Although malaria has been controlled in many local and regional populations, the permanent elimination of malaria parasites throughout the world remains an elusive goal, and the disease continues to claim nearly one million lives each year. In 2007, Bill and Melinda Gates called for a renewed effort to eradicate malaria worldwide. Some skeptics have questioned the feasibility of doing so because of failed attempts to eradicate malaria in the 20th century. In a new commentary, National Institutes of Health scientists B. Fenton Hall, M.D., Ph.D., and Anthony S. Fauci, M.D., director of the NIH National Institute of Allergy and Infectious Diseases (NIAID), discuss the lessons learned from past attempts to eradicate malaria and identify key challenges to achieving success today.
The renewed effort to eradicate malaria will require a long-term commitment that incorporates multiple activities, interventions and approaches, they assert. As success in controlling malaria is achieved, the behavior and distribution of malaria parasites and the mosquitoes that spread them are likely to change. Scientists must be prepared to anticipate these changes and alter their strategies to keep ahead of them by developing a robust pipeline of new tools and interventions. The authors note that such a pipeline will require a sustained research effort, as NIAID recently outlined in the Strategic Plan for Malaria Research and the NIAID Malaria Research Agenda. NIAID is the lead U.S. government agency that supports basic biomedical and clinical research in malaria.
To reach the goal of malaria eradication, the authors write that several research challenges must be addressed and overcome. These include
- Translating basic research advances into usable malaria interventions
- Developing a rapid point-of-care diagnostic test that can be used to detect infection in people without symptoms of malaria, which will become even more important to the eradication effort as malaria becomes less prevalent
- Finding vaccines and other interventions that block the malaria parasite at different stages of its life cycle
- Understanding in more detail not only the most deadly malaria parasite, Plasmodium falciparum, but also non-falciparum parasite species
- Maintaining a vigorous, long-term research effort as scientists and public health personnel work to eliminate and eradicate malaria from every part of the globe
Although these challenges are formidable, the authors conclude that with long-term commitment and sustained effort, malaria eradication can be achieved.
In a second commentary, NIAID malaria experts Louis H. Miller, M.D., and Susan K. Pierce, Ph.D., argue that malaria eradication will not be possible with existing tools. What is needed, the authors contend, is a modern-day "Manhattan Project" aimed at developing methods to modify mosquitoes so that they are unable to act as vectors of malaria and to introduce such modifications into multiple mosquito populations in a way that the modification can be spread and sustained within the population. Such an approach will require the recruitment of bright young minds into the field of insect biology and unwavering support of research into malaria vector biology.
BF Hall and AS Fauci. Malaria control, elimination, and eradication: The role of the evolving biomedical research. Journal of Infectious Diseases DOI: 10.1086/646611 (2009).
LH Miller and SK Pierce. Perspective on malaria eradication: The need for a malaria Manhattan Project. Journal of Infectious Diseases DOI: 10.1086/646612 (2009).
Anthony S. Fauci, M.D., Director of NIAID; and B. Fenton Hall, M.D., Ph.D., Chief, Parasitology and International Programs Branch, Division of Microbiology and Infectious Diseases, NIAID.
Louis H. Miller, M.D., Chief, Malaria Vaccine Development Branch; and Susan K. Pierce, Ph.D., Chief, Laboratory of Immunogenetics, Division of Intramural Research, NIAID.
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