Every major global public health success has had technical consensus as one crucial element. That message came out prominently in the large successes we looked at in Millions Saved; in virtually all cases, major progress was spurred when the technical community met, reviewed evidence, argued and finally came up with a way of thinking about a particular problem and an agreement about the public health approach to support. This is distinct from proclamations by funders or politicians that force a sort of "party line"; it's a genuine agreement among those whose day job is working on the scientific and technical issues related to improving health.To date, that technical consensus has been sorely missing in the malaria field, which has been characterized by an often unproductive combination of infighting and championing particular interventions (the bednet people, the ACT people, the DDT people). That's why when global health leaders have promised big gains against the disease, or even eradication, I've been a skeptic on the sidelines. But the article "A New Global Malaria Eradication Strategy" (Download file) by Richard Feachem and Oliver Sabot in the Lancet opens the door to just the sort of discussion, evidence-building and debate that will get the community where it needs to go.They propose a two-part global malaria strategy:
First, control efforts would be intensified in the heartland of the malaria endemic - the holoendemic and hyperendemic regions of tropical Africa, Asia, and Latin America. Second, and currently, countries at the margins of the endemic zone would attempt to completely interrupt transmission of the disease at the same time. Over time, as each country eliminates transmission, one or more of their neighbours would begin to pursue elimination with the newly malaria-free area as a foundation, benefiting from the reductions in transmission achieved by the intensified control effort. This process would continue until malaria was eradicated or new technology enabled a shift in strategy.
Importantly, Feachem and Sabot recognize that "this approach is only one possible path to malaria eradication," and they challenge others in the field to mobilize the best evidence and thinking around alternatives - not with the goal of fostering competing lobbies for money, but with the aim of having the technical community to hash things out and generate that all-important strategy that is understood and endorsed by technical leaders. Years from now, those writing about the great successes in public health may find themselves citing this moment as a genuine milestone.
