New WHO advisory group tackles key questions on malaria eradication

11 October 2016

Over the last 15 years, the world has seen unprecedented progress in the fight against malaria. Globally, the rate of new malaria cases has declined by 37%. Malaria death dates have plunged by 60%.

In the last decade alone, 7 countries have been certified by WHO as malaria-free. For the first time in 2015, the WHO European Region, comprised of 53 countries, reported zero indigenous cases of the disease.

UN Member States are increasingly calling for malaria elimination in their own country or region, prompting renewed discussion around the ultimate goal of global malaria eradication.

Key definitions

WHO defines malaria control as the reduction of disease incidence, prevalence, morbidity or mortality to a locally acceptable level as a result of deliberate efforts. Continued intervention efforts are required to sustain control.

Malaria elimination is the interruption of local transmission (reduction to zero incidence) of a specified malaria parasite in a defined geographical area as a result of deliberate activities. Continued measures to prevent re-establishment of transmission are required.

Malaria eradication is the permanent reduction to zero of the worldwide incidence of infection caused by human malaria parasites as a result of deliberate activities. Interventions are no longer required once eradication has been achieved.

New WHO advisory group

From 29–30 August, 13 eminent leaders and scientists representing a range of disciplines and geographies convened in Geneva for the inaugural meeting of the WHO Strategic advisory group (SAG) on malaria eradication. They were supported by representatives from WHO collaborating centres, WHO staff and other key stakeholders.

Over the next 2 years, SAG members will analyse the evolving malaria landscape, taking into consideration a broad set of factors that underpin the disease: biological, technical, financial, socio-economic, political and environmental. Members will review trends in poverty and population growth, mobility, agricultural use, urbanization and communication. They will consider, among other factors, the role of climate change and potential developments in research and innovation.

A former (and failed) attempt at eradication

In his opening remarks at the meeting, Dr Ren Minghui, WHO Assistant Director General for HIV/AIDS, Tuberculosis, Malaria and Neglected Tropical Diseases, reminded participants of the Global Malaria Eradication Programme (GMEP), an initiative launched in 1955 that succeeded in eliminating malaria in 15 countries and lowering the malaria burden in many more.

But eradicating malaria turned out to be a more complex task than imagined. In some areas, substantial gains in malaria control were lost in resurgences of the disease, sometimes of epidemic proportions. There was no real progress in sub-Saharan Africa, which today accounts for approximately 90% of all malaria cases and deaths.

GMEP was discontinued in 1969, but the longer-term objective remained unchanged. WHO reaffirmed the “ultimate goal of eradication” at the Twenty-second World Health Assembly through resolution WHA22.39.

Background and SDG context

As background for their deliberations, members of the SAG heard from prominent experts on ongoing and past disease eradication programmes, including GMEP, polio and smallpox. Other speakers reviewed recent trends in key determinants of malaria: economic development, poverty, population growth and movement, and urbanization.

Addressing the SAG on 30 August, Dr Margaret Chan, Director-General of WHO, urged members of the advisory group to frame their discussions within the broader global development agenda. “Pay attention to the Sustainable Development Goals (SDGs),” she said, noting that the 15-year global development agenda would influence financing decisions and the political commitment of world leaders.

The SDGs were unanimously adopted by world leaders at the UN General Assembly in September 2015. “Ending malaria epidemics” is a target of SDG Goal 3; WHO interprets this as achieving the 2030 targets of the Global Technical Strategy for Malaria 2016-2030.

Next steps

There was a general consensus among SAG members that country leadership and predictable financing were an essential foundation for any disease programme. Many highlighted the need for strong surveillance systems and for the authentic engagement of affected communities. Ongoing investment in research and innovation were seen as critical to the success of any eradication effort.

SAG members agreed that WHO must lead the eradication debate and reaffirm its commitment to malaria eradication while explicitly not launching an eradication campaign at this point in time. The two key decision points from the meeting were:

  • To develop a position statement that clarifies the current terminology around malaria “elimination” and “eradication” and confirms WHO’s commitment to long-term malaria eradication.
  • To undertake analyses to provide advice to WHO on the determinants, expected cost, timeframe, and potential future strategies for malaria eradication over the ensuing decades.

Meeting in Geneva from 14–16 September, members of the WHO Malaria Policy Advisory Committee endorsed these decision points. With support from the WHO Global Malaria Programme, SAG members are currently drafting a position statement that clearly defines the Organization’s position with respect to malaria eradication.