Engineering the Future

In 1900, nearly all of the roughly 200 countries in the world had endemic malaria. In 2017, there were 86 such countries and the pace of malaria elimination has accelerated in recent years: between 2000 and 2017, 20 countries achieved elimination and several others are on track to eliminate by 2020. Building off these successes, an increasing number of countries and regions are setting malaria elimination goals and developing strategies and road maps to guide and monitor progress. Global malaria organizations and donors are revising their policies in recognition and support of the growing momentum towards elimination at the country and regional levels.

Global social, economic, and environmental trends are, in most places, helping to reduce malaria. The Commission’s models show that these trends alone will lead to greatly reduced but still widespread malaria by 2050. When the impact of enhanced access to high-quality diagnosis, treatment, and vector control is factored in, the 2050 projections show a world largely malaria-free, but with low-level transmission persisting in pockets across roughly ten countries in equatorial Africa (Figure 5B).

Figure 5B ([in full report]) – Projected future effect of global trends and enhanced malaria control on malaria endemicity

The map shows Plasmodium falciparum infection prevalence (children aged 2–10 years) projected for the year 2050. In this projection, malaria intervention coverage was enhanced above 2017 levels to reach 80% effective coverage of insecticide-treated nets, indoor residual spraying, and artemisinin-based combination therapies.

Eradication requires that we bend the curve to transform this modeled future into an engineered future of a world free of malaria by 2050. The Commission argues that this can be achieved by 1) improving malaria program management and implementation and making better use of existing tools—what we call the software of eradication, 2) rolling out new tools—the hardware of eradication, and 3) increasing financial investment in malaria elimination and eradication efforts. Success in these three areas will depend on strong leadership and the establishment of accountability mechanisms at sub-national, national, regional, and global levels.