Wherever malaria has been eliminated, success was likely to have been based on the interplay of a series of mechanisms. In the United States it may have coincided with the advent of residual insecticides, but there were a variety of factors associated with the success. These were seasonal changes, environmental factors, political decisions that affected where people could live, the advent of improved treatments and increase in wealth and improvement of living standards. The same can be said of Italy and much of Europe in the early part of the 20th Century. The International efforts to eradicate malaria following the advent of residual insecticides and the drug chloroquine after World War II were successful in parts of Europe and Asia, but failed in much of Africa, South America and Eastern Asia. Lessons learned were that tools were inadequate, both insecticides and drugs failed due to the evolution of resistant vectors and parasites, and the logistics and expenses were not sustainable. One thing that was learned was that it is unwise to squander the efficacy of a cheap and useful drug like chloroquine on uncontrolled and unmanaged use and there was insufficient research for the interventions. The platter of public health was empty. To a large extent the platter has been replenished, but the current strategy to control malaria has lost focus. Control is often seen mainly to reduce mortality by uncontrolled use of the one effective drug available, but evidence from history has shown this is will not eliminate the parasite population. Emphasis needs to be placed on an integrated approach that is targeted against the parasite. The use of insecticide either sprayed on walls or on bednets has been effective in reducing transmission but this too is not sustainable mainly due to use patterns, decline of insecticide activity or ineffective coverage. Success in the past was in fact based on improvements in the overall public health infrastructure, because no intervention can be operational without an effective and efficient public health system. Someone needs to carry out and monitor the intervention, and a resident infrastructure is a key component. You cannot control what you do not measure and the whole effort to control malaria, particularly in Africa needs scientific coordination. Is not this the role of a restructured and adequately funded WHO Global Malaria Programme?