Recent calls to eliminate malaria from Hispaniola — the last Caribbean island with endemic transmission of Plasmodium falciparum — are timely and important, write Joseph Keating, Donald Krogstad and Thomas Eisel from Tulane University in the United States in The Lancet Infectious Diseases.

It would provide proof of principle that malaria elimination is possible in complex environments. But elimination is also needed because there is now evidence of chloroquine resistance in Haiti and fast action is needed before the country is forced to switch to a more expensive combination therapy.

Lessons learnt in Haiti will be critical for informing other countries seeking malaria elimination. If elimination cannot be achieved on this small Caribbean island, there is little hope that it can be achieved in Sub-Saharan Africa where the malaria burden is higher and its control more complicated, say the authors.

But they add that elimination strategies used on the island should not be oversimplistic adaptation of control measures used in Africa or other endemic areas.

The key to eliminating malaria in Hispaniola lies in using a combination of methods to eliminate the parasite reservoir in human beings, prevent transmission and mobilise the community to seek out diagnosis and treatment.

The cost of eliminating malaria in Hispaniola may be high — but it would set a precedent for health diplomacy and is a prerequisite to any global malaria elimination campaign.