What to read after Malaria eradication?

In 2016, at the request of the WHO Director-General, a group of scientists and public health experts from around the world were brought together to advise WHO on future scenarios for malaria, including whether eradication was feasible. Over three years, the members of the Strategic Advisory Group on Malaria Eradication (SAGme) analysed trends and reviewed future projections for the factors and determinants that underpin malaria. Our analysis and discussions reaffirmed that eradication will result in millions of lives saved and a return on investment of billions of dollars. We did not identify biological or environmental barriers to malaria eradication. In addition, our review of models accounting for a variety of global trends in the human and biophysical environment over the next three decades suggests that the world of the future will have much less malaria to contend with. However, even with our most optimistic scenarios and projections, we face an unavoidable fact: using current tools, we will still have 11 million cases of malaria in Africa in 2050. Under these circumstances, it is impossible to set a target date for malaria eradication, to formulate a reliable operational plan for malaria eradication or to give it a price tag. Our current priority should be to establish the foundation for a successful future eradication effort. At the same time, we need to guard against the risk of failure, as such failure might lead to the waste of huge sums of money, frustrate all those involved (national governments and malaria experts alike), and cause a lack of confidence in the global health community's ability to rid the world of this disease. We need a renewed drive towards research and development (R&D) on vector control, chemotherapy and vaccines in order to develop the transformative tools and knowledge base necessary for achieving eradication in the highest burden areas. We need political leadership that makes effective and efficient use of increased domestic and international funding. We need bespoke national and subnational strategies guided by improved use of data and stronger delivery systems to provide the appropriate mix of services to all those in need, without financial hardship. We need strengthened cross-border, regional and international cooperation on malaria control and elimination efforts worldwide. When these critical foundations are laid, we believe that the world will be in a much stronger position to make the final and credible push for eradication. As we complete our work in 2019, we recognize that the world stands at a crossroads in the fight against malaria. Despite huge progress in reducing malaria cases and deaths between 2000 and 2015, in the last five years, we have witnessed the stalling of global progress. The world is not on track to meet the 2020 milestones that will lead us to lower case incidence and mortality by 90% by 2030 (from 2015 levels) (5). Without massive concerted and coordinated action, we are unlikely to meet these targets. While we are certain that eradication by a specific date is not a promise we can make to the world just yet, there is a clear agenda - beginning with getting back on track to achieve the goals of the GTS - that should immediately be pursued to make eradication possible.