is isolated, treated, and prevented from causing further transmission.
Understanding of transmission between animal and human hosts relevant for zoonotic reservoirs has only recently gained attention. For example, P. Lessons from other campaigns suggest that for eradication to be feasible, a vaccine or an equivalent means is needed to convey long-term protection, as in the case of smallpox Barrett , Even if other measures could be implemented to confer protection similar to a vaccine, many challenges remain.
Drug resistance is on the rise, and pyrethroid resistance has emerged after large-scale distribution of LLINs John, Ephraim, and Andrew ; Trape and others ; Tulloch and others The smallpox and polio eradication campaigns implemented eradication-specific management systems that could be integrated into existing health systems Aylward and others , used performance indicators to measure management processes, trained adequate numbers of staff and gave them incentives to execute eradication-specific tasks, developed a robust surveillance system, and expanded financing to support a stronger health care system Henderson Through implementation of the smallpox, polio, and guinea-worm programs, innovative breakthroughs were made in organizing large-scale nationwide campaigns; in devising new methods for approaching and mobilizing communities; in developing effective national surveillance networks and using the data to support better strategies; in fostering effective and relevant research programs to facilitate disease control; and in mobilizing support at international, national, and local levels.
Lessons learned from these efforts are critical for malaria eradication. Building programs capable of proactively mitigating the risk of transmission requires careful planning rather than reactive emergency response measures. It cannot be accomplished or maintained by spasmodic effort. The success of malaria eradication will depend on the ability to mobilize collective action. At a minimum, universal political commitment to achieving an agreed-on target is required, as are financial resources to sustain that commitment.
Although countries may be willing to eliminate the disease within their borders, the last country to eliminate it has little incentive to do so on its own, given the larger interests of all other countries Barrett The smallpox eradication program nearly failed because of lack of political commitment Barrett , and the GMEP was cut short for the same reason.
Although global attitudes have shifted toward malaria elimination and eradication, political and financial support is needed to bolster the goal of global eradication, should that goal be adopted for malaria.
There are concerns that concentrating resources in areas with lower burdens of disease may divert resources from lower-income countries with higher burdens of disease Shah ; however, progress in low-burden countries is likely to drive global progress toward eradication Newby and others In addition, because malaria-free countries stand to benefit from eradication, they have an incentive to offer financial assistance if they are assured that the last countries will work toward elimination Barrett ; Taylor, Cutts, and Taylor Despite the absence of a highly efficacious vaccine, many countries around the globe have successfully eliminated malaria and prevented its reintroduction.
As malaria elimination progresses in more areas, the case for global eradication is likely to become more compelling. Promising new tools are already in the product development pipeline, including radical treatments, sensitive rapid diagnostic tests, and next-generation vector control methods. Piloting the effective use of these innovations will ensure that they can be scaled up safely and effectively.
The introduction of game-changing innovations—including anti-infection or transmission-blocking vaccines and novel mosquito control strategies—could substantially accelerate this next phase. As new technologies and advances occur, the cost of elimination may decline as efficiencies are realized and targeting becomes increasingly focused. Elimination may become progressively easier with new drug therapies, simplified treatment regimens, and more effective vaccines. With smallpox, the targeted nature of surveillance and containment and improved needle technology for vaccinations contributed significantly to the success of the eradicaton campaign.
Malaria eradication calls for a long-term investment that will yield dividends over time. However, eliminating malaria transmission worldwide will require renewed focus in several areas. Strengthening the human resource capacity of programs is essential. Combating the threat of importation will require collaborative regional surveillance efforts that reach communities and the private sector.
In addition, as new tools become available, support will be required for their adoption and rapid uptake to combat the effects of drug and insecticide resistance.
These actions all require sustained political and financial commitment to ensure success. The following annexes to this chapter are as follows. Despite a highly receptive environment in Taiwan, China, intensive spraying combined with improved housing and socioeconomic conditions, better environmental management, and strong case management reduced morbidity to very low levels, and the WHO certified Taiwan, China, as being malaria free in Yip Polymerase chain reaction testing in African and Asian settings shows a higher proportion of both P.
In the case of smallpox, there were no long-term carriers, survivors gained lifetime immunity, infections were easily detected, only symptomatic persons could transmit the disease, and vaccination of only 80 percent of the population was necessary to eliminate transmission Barrett This work is available under the Creative Commons Attribution 3. Under the Creative Commons Attribution license, you are free to copy, distribute, transmit, and adapt this work, including for commercial purposes, under the following conditions:.
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Examples of components can include, but are not limited to, tables, figures, or images. Turn recording back on. National Center for Biotechnology Information , U. Search term. Introduction The world has made tremendous progress in the fight against malaria in the past 15 years.
What Are Elimination and Eradication? Progress Toward Malaria Elimination Elimination in the Twentieth Century Until the mid-nineteenth century, malaria was endemic in most countries across the globe. Map Lessons Learned and Planning for Success Lessons learned from the GMEP highlight the fact that a single strategy is unlikely to be successful everywhere given the complexities of malaria transmission systems, and given that a long-term commitment with a flexible strategy that includes community involvement, integration with health systems, and the development of agile surveillance systems with supporting infrastructure is needed Najera, Gonzalez-Silva, and Alonso Challenges and Threats to Success In contrast to previous attempts at eradication, current efforts explicitly acknowledge that malaria eradication requires a long-term effort incorporating multiple activities and embracing multiple interventions, disciplines, approaches, and organizations.
Eliminating P. Reaching High-Risk Populations In malaria-eliminating settings, parasite reservoirs are increasingly clustered in high-risk populations or in geographically restricted foci of transmission Sturrock and others Addressing Artemisinin Resistance Resistance of parasites to artemisinin derivatives, the mainstay of malaria treatment, is a mounting problem. Malaria Elimination Interventions and Strategies Elimination and control rely on similar interventions: high-quality case management, vector control, and surveillance.
Vector Control Vector control, a key intervention for preventing malaria transmission by Anopheles mosquitoes, includes indoor residual spraying with insecticide, use of LLINs, larviciding, and environmental management to remove breeding sites WHO Residual Transmission and New Tools for Control Despite high coverage of LLINs and indoor residual spraying, transmission persists in many areas because of residual transmission, defined as transmission sustained by vectors that evade contact with these two indoor interventions and that rest outdoors and bite humans or animals Killeen Entomological Surveillance and Integrated Vector Management Robust entomological surveillance and monitoring is critical to guiding vector control interventions.
Maintenance of Low Transmission The rate of progress toward elimination and the level of interventions required to interrupt transmission depend on the strength of the health system to detect and respond to cases; the level of investment in malaria programs; and various other factors, including biological determinants, the environment, and the social, demographic, political, and economic realities in the particular country.
Diagnosis and Treatment At present, the WHO considers quality-assured microscopy the gold standard for diagnosing clinical malaria. Mass Drug Administration Interest in the empiric administration of a therapeutic antimalarial regimen to an entire population at the same time, otherwise known as mass drug administration MDA , has recently been renewed.
Epidemiological Surveillance Robust and responsive surveillance systems that identify and eliminate transmission foci are critical for the success of malaria control and elimination. Vaccines Malaria vaccines include pre-erythrocytic vaccines that aim to prevent blood-stage infection, blood-stage vaccines that clear parasitemia and prevent clinical disease, and transmission-blocking vaccines that prevent infection of mosquitoes and interrupt transmission Horton Program Management Reorienting a program from control toward elimination involves retraining staff, developing strong surveillance capacity, building a data architecture that can monitor and direct activities, instituting managerial practices that ensure a capable and ready workforce, and changing program tasks from curative services to preventive community action.
Economics and Financing of Malaria Elimination One of the strongest arguments against eliminating or eradicating any disease involves the costs associated with finding and treating a decreasing number of cases Lines, Whitty, and Hanson Three methods can be used to assess the incremental costs and associated benefits of malaria elimination: Analyzing the costs and benefits of an elimination program, summarized using a benefit-cost ratio.
Determining the financial cost savings of an elimination campaign relative to alternative scenarios for example, control or resurgence costs. Evaluating the macroeconomic impact of malaria control and elimination against the economic burden that malaria places on society.
Costs and Benefits Since the conclusion of the GMEP in the s, several studies have reported the costs and consequences of malaria elimination and control, but few benefit-cost analyses have been conducted table Benefits Many of the economic benefits associated with malaria interventions extend beyond health to include larger macroeconomic and demographic effects.
Figure Financial Cost Savings of Elimination Relative to Alternative Scenarios To generate results most relevant to policy, malaria elimination requires a comparison of cost with a counterfactual scenario of malaria control, the costs of which vary substantially with the level of control.
Macroeconomic Gains from Malaria Elimination Several studies have explored the association between malaria and economic productivity Audibert, Mathonnat, and Henry ; Badiane and Ulimwengu ; Girardin and others and can be used to build the investment case.
Financing and Efficiency Development assistance for malaria quadrupled between and Prospects for Malaria Eradication The benefits of achieving and maintaining elimination include a strong public good component—an incremental contribution to global malaria eradication.
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