For the first time in 10 years, WHO has published new policy guidance on malaria elimination. It provides countries with a set of tools and strategies for achieving and maintaining elimination, regardless of where they lie across the spectrum of malaria transmission.
The 2017 Framework for malaria elimination was officially released at a global forum attended by national programme managers from the E2020, a group of countries that, according to a WHO analysis, have the potential to reach zero indigenous cases of malaria by 2020.
Speaking at the forum on 16 March, Dr Pedro Alonso, Director of the Global Malaria Programme, noted the need for new guidance on elimination to keep pace with the dramatic changes seen in the malaria landscape over the last decade.
“The large-scale roll-out of core malaria control tools has translated into very significant reductions in disease burden,” said Dr Alonso. “We have new policy guidance and tools that were not available before, as well as new strategies. More countries are eliminating malaria or are making steady progress towards that goal. All of these advances called for a deep revision of our guidance on elimination.”
WHO’s 2007 guidance on elimination focused only on countries with low and moderate transmission settings. The new guidance recognizes that malaria transmission represents a continuum; it is designed to support all malaria-endemic countries. Programme actions are highlighted across the spectrum of transmission intensity, from high to very low.
The new framework includes a streamlined process for WHO certification of malaria elimination and clarifies the threshold for reestablishment of transmission. It offers new guidance on setting targets and systems to verify malaria-free areas within a country’s borders, which can be an important foundation for future national certification.
There are a number of other updates, including an overview of the critical requirements for achieving and maintaining elimination. A complete list of key changes can be found on pages 9–10 of the framework.
A broad, consultative process
The new guidance was developed over the course of 18 months by the WHO Secretariat and an independent Evidence Review Group chaired by Dr Rick Steketee, Director of the Malaria Control and Elimination Partnership in Africa (MACEPA), a program at PATH. It involved a broad process of consultation with national programme managers and culminated in a final review in September 2016 by the Malaria Policy Advisory Committee (MPAC).
At the latest MPAC meeting, held from 22–24 March, Dr Alonso reminded participants that the guidance does not offer a “one size fits all” approach; in each country, interventions will need to be tailored to local contexts. He noted that the 2017 elimination framework is not “carved in stone” and will be updated as new tools and strategies become available.
This guidance builds on and is fully aligned with WHO’s Global Technical Strategy for Malaria, a 15-year framework for all countries working to control and eliminate malaria. Malaria elimination in at least 10 countries is one of the strategy’s near-term targets for 2020.