Solving the Sisyphean Problem of Malaria in Zanzibar

Abstract

The Global Malaria Action Plan (GMAP), a consensus framework for coordinated action, aims to end malaria deaths by 2015 and eventually to eradicate malaria. The plan calls for universal access to effective antimalarial drugs and universal coverage with appropriate vector interventions. Strategic planning for how best to reach these goals has been left to individual countries, some of which have already made plans to eliminate malaria, i.e., to rid their countries of malaria parasites and to suppress transmission from imported malaria (travelers carrying malaria infections from one region into another) so that locally acquired cases are rare. Critics have argued that plans for national elimination distract attention and resources from the priority of reducing malaria's heavy burden in sub-Saharan Africa and that a better strategy would be “control,” i.e., reducing malaria to a minor public health problem. These sides reflect the bipolar history of antimalaria efforts. When funding collapsed for a previous attempt to eradicate malaria, control defined the malaria agenda through decades of neglect. Control and elimination are often presented as opposite sides of a debate over how to allocate billions of dollars allocated globally for malaria aid. But a recent study in Zanzibar concluded the dichotomy was false. A more urgent problem is continuity. How can enthusiasm for funding malaria be sustained?