Richard Steketee: “Using the tools available today, it is possible to eliminate malaria from an endemic region”

Dr. Rick Steketee, director of the Malaria Control and Elimination Partnership in Africa (MACEPA) Project at  PATH, delivered a lecture on how to move from malaria control to its elimination. 

The expert underlined that, although the biology of the parasite, of the vector and of the disease, as well as the interventions and the context in which they are applied are complex, it is important to stay simple in order to identify where to intervene in the transmission dynamics of the disease. He pointed out that, given that the parasite needs 7-10 days to mature within the vector, only female mosquitoes that manage to survive beyond 7 days between two bites, assuming they bit an infected individual, are capable of transmitting the disease. At the end, he said, it’s all about two factors: mosquito survival and the likelihood of picking up the parasite when biting. Playing with these two parameters, it is possible to calculate that if the parasite burden among the population falls to 10% and the mosquito survival is equal to or below 70%, the disease transmission will drop to zero.   

He then introduced the example of Zambia, a country that has a high burden of malaria but that in less than 6 years has shifted from a control to an elimination strategy. During two years they applied a high standard of care in the south of Zambia, with the distribution of new insecticide-treated bed nets, indoor residual spraying with chemicals against which there is no resistance, and a rapid reporting and case investigation system. To this, they added a mass antimalarial drug administration in 56,000 households and more than 300,000 people. The final results of the study are not available yet, but in less than two years the disease prevalence in the region has dropped more than 80%. 

No country in Sub-Saharan Africa has ever eliminated malaria. However, “this project in Zambia provides evidence that it is possible to achieve with the available tools, even in high transmission areas”, he pointed out.  The second battle, he added, will be to maintain the elimination and avoid reintroductions from neighboring regions with high malaria prevalence.   

Dr. Steketee is also a member of the scientific advisory committee of MALTEM, the core project of “la Caixa contra la Malaria”, whose goal is to generate scientific evidence for malaria elimination in Southern Mozambique, and is chairing the panel on 'Combination interventions and modeling' of the MalERA Refresh initiative that held a meeting in Barcelona the previous day.