“Remarkable solutions to impossible problems”: lessons for malaria from the eradication of smallpox

Abstract

Background Malaria elimination and eventual eradication will require internationally coordinated approaches; sustained engagement from politicians, communities, and funders; efficient organizational structures; innovation and new tools; and well-managed programmes. As governments and the global malaria community seek to achieve these goals, their efforts should be informed by the substantial past experiences of other disease elimination and eradication programmes, including that of the only successful eradication programme of a human pathogen to date: smallpox. Methods A review of smallpox literature was conducted to evaluate how the smallpox programme addressed seven challenges that will likely confront malaria eradication efforts, including fostering international support for the eradication undertaking, coordinating programmes and facilitating research across the world’s endemic countries, securing sufficient funding, building domestic support for malaria programmes nationally, ensuring strong community support, identifying the most effective programmatic strategies, and managing national elimination programmes efficiently. Results Review of 118 publications describing how smallpox programmes overcame these challenges suggests eradication may succeed as a collection of individual country programmes each deriving local solutions to local problems, yet with an important role for the World Health Organization and other international entities to facilitate and coordinate these efforts and encourage new innovations. Publications describing the smallpox experience suggest the importance of avoiding burdensome bureaucracy while employing flexible, problem-solving staff with both technical and operational backgrounds to overcome numerous unforeseen challenges. Smallpox’s hybrid strategy of leveraging basic health services while maintaining certain separate functions to ensure visibility, clear targets, and strong management, aligns with current malaria approaches. Smallpox eradication succeeded by employing data-driven strategies that targeted resources to the places where they were most needed rather than attempting to achieve mass coverage everywhere, a potentially useful lesson for malaria programmes seeking universal coverage with available tools. Finally, lessons from smallpox programmes suggest strong engagement with the private sector and affected communities can help increase the sustainability and reach of today’s malaria programmes. Conclusions It remains unclear whether malaria eradication is feasible, but neither was it clear whether smallpox eradication was feasible until it was achieved. To increase chances of success, malaria programmes should seek to strengthen programme management, measurement, and operations, while building flexible means of sharing experiences, tools, and financing internationally.

Scaling up malaria elimination management and leadership: a pilot in three provinces in Zimbabwe, 2016–2018

“…Implementation challenges are the biggest unaddressed problem facing malaria programmes today. Notable recent publications state the urgent need to build leadership and management capacity at the lower levels of health systems to overcome this problem [3,23,24]. This pilot demonstrates that a participatory, organization development and quality improvement approach has broad ranging effects, including: improving local delivery of interventions, tailoring strategies to target specific populations, finding efficiencies in the system that could not be found using the traditional top-down approach, and improving motivation and communication between different cadres of health workers.…”

Scaling up Malaria Elimination Management and Leadership: A pilot in three provinces in Zimbabwe, 2016 -2018

“…Notable recent publications state the urgent need to build leadership and management capacity at the lower levels of health systems to overcome this problem. 3,24,25 Our pilot demonstrates that a participatory, organization development and quality improvement approach has broad ranging effects, including inter alia: improving local delivery of interventions, tailoring strategies to target specific populations, finding efficiencies in the system that could not be found using Health system building blocks from WHO's Framework for Action [19] Figure 2…”

Micro-Stratification for Malaria Transmission Risk in a High Burden Area of Honduras

“…Evidence-based decisions are the core recommendation of WHO guidelines; however, limited country evidence is published on this subject and moreover, scienti c reports from the American countries are basically historical. (45) To the best of the authors' knowledge, the results here are the rst efforts to characterize local malaria transmission hotspots in Mesoamerica using an operational investigation approach based on available epidemiological and entomological data, human movement information, ecological and demographic parameters, and health system factors at the level of a locality. National malaria elimination programs must include a similar evidence-based approach using all available data for operational planning as a priority to achieve the global goal of malaria elimination.…”