SCIENCE sciencemag.org 30 AUGUST 2019 • VOL 365 ISSUE 6456 847PHOTO: SIA KAMBOU/AFP/GETTY IMAGES
I
n 2007, philanthropists Bill and Melinda
Gates stunned many scientists when, at
a meeting in Seattle, Washington, they
called for the worldwide eradication
of malaria. Many felt malaria was so
entrenched—there were almost 250 mil-
lion cases annually—and so difficult to
fight that any talk of eradication was pre-
mature. But it’s hard to ignore two of the
world’s most generous funders, and both
the World Health Organization (WHO)
and researchers embraced the idea. Soon, a
flurry of working groups, scientific papers,
and public health strategies were laying
the groundwork.
But the consensus is dissolving. Last
week, WHO dropped a minor bombshell of
its own when it released the summary of a
report that says malaria eradication isn’t
feasible in the foreseeable future. And it
argues that setting any deadline will un-
dermine disease control efforts, as it did
when WHO set a similar goal 64 years ago.
“We must not set the world up for another
failed malaria eradication effort that could
derail attempts to achieve our vision for
decades,” says the report from WHO’s Stra-
tegic Advisory Group on Malaria Eradica-
tion (SAGme).“It’s a watershed moment,” says Willem
Takken, a retired medical entomologist
from Wageningen University & Research
in the Netherlands. “Basically WHO now
admits we won’t get rid of malaria any-
time soon.”
A second high-caliber group, however,
disagrees. On 9 September, the Lancet Com-
mission on Malaria Eradication, a group of
26 academics from around the globe, will
publish a study recommending that the
world set a 2050 target for eradication,
sources tell Science. The commission will
also offer a timeline and concrete steps for
reaching the goal. A deadline will help raise
money and keep the field energized, says
Arjen Dondorp, head of the Mahidol Oxford
Tropical Medicine Research Unit in Bang-
kok and a member of the Lancet group: “It’s
mainly about keeping up the spirit.”
The Lancet commission plans a high-
profile announcement at WHO headquar-
ters in Geneva, Switzerland. That prompted
a preemptive strike by SAGme. It published
its summary and held a press conference
on 22 August, even though the full report
is months away, “partly because of the noise
that may be generated around” the Lan-
cet report, says Pedro Alonso, director of
WHO’s Global Malaria Programme. “It is
making sure that the community doesn’t godown a single line of thinking.”
The debate is about more than just the
usefulness of bold goals in global health.
The focus on eradication has skewed sci-
entists’ and funders’ priorities, says Brian
Greenwood, a malariologist at the London
School of Hygiene & Tropical Medicine. For
instance, much energy has been spent in
countries on the fringes of the malaria map—
such as Sri Lanka, Bhutan, and El Salvador—
where eliminating the parasite was relatively
easy. Such “early wins” boosted morale but
diverted attention from African countries
where thousands of children were dying of
malaria, Greenwood says. He recalls seeing
16 children with cerebral malaria in a hospi-
tal in Sierra Leone and thinking that talk of
eradication was premature.
WHO first adopted the goal of malaria
eradication in 1955, after the insecticide DDT
made killing mosquitoes easy and cheap. The
effort saw major successes, until insecticide
resistance emerged. The campaign made lit-
tle headway in Africa, however, and in 1969
the World Health Assembly moved to effec-
tively end it by shifting responsibility for ma-
laria control to national governments, while
still retaining eradication as a long-term goal.
That caused interest in the disease to plum-
met and the parasite to resurge.
When the Bill & Melinda Gates FoundationIN DEPTH
A woman watches
over a child with
malaria in a hospital
in Jacqueville,
Ivory Coast, in April.By Martin EnserinkGLOBAL HEALTHEradication goal splits malaria community
A Lancet panel wants to end the disease by 2050. A WHO panel says that’s not realistic
Published by AAAS