Is it still too soon to assign an end date for malaria?

MANILA — Though there’s a strong consensus globally on the need to eradicate malaria, a group of experts on Friday held off predicting an end date or putting a price tag on what it would cost to wipe out the disease.

Even with the scale-up of current tools to fight malaria, Africa will still have about 11 million people infected with the disease by 2050, according to a report published Friday by the World Health Organization Strategic Advisory Group on Malaria Eradication.

“In other words, we would still be quite short of having eradicated this infection,” said Pedro Alonso, director of WHO's global malaria program.

The experts’ call for caution in setting end dates for malaria eradication heeds the lessons of past failed eradication attempts. The Global Malaria Eradication Program, approved by the 8th World Health Assembly in 1955, received huge political support and resources, particularly from the United States. But its failure led to a withdrawal of support for malaria programs.

“It took a good two to three decades to get back malaria squarely in the agenda,” Alonso said. “We are very aware that setting dates when we have no evidence for them or setting unreasonable expectations can result in frustration and backlashes. And we don't want to do that.”

In 2007, the Bill and Melinda Gates again floated the idea of eradication. But Alonso and several colleagues said it was not possible with the limited tools available to fight malaria at the time. The lack of new and better tools to fight malaria continue to be a challenge today.

Before resistance kicked in, Insecticide-treated bednets had an efficacy rate of 40%. Currently available drugs aren’t able to provide long-term protection to individuals living in malaria-endemic areas. The world’s first malaria vaccine is a welcome development, but it currently has an efficacy rate of only 40%, said the WHO director.

“With our current armamentarium, we can go far, but ... we will always fall short of eradicating because our tools are very imperfect,” Alonso said.

“But I believe we can now have a reasonable data-informed discussion about the eradication that will allow us to manage expectations in a much more thoughtful way, moving away from high advocacy, inspirational declarations that can be useful at times, but … that's not what is expected from WHO. We are a technical agency. We route our opinions on the best scientists informing us and on the best data available,” he said.

To get the world a step closer to eradication, the report underscored the need for building stronger health systems, improving malaria surveillance, and placing renewed emphasis on the research and development of new tools against malaria. One oft-cited consequence of the 1950s malaria eradication attempt was the decline in malaria research believing the world already has the tools and knowledge to eradicate the disease.

The WHO report comes amid renewed interest on eradication, and ahead of the launch in September of the first report of the Lancet Commission on Malaria Eradication, which is expected to answer questions such as the cost of eradication, and who’s going to pay for it.

The report was not supposed to come out until later this year, but WHO fast-tracked the report’s executive summary to ensure participants at the upcoming WHO-hosted forum “Rising to the Challenge of Malaria Eradication” on Sept. 9 will have access to the report’s findings alongside that of the Lancet Commission report, said WHO spokeswoman Sarah Russell.