Writing in a Lancet review, Chris Cotter of the Global Health Group at the University of California, San Francisco, and colleagues discuss progress in reducing malaria incidence and related mortality since 2000, noting, “WHO estimates that between 2000 and 2010, global malaria incidence decreased by 17 percent and malaria-specific mortality rates by 26 percent.” They focus on progress in the 34 malaria-eliminating countries, writing, “These successes have been driven by several factors, including increased funding, effective vector control, strengthening of health systems, improved case management with more effective treatment regimens, and improved case reporting and surveillance,” as well as increasing per capita gross domestic products. However, “[a] striking and common epidemiological shift in malaria-eliminating countries is the increasing proportions of adults and men among all malaria cases,” the authors note, adding that malaria transmission continues in hard-to-reach populations and imported cases also pose a threat.

“The epidemiological shift in the populations most at risk of malaria raises important technical, operational, and financial questions for malaria-eliminating countries and those reaching a state of controlled low-endemic malaria,” Cotter and colleagues write, adding, “Traditional control interventions are likely to be inadequate to effectively address these changes — novel strategies to tackle such trends need to be systematically explored.” The authors discuss surveillance, diagnostics, mass drug administration, and vector control strategies. “Regional and multi-country funding mechanisms need to be launched to support malaria elimination and encourage national investment in elimination efforts,” they write, concluding, “In the current climate these mechanisms are more likely to come from regional than global leadership” (9/7).