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  • Malaria elimination 'most feasible' in Latin America


[SANTIAGO/LONDON] Malaria elimination is most feasible in Latin America and least feasible in Central and West Africa, according to a study mapping 99 malaria-endemic countries.

Malaria elimination has been ongoing since the 1900s, Richard Feachem, director of the Global Health Group at the University of California, San Francisco, said at a press conference in London, United Kingdom, today.

Feachem said that a reasonable estimate for global eradication of malaria is 2050–2060. He was speaking at a launch of a series of papers on malaria elimination in The Lancet.

One paper examined how likely different countries are to stop transmission of Plasmodium falciparum malaria with existing control measures — and thus eliminate the disease.

The study used existing data to rank countries according to technical and operational feasibility of elimination. This included factors such as the intensity of disease transmission, the state of health systems, infrastructure, political stability, and political commitment to achieving and sustaining elimination.

A lack of data on Plasmodium vivax meant the study could only produce robust estimates for P. falciparum.  

The results show that eliminating P. falciparum is most feasible in Latin America, where less than a 50 per cent reduction in 2007 transmission levels is needed to achieve elimination.This is due to economic development, improved health systems, and good accessibility to populations at risk in the region, as well as the relatively low transmission levels of the disease.

Latin American countries on the road to elimination are: Argentina, Costa Rica, Dominican Republic, El Salvador, Mexico, Panama and Paraguay. Haiti was on this list before the January earthquake.

In Africa, only a few countries — including Botswana, Djibouti and Swaziland — are well placed to eliminate P. falciparum with existing methods. In this region a new vaccine will likely be necessary for malaria elimination, said Geoff Targett, emeritus professor of immunology of parasitic diseases at London School of Hygiene and Tropical Medicine and member of the Malaria Elimination Group.

Countries in West and Central Africa face the greatest obstacles. They need a more than 90 per cent reduction in 2007 transmission levels to achieve elimination.

"Before embarking on an elimination campaign, countries must conduct a comprehensive and rigorous feasibility assessment that draws on detailed evidence that is not easily summarized at global scales," Andrew Tatem, lead author of the study and a researcher at the Emerging Pathogens Institute of the University of Florida, United States, told SciDev.Net.

Justin Cohen of the Malaria Control Team at the global health organisation Clinton Health Access Initiative said that "this work demonstrates that quantitative approaches can provide objective insights into the feasibility of malaria elimination — a sometimes contentious subject".

The Malaria Elimination Group will have its annual meeting at the Mexico–Guatemala border in ten days time "to review the Central American experience with representatives from those countries to ask about their views on what is possible for them," Feachem said.

"It will take a lot of regional collaboration, and the cross-border dimension will be critical because there are significant population movements across those borders." Such cross-border movements can import malaria cases to countries that have eliminated the disease.

Link to full malaria elimination series in The Lancet

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