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In order to progress to global eradication, what's most important?

A vaccine. Without it we can't win
24% (118 votes)
Get new and effective public health insecticides to market
9% (43 votes)
Get the next generation of drugs to market
5% (23 votes)
Political will in endemic countries
63% (313 votes)
Total votes: 497

Comments

Submitted by Guido (not verified) on
If there's urgency we can fight it! Let's find and create more sense of urgency! And let's be innovative and use 3.0 thinking and tech....

William Jobin's picture
Submitted by William Jobin on
In several countries, malaria has been effectively suppressed by following the First Pathway. In this pathway the effort starts by ecological modifications which minimize mosquito breeding and biting. Once the modifications in mosquito ecology and human ecology have been made, then the ephemeral and costly drugs and biocides can be used efficiently. (These countries include the USA, Puerto Rico, Italy, the Holy Land, and Turkmenistan). Conversely, if the drugs and biocides are used first, the programs are doomed, such as the WHO, RBM and US PMI programs. Furthermore these programs come from outside the endemic countries, thus also keeping the expertise and commitment outside. As soon as the outside financing falters - as is happening now - the programs collapse..... The only countries which have successfully suppressed malaria have followed this First Pathway. None of the countries which have not followed it, but rather started with the seductive and expensive drugs and biocides, have been successful. The best pathway is clear, but unfortunately it doesn't look like WHO or PMI are going to change. So we should be prepared for another collapse in the global program, as occurred with the WHO program in 1969..... It would be nice to think that we learn from our mistakes, but apparently in WHO and the US PMI that is not true.

William Jobin Director of Blue Nile Associates

Mark Hoppe's picture
Submitted by Mark Hoppe on
No one single factor is most important. Taking a holistic and systematic approach that includes all of the above, and more, is the only way to achieve sustainable control, and eventually eradication. We need to move out of our silos of vector control, disease management, environmental modification, etc., view "malaria" as a system that includes humans, mosquitoes, Plasmodium and the wider environment, and take coordinated multi-disciplinary action to address it. So for me, a holistic approach is the most important factor.

Bart G.J. Knols's picture
Submitted by Bart G.J. Knols on
Dear Mark, A 5th answer 'all of the above' would probably have yielded a 100% score. But that is not the point. We always need to prioritise and cannot do everything...so tough choices need to be made, including filling out this poll ;-) Best, Bart

Submitted by Miles Markus on
It will/would probably be important to deal with (inter alia) the hypnozoite parasite reservoir. However, see the June 2015 issue of "Trends in Parasitology".

Submitted by Tony Kiszewski (not verified) on
Vaccine or not, global eradication is not a viable goal. I would guess that the shift in focus from suppression to eradication, by ignoring many more sustainable and appropriate methods of intervention, will end up costing many more lives than it saves, and probably has already.

William Jobin's picture
Submitted by William Jobin on
You are right on Tony, but we know the problem was caused by a certain rich man, who we all admire but who doesn't know beans about malaria, and has too many admirers who are afraid to tell him the truth. And the idea of vaccines and eradication fits into the current fascination with Modern Science and gleaming laboratories, but shows an abysmal lack of understanding of history. Let us pray that before the whole effort comes crashing down, someone will become aware - as Mark Hoppe says - that malaria is an ecological disease, and to suppress it we need to take a holistic and ecological approach. Someday.

William Jobin Director of Blue Nile Associates

Submitted by Roly Gosling on
Along with political commitment we need to improve efficiency of our programs. How do we do this? There are tools used by industry that could and should be utilized by modern malaria control programs. These include: rapid reporting systems; geolocation functions for both reporting incident cases, active case finding and where interventions are located; use of decision support systems to automatically generate implementation relevant and timely information to different levels of the system. In addition, more has to be done to improve the motivation of program staff and their leadership. Again lessons can be learnt from other spheres - industry often invests heavily in leadership and incentivization of the workforce. I personally think we are barking up the wrong tree expecting malaria elimination to be reached with a single drug, vaccine or insecticide. It is more about implementation in the right place at the right time with the right tool.

Roly Gosling

Hemant Kumar Bankhede's picture
Submitted by Hemant Kumar Ba... on
Hello Dr. Roly I agree and support the improvement & efficiency is prime requirement and tool that can be used is the Collaboration between Government policy maker, NGO, Non profit organizations, Academics and Industries to support research and implementation of policy. Collaboration will enable: 1. Efficient utilization of resources and funds 2. Fill Knowledge gap 3. speed up research, prevention and control policy for malaria.

Hemant Kumar Bankhede

Submitted by Thierry Bobanga (not verified) on
To control Malaria effectively, we must consider specificity of countries or sites.

Andrew Lover's picture
Submitted by Andrew Lover on
"Local malaria problems must be solved largely on the basis of local data. It is rarely safe to assume that the variables in one area will behave in the same way as they do in another area, however closely the two regions may seem to resemble each other in topography and climate. Large sums of money have been wasted in attempted malaria control when malariologists have forgotten this fundamental fact." -Paul F. Russell, 1946 [From: Russell PF, West LS, Manwell RD. Practical malariology. Philadelphia: W.B. Saunders; 1946.]

Submitted by Thierry Bobanga (not verified) on
Eradication could be obtain with global analysis of the disease and political will in endemic countries