Abstract
Two recent initiatives, the World Health Organization (WHO) Strategic Advisory Group on Malaria Eradication and the Lancet Commission on Malaria Eradication, have assessed the feasibility of achieving global malaria eradication and proposed strategies to achieve it. Both reports rely on a climate-driven model of malaria transmission to conclude that long-term trends in climate will assist eradication efforts overall and, consequently, neither prioritize strategies to manage the effects of climate variability and change on malaria programming. This review discusses the pathways via which climate affects malaria and reviews the suitability of climate-driven models of malaria transmission to inform long-term strategies such as an eradication programme. Climate can influence malaria directly, through transmission dynamics, or indirectly, through myriad pathways including the many socioeconomic factors that underpin malaria risk. These indirect effects are largely unpredictable and so are not included in climate-driven disease models. Such models have been effective at predicting transmission from weeks to months ahead. However, due to several well-documented limitations, climate projections cannot accurately predict the medium- or long-term effects of climate change on malaria, especially on local scales. Long-term climate trends are shifting disease patterns, but climate shocks (extreme weather and climate events) and variability from sub-seasonal to decadal timeframes have a much greater influence than trends and are also more easily integrated into control programmes. In light of these conclusions, a pragmatic approach is proposed to assessing and managing the effects of climate variability and change on long-term malaria risk and on programmes to control, eliminate and ultimately eradicate the disease. A range of practical measures are proposed to climate-proof a malaria eradication strategy, which can be implemented today and will ensure that climate variability and change do not derail progress towards eradication.
Highlights
An attempt by the World Health Organization (WHO) to rid the world of malaria once and for all ended in failure and loss of morale, despite advances that led to elimination in several countries
Unlike the Lancet Commission, the S AGME concluded that setting a target date for eradication is premature, both reports set out an agenda for achieving eradication in the near future
Underpinning their recommendations is an assessment of how long-term trends in several drivers of malaria risk, including climate change, might benefit or hinder a push for eradication
Summary
A world free from malaria is a shared vision for the global health community. Fifty years ago, an attempt by the World Health Organization (WHO) to rid the world of malaria once and for all ended in failure and loss of morale, despite advances that led to elimination in several countries. A variety of statistical and dynamical transmission models of malaria transmission, driven by climate variables, have been used to predict likely changes in the geographic distribution of the disease in a warmer world, all else being equal [2, 3] This simplistic approach to explaining the spatial and temporal dynamics of malaria at the global scale is contrasted with that of renowned malariologist, Hacket, who in 1937 said: “everything about malaria is so moulded and altered by local conditions that it becomes a thousand different diseases and epidemiological puzzles. This paper, which has evolved from work commissioned by the SAGME, proposes a new framework for incorporating climate into a malaria eradication strategy, which can be extended to long-term planning for a range of public health concerns It asserts that the evidence supporting the claim that climate change will not pose a problem for eradication is weak and that climate should be considered carefully in the design of long-term malaria control, elimination and eradication programmes. The proposed approach offers practical, actionable steps that can be implemented today and which will ensure that climate variability and change do not derail progress towards malaria eradication
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