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Preventing Resurgence: The Key to Malaria Eradication

Updated: May 19, 2023

Every year, World Malaria Day is observed on April 25th to raise awareness about the importance of continued investment and sustained political commitment for malaria prevention and control. While significant progress has been made in controlling malaria in many parts of the world, the disease remains a major global health challenge, especially in Africa.

According to the WHO, Africa suffers from a disproportionately high share of global malaria burden: in 2021, the region recorded 95% of all malaria cases and 96% of deaths.

Countries face numerous challenges when it comes to eradicating malaria. However, there are a number of practical solutions to sustain successful malaria control programs.

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The paradox of Success and the Threat of Complacency

Many countries have made significant progress in controlling malaria through various measures such as the use of insecticides and mosquito nets. However, the challenge lies in preventing the reintroduction or resurgence of the disease, especially in countries where it is endemic.

A review in the Malaria Journal of 75 resurgence events in 61 countries, occurring from the 1930s through the 2000s, showed that, at least partly, a resurgence was due to a weakening of malaria control programmes for a variety of reasons, particularly funding disruptions.

The paradox of success in malaria control is that the more successful the program is, the less visible the disease becomes, and the greater the risk that funding will be withdrawn or operations will be conducted in a lackadaisical fashion.

Preventing Malaria Resurgence: A Paradigm Shift is Required

To prevent the resurgence of malaria, a paradigm shift is required from a focus on short-term burden reduction to a long-term, immunization-like program of routine activities that are planned and budgeted for, regardless of the present burden of disease. The critical causes of resurgence of malaria were not the failures of technical solutions; they were the failures of malaria programs to implement the technical solutions sufficiently well.

Continuous Surveillance and Predictive Modelling

Continuous surveillance is crucial in maintaining a baseline standard of malaria control. Predictive modelling and AI can play a vital role in predicting where malaria cases are being reported, which parts of the country are affected, and where efforts should be directed. If predictive models show a specific region reporting too many cases, efforts, such as vector control, a high-effective way to reduce malaria transmission, which includes the deployment of either insecticide-treated nets (ITNs) or indoor residual spraying (IRS), can be directed to that area.

Maintaining Funding and Support

Ongoing funding and support for malaria campaigns are essential for sustaining eradication efforts.

Prevention of Re-establishment (POR) Plan

All countries need a prevention of re-establishment (POR) plan which sets out how to ensure that there is no resurgence of indigenous malaria in a malaria-free country. The plan might include any number of steps, such as those already mentioned, as well as robust passenger and migrant screening programs and cross-border collaborations.

Long-term Planning for Long-Term Success

In conclusion, eradicating malaria requires continuous effort and investment. As long as malaria remains a threat in one part of the world, it is a threat to all. The fight against malaria is not over once it is eradicated in a region or country. Continuous surveillance, predictive modelling, maintaining funding and support, and a strong POR plan are crucial for sustaining successful malaria control programs. On this World Malaria Day, let us renew our commitment to eradicating this deadly disease and work together towards a malaria-free world.


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