Lancet Commission to develop first-ever roadmap for malaria eradication

SAN FRANCISCO — The Lancet Commission on Malaria Eradication launched Tuesday, bringing together 24 experts from around the world to develop the first-ever roadmap for malaria eradication.

The new commission is a joint endeavor between The Lancet, a highly regarded medical journal, and the Global Health Group at the University of California, San Francisco, with financial support from the Bill & Melinda Gates Foundation.

The 24 commissioners will develop a roadmap, to be published in The Lancet in 2019, with a detailed analysis of why and how to pursue malaria eradication, as well as maps and models outlining factors that could accelerate or block progress.

“This will be the first cohesive document on malaria eradication and how to get there,” said Ingrid Chen, assistant professor at UCSF and lead for the commission’s secretariat, which is hosted by the university. “We ask what is possible, and what needs to happen, and then work backwards from there when it comes to the scientific, financial and operational requirements.”

The Lancet has previously run commissions on subjects such as pollution and health, and defeating AIDS, in partnership with UNAIDS.

“At its best, a Lancet Commission allows a group of experts representing a diversity of perspectives to come together to produce a major new statement on an important global

health topic; to go beyond current thinking with synthesis and analysis; and to debate among people from numerous perspectives, in order to come up with a new understanding of a global health topic, very often resulting in a new direction for the future,” Sir Richard Feachem, director of UCSF’s Global Health Group and chair of the commission, told Devex.

The project builds on past leadership from UCSF in the fight against malaria, including its Malaria Elimination Initiative, which generates evidence, shares best practices, and builds consensus in order to “shrink the malaria map.” UCSF also hosts another Lancet Commission on Investing in Health.

Richard Horton, editor-in-chief of The Lancet, said that UCSF — which led the journal’s 2010 series on malaria elimination — is “well-positioned to take this work to the next level, informing the steps that must be taken to eradicate the disease once and for all.”

The secretariat at UCSF will work closely with The Lancet and the commissioners to ensure the insights put forward by the group translate into a cohesive final report, and have reach across the global malaria community.

The goal: eradication

“Malaria elimination efforts focus on stopping transmission of the disease within a country or regional borders, whereas malaria eradication refers to a long-term goal to permanently end malaria throughout the world,” Chen told Devex. “When we focus on eradication, we need to make detailed scientific assessments of where the world is going, and consider the impact of climate change, urbanization, and population flow on disease burden.”

Eradication also needs to be forward thinking, taking into account tools that could be developed in the future, as well as those we already have today, she said.

“We believe eradication is the only answer for a disease like malaria that develops resistance to tools over time and surges back every time we let off the pressure,” said Bruno Moonen, deputy director for malaria at the Gates Foundation and one of the 24 commissioners.

“For that, and other reasons, malaria eradication will not be like previous efforts to end diseases,” he said. “We [have seen] that in the past few years as [issues around] funding, resistance to existing tools, and operational setbacks have led to a plateau in progress.”

The Gates Foundation, which, like UCSF, has helped to mainstream the ideas of elimination and eradication, funds a range of scientific and technical efforts to tackle the difficult questions of how to do so, he said. The output of the Lancet Commission should help to answer some of them, he added.

“Eradication is an aspiration we share, but a plan for which we do not currently have,” said Moonen.

The commissioners

"Malaria affects some of the most vulnerable people in the world,” Winnie Mpanju-Shumbusho, board chair of the RBM Partnership to End Malaria, and another of the 24 commissioners, told Devex.

“Ending this scourge requires social and socio-economic factors to be taken into account alongside scientific considerations. This group is poised to address the challenge.”

Mpanju-Shumbusho added that: “Commissioners have diverse in-depth expertise to allow us to look at the issue from all sides — from economics, to evolutionary biology, to tool innovation — and there is strong representation from malaria-endemic regions.”

The diversity of experiences — spanning global development, spatial epidemiology, disease eradication, and more — will allow the group to take a comprehensive and multifaceted approach to ending the disease, she said.

The announcement of the commission comes as world leaders gather to discuss the disease at the Multilateral Initiative on Malaria conference in Dakar, Senegal, as well as at the Commonwealth Heads of Government meeting in London, United Kingdom, next week.

The group first met in Santa Cruz, California, in October, Feachem said, with upcoming meetings in May at Wilton Park in the U.K., and in December in California.

Feachem initially convened leaders as part of the Malaria Elimination Group, which launched in 2007, and had its final meeting in Chennai, India, in 2016. Once the previously controversial “elimination” terminology became mainstream, the group evolved into the Malaria Eradication Group, which held its first meeting in Santa Cruz, and morphed into the Lancet Commission, Feachem told Devex.

The group is made up of people who hold different opinions, in order to stimulate real debate and avoid “groupthink,” he added.

“There is no speechifying — no long lectures, no speeches — but quick identification of the difficult subject matter, which is then debated very vigorously,” he said. “For example, there are people on the commission who believe significant amounts of additional aid dollars are required to eradicate, and people who believe that is probably not the case, and that we could eradicate on roughly today’s aid investment level.”

The Lancet Commision on Malaria Eradication is also able to avoid the institutional politics that can get in the way of progress at the big institutions trying to tackle the issue, said Feachem, who was founding executive director of the Global Fund to Fight AIDS, Tuberculosis and Malaria.

“Success would be a major shift in the global consensus and the regional consensus towards the idea that eradication is possible, and that eradication should be vigorously pursued, and those are two separate things,” he said.