Editing Malaria (section)

==Eradication efforts==
[[File:Members of the Malaria Commission on the Danube delta, 1929 Wellcome L0011626.jpg|thumb|Members of the Malaria Commission of the [[League of Nations]] collecting larvae on the [[Danube delta]], 1929]]

Malaria has been successfully eliminated or significantly reduced in certain areas, but not globally. Malaria was once common in the United States, but the US eliminated malaria from most parts of the country in the early 20th century using vector control programs, which combined the monitoring and treatment of infected humans, draining of [[wetland]] breeding grounds for agriculture and other changes in [[water management]] practices, and advances in sanitation, including greater use of glass windows and screens in dwellings.<ref name="Meade-2010"/>  The use of the [[pesticide]] DDT and other means eliminated malaria from the remaining pockets in southern states of the US in the 1950s, as part of the [[National Malaria Eradication Program]].<ref name="Williams-1963"/>  Most of [[Europe]], [[North America]], [[Australia]], [[North Africa]] and the [[Caribbean]], and parts of [[South America]], [[Asia]] and [[Southern Africa]] have also eliminated malaria.<ref>{{cite web|title=Malaria Elimination Group description and list of elimination countries |access-date=2011-07-12 |url=http://www.malariaeliminationgroup.org/resources/elimination-countries |url-status=dead |archive-url=https://web.archive.org/web/20110727060254/http://www.malariaeliminationgroup.org/resources/elimination-countries |archive-date=27 July 2011 |df=dmy }}</ref> The WHO defines "elimination" (or "malaria-free") as having no domestic transmission (indigenous cases) for the past three years. They also define "pre-elimination" and "elimination" stages when a country has fewer than 5 or 1, respectively, cases per 1000 people at risk per year. In 2021, the total of international and national funding for malaria control and elimination was $3.5 billion—only half of what is estimated to be needed.<ref name="UNICEF DATA-2"/> According to UNICEF, to achieve the goal of a malaria-free world, annual funding would need to more than double to reach the US$6.8 billion target.<ref name="UNICEF DATA-2" />

In parts of the world with rising living standards, the elimination of malaria was often a collateral benefit of the introduction of window screens and improved sanitation.<ref name="Gladwell-2001"/> A variety of usually simultaneous interventions represents best practice. These include [[antimalarial drugs]] to prevent or treat infection; improvements in public health infrastructure to diagnose, sequester and treat infected individuals; [[mosquito net|bednets]] and other methods intended to keep mosquitoes from biting humans; and [[vector control]] strategies<ref name="World Health Organization-2009">{{cite web | date = 2009 | publisher = World Health Organization | url = http://whqlibdoc.who.int/publications/2009/9789241563901_eng.pdf | title = World Malaria Report | access-date = December 17, 2009 | archive-date = January 12, 2010 | archive-url = https://web.archive.org/web/20100112144947/http://whqlibdoc.who.int/publications/2009/9789241563901_eng.pdf | url-status = live }}</ref> such as [[larvacide|larvaciding]] with insecticides, ecological controls such as draining mosquito breeding grounds or introducing fish to eat larvae and [[indoor residual spraying]] (IRS) with insecticides.

===Initial WHO program (1955–1969)===
[[File:L0074987 Malaria eradication - the world united against malaria (20675407876).jpg|thumb|right|1962 Pakistani postage stamp promoting malaria eradication program]]

In 1955 the WHO launched the Global Malaria Eradication Program (GMEP).<ref name="Duintjer-2009">{{cite journal | vauthors = Duintjer Tebbens RJ, Thompson KM | title = Priority Shifting and the Dynamics of Managing Eradicable Infectious Diseases | journal = Management Science | volume = 55 | issue = 4 | pages = 650–663 | year = 2009 | doi = 10.1287/mnsc.1080.0965 }}</ref> The program relied largely on DDT for mosquito control and rapid diagnosis and treatment to break the transmission cycle.<ref>{{cite journal | vauthors = Mendis K, Rietveld A, Warsame M, Bosman A, Greenwood B, Wernsdorfer WH | title = From malaria control to eradication: The WHO perspective | journal = Tropical Medicine & International Health | volume = 14 | issue = 7 | pages = 802–809 | date = July 2009 | pmid = 19497083 | doi = 10.1111/j.1365-3156.2009.02287.x | s2cid = 31335358 | doi-access = free }}</ref> The program eliminated the disease in "North America, Europe, the former [[Soviet Union]]",<ref name="Sadasivaiah-2007"/> and in "[[Taiwan]], much of the [[Caribbean]], the [[Balkans]], parts of northern Africa, the northern region of Australia, and a large swath of the South Pacific"<ref name="Gladwell-2001">{{cite news | vauthors = Gladwell M |author-link=Malcolm Gladwell |title=The Mosquito Killer |newspaper=The New Yorker |date=July 2, 2001 |url=http://gladwell.com/the-mosquito-killer/ |access-date=August 20, 2014 |archive-url=https://web.archive.org/web/20160416165010/http://gladwell.com/the-mosquito-killer/ |archive-date=April 16, 2016 |url-status=dead }}</ref> and dramatically reduced mortality in [[Sri Lanka]] and India.<ref name="Harrison-1978"/>

However, failure to sustain the program, increasing mosquito tolerance to DDT, and increasing parasite tolerance led to a resurgence. In many areas early successes partially or completely reversed, and in some cases rates of transmission increased.<ref name="Chapin-1981">{{cite journal | vauthors = Chapin G, Wasserstrom R | title = Agricultural production and malaria resurgence in Central America and India | journal = Nature | volume = 293 | issue = 5829 | pages = 181–185 | year = 1981 | pmid = 7278974 | doi = 10.1038/293181a0 | s2cid = 4346743 | doi-access = free | bibcode = 1981Natur.293..181C }}</ref> Experts tie malarial resurgence to multiple factors, including poor leadership, management and funding of malaria control programs; poverty; civil unrest; and increased [[irrigation]]. The evolution of resistance to first-generation drugs (e.g. [[chloroquine]]) and to insecticides exacerbated the situation.<ref name="van den Berg-2008">{{cite web|url=http://www.pops.int/documents/ddt/Global%20status%20of%20DDT%20SSC%2020Oct08.pdf|title=Global status of DDT and its alternatives for use in vector control to prevent disease| vauthors = van den Berg H | date=October 23, 2008|publisher=[[Stockholm Convention on Persistent Organic Pollutants]]/[[United Nations Environment Programme]]|access-date=November 22, 2008|archive-url=https://web.archive.org/web/20101217022138/http://www.pops.int/documents/ddt/Global%20status%20of%20DDT%20SSC%2020Oct08.pdf|archive-date=December 17, 2010|url-status=dead|df=mdy-all}}</ref><ref name="Feachem-2007">{{cite journal | vauthors = Feachem RG, Sabot OJ | title = Global malaria control in the 21st century: a historic but fleeting opportunity | journal = JAMA | volume = 297 | issue = 20 | pages = 2281–2284 | date = May 2007 | pmid = 17519417 | doi = 10.1001/jama.297.20.2281 }}</ref> The program succeeded in eliminating malaria only in areas with "high socio-economic status, well-organized healthcare systems, and relatively less intensive or seasonal malaria transmission".<ref name="Sadasivaiah-2007">{{cite journal | vauthors = Sadasivaiah S, Tozan Y, Breman JG | title = Dichlorodiphenyltrichloroethane (DDT) for indoor residual spraying in Africa: how can it be used for malaria control? | journal = The American Journal of Tropical Medicine and Hygiene | volume = 77 | issue = 6 Suppl | pages = 249–263 | date = December 2007 | pmid = 18165500 | doi = 10.4269/ajtmh.2007.77.249 | doi-access = free }}</ref>

For example, in [[Sri Lanka]], the program reduced cases from about one million per year before spraying to just 18 in 1963<ref>{{cite book|title=The Coming Plague: Newly Emerging Diseases in a World Out of Balance|page=51| vauthors = Garrett L |url=https://books.google.com/books?id=v9RY2PVOtOMC&pg=PA51|year=1994|publisher=Farrar, Straus and Giroux|isbn=978-1-4299-5327-6|access-date=August 29, 2022|archive-date=October 19, 2021|archive-url=https://web.archive.org/web/20211019223243/https://books.google.com/books?id=v9RY2PVOtOMC&pg=PA51|url-status=live}}</ref><ref>{{cite news | url = https://www.nytimes.com/2010/12/28/health/28global.html | title = Malaria: A Disease Close to Eradication Grows, Aided by Political Tumult in Sri Lanka |  vauthors = McNeil Jr DG | work = The New York Times | date = December 27, 2010 | access-date = February 7, 2017 | archive-date = January 4, 2017 | archive-url = https://web.archive.org/web/20170104050535/http://www.nytimes.com/2010/12/28/health/28global.html | url-status = live }}</ref> and 29 in 1964. Thereafter the program was halted to save money and malaria rebounded to 600,000 cases in 1968 and the first quarter of 1969. The country resumed DDT vector control but the mosquitoes had evolved resistance in the interim, presumably because of continued agricultural use. The program switched to [[malathion]], but despite initial successes, malaria continued its resurgence into the 1980s.<ref name="Harrison-1978">{{cite book|title=Mosquitoes, Malaria, and Man: A History of the Hostilities Since 1880|isbn=978-0-525-16025-0| vauthors = Harrison GA |url=https://books.google.com/books?id=mfkBr2oskyEC|year=1978|publisher=Dutton|access-date=August 29, 2022|archive-date=October 19, 2021|archive-url=https://web.archive.org/web/20211019210418/https://books.google.com/books?id=mfkBr2oskyEC|url-status=live}}</ref><ref>{{cite journal | vauthors = Karunaweera ND, Galappaththy GN, Wirth DF | title = On the road to eliminate malaria in Sri Lanka: lessons from history, challenges, gaps in knowledge and research needs | journal = Malaria Journal | volume = 13 | pages = 59 | date = February 2014 | pmid = 24548783 | pmc = 3943480 | doi = 10.1186/1475-2875-13-59 | doi-access = free }}</ref>

Due to vector and parasite resistance and other factors, the [[Eradication of infectious diseases|feasibility of eradicating malaria]] with the strategy used at the time and resources available led to waning support for the program.<ref name="Nájera-2011">{{cite journal | vauthors = Nájera JA, González-Silva M, Alonso PL | title = Some lessons for the future from the Global Malaria Eradication Programme (1955-1969) | journal = PLOS Medicine | volume = 8 | issue = 1 | pages = e1000412 | date = January 2011 | pmid = 21311585 | pmc = 3026700 | doi = 10.1371/journal.pmed.1000412 | doi-access = free }}</ref> WHO suspended the program in 1969<ref name="Duintjer-2009"/><ref name="Nájera-2011"/> and attention instead focused on controlling and treating the disease. Spraying programs (especially using DDT) were curtailed due to concerns over safety and environmental effects, as well as problems in administrative, managerial and financial implementation.<ref name="Chapin-1981"/> Efforts shifted from spraying to the use of [[Mosquito net|bednets]] impregnated with insecticides and other interventions.<ref name="Sadasivaiah-2007"/><ref name="Rogan-2005">{{cite journal | vauthors = Rogan WJ, Chen A | title = Health risks and benefits of bis(4-chlorophenyl)-1,1,1-trichloroethane (DDT) | journal = The Lancet | volume = 366 | issue = 9487 | pages = 763–773 | year = 2005 | pmid = 16125595 | doi = 10.1016/S0140-6736(05)67182-6 | url = https://zenodo.org/record/1259797 | access-date = June 13, 2019 | url-status = live | s2cid = 3762435 | archive-url = https://web.archive.org/web/20191017205259/https://zenodo.org/record/1259797 | archive-date = October 17, 2019 }}</ref>

===After 1969===
[[File:World-map-of-past-and-current-malaria-prevalence-world-development-report-2009.png|thumb|upright=1.3|right|Regions where malaria has been eliminated {{as of|2009|lc=y}}]]

Target 6C of the [[Millennium Development Goals]] included reversal of the global increase in malaria incidence by 2015, with specific targets for children under five years old.<ref name="Sato-2021">{{cite journal | vauthors = Sato S | title = Plasmodium-a brief introduction to the parasites causing human malaria and their basic biology | journal = Journal of Physiological Anthropology | volume = 40 | issue = 1 | pages = 1 | date = January 2021 | pmid = 33413683 | pmc = 7792015 | doi = 10.1186/s40101-020-00251-9 | doi-access = free }}</ref>  Since 2000, support for malaria eradication increased, although some actors in the global health community (including voices within the WHO) view malaria eradication as a premature goal and suggest that the establishment of strict deadlines for malaria eradication may be counterproductive as they are likely to be missed.<ref>{{cite journal | vauthors = Enserink M |title=Is setting a deadline for eradicating malaria a good idea? Scientists are divided |journal=Science |date=29 March 2021 |doi=10.1126/science.aaz2906 }}</ref> One of the targets of [[Sustainable Development Goal 3|Goal 3]] of the [[United Nations|UN]]'s [[Sustainable Development Goals]] is to end the malaria epidemic in all countries by 2030.

In 2006, the organization [[Malaria No More]] set a public goal of eliminating malaria from Africa by 2015, and the organization claimed they planned to dissolve if that goal was accomplished. In 2007, [[World Malaria Day]] was established by the 60th session of [[World Health Assembly|the World Health Assembly]]. As of 2018, they are still functioning.<ref name="Strom-2011"/> 
[[File:Malaria Eradication- Back to the Future.webm|thumb|Video recording of a set of presentations given in 2010 about humanity's efforts towards malaria eradication]]

{{As of|2012}}, [[The Global Fund to Fight AIDS, Tuberculosis and Malaria|The Global Fund to Fight AIDS, Tuberculosis, and Malaria]] has distributed 230&nbsp;million insecticide-treated nets intended to stop mosquito-borne transmission of malaria.<ref name="Global Fund"/> The U.S.-based [[Clinton Foundation]] has worked to manage demand and stabilize prices in the artemisinin market.<ref name="Schoofs-2008"/> Other efforts, such as the Malaria Atlas Project, focus on analysing climate and weather information required to accurately predict malaria spread based on the availability of habitat of malaria-carrying parasites.<ref name="Guerra-2007"/> The [[Malaria Policy Advisory Committee]] (MPAC) of the [[World Health Organization]] (WHO) was formed in 2012, "to provide strategic advice and technical input to WHO on all aspects of malaria control and elimination".<ref>{{cite web|title=Executive summary and key points|url=https://www.who.int/entity/malaria/publications/world_malaria_report_2013/wmr13_summary_key_points.pdf?ua=1|work=World Malaria Report 2013|publisher=World Health Organization|access-date=13 February 2014|url-status=live|archive-url=https://web.archive.org/web/20160304091723/http://www.who.int/entity/malaria/publications/world_malaria_report_2013/wmr13_summary_key_points.pdf?ua=1|archive-date=4 March 2016}}</ref>

In 2015 the WHO targeted a 90% reduction in malaria deaths by 2030,<ref name="Fletcher-2019" /> and [[Bill Gates]] said in 2016 that he thought global eradication would be possible by 2040.<ref>{{cite web |url=http://www.cfr.org/public-health-threats-and-pandemics/can-malaria-eradicated/p38243 |title=Can Malaria Be Eradicated? | vauthors = Radwick D |date=October 5, 2016 |publisher=[[Council on Foreign Relations]] |url-status=live |archive-url=https://web.archive.org/web/20161005201520/http://www.cfr.org/public-health-threats-and-pandemics/can-malaria-eradicated/p38243 |archive-date=October 5, 2016 }}</ref> According to the WHO's World Malaria Report 2015, the global mortality rate for malaria fell by 60% between 2000 and 2015. The WHO targeted a further 90% reduction between 2015 and 2030,<ref>{{cite web |url=https://www.who.int/malaria/media/world-malaria-report-2015/en/ |archive-url=https://web.archive.org/web/20151217125416/http://www.who.int/malaria/media/world-malaria-report-2015/en/ |url-status=dead |archive-date=December 17, 2015 |title=Fact Sheet: World Malaria Report 2015 |date=9 December 2015}}</ref> with a 40% reduction and eradication in 10 countries by 2020.{{sfn|WHO|2020|p={{page needed|date=July 2024}}}} However, the 2020 goal was missed with a slight increase in cases compared to 2015.<ref name="WHO-2020">{{Cite web|url=https://www.who.int/teams/global-malaria-programme/reports/world-malaria-report-2020|title=World Malaria Report 2020|website=www.who.int|access-date=2021-05-26|archive-date=2022-03-25|archive-url=https://web.archive.org/web/20220325191334/https://www.who.int/teams/global-malaria-programme/reports/world-malaria-report-2020|url-status=live}}</ref> Additionally, UNICEF reported that the number of malaria deaths for all ages increased by 10% between 2019 and 2020, in part due to service disruptions related to the COVID-19 pandemic, before experiencing a minor decline in 2021.<ref name="UNICEF DATA-2"/>

Before 2016, the Global Fund against HIV/AIDS, Tuberculosis and Malaria had provided 659 million ITN (insecticide treated bed nets), organise support and education to prevents malaria. The challenges are high due to the lack of funds, the fragile health structure and the remote indigenous population that could be hard to reach and educate. Most of indigenous population rely on self-diagnosis, self-treatment, healer, and traditional medicine. The WHO applied for fund to the Gates Foundation which favour the action of malaria eradication in 2007.<ref>{{cite journal | vauthors = Chandler CI, Beisel U | title = The Anthropology of Malaria: Locating the Social | journal = Medical Anthropology | volume = 36 | issue = 5 | pages = 411–421 | date = July 2017 | pmid = 28318308 | doi = 10.1080/01459740.2017.1306858 }}</ref> Six countries, the United Arab Emirates, Morocco, Armenia, Turkmenistan, Kyrgyzstan, and Sri Lanka managed to have no endemic cases of  malaria for three consecutive years and certified malaria-free by the WHO despite the stagnation of the funding in 2010.<ref name="Sato-2021"/> The funding is essential to finance the cost of medication and hospitalisation cannot be supported by the poor countries where the disease is widely spread. The goal of eradication has not been met; nevertheless, the decrease rate of the disease is considerable.

While 31 out of 92 endemic countries were estimated to be on track with the WHO goals for 2020, 15 countries reported an increase of 40% or more between 2015 and 2020.<ref name="WHO-2020"/> Between 2000 and 30 June 2021, twelve countries were certified by the WHO as being malaria-free.  Argentina and Algeria were declared free of malaria in 2019.<ref name="WHO-2020"/><ref>{{Cite web|url=https://www.who.int/news/item/22-05-2019-algeria-and-argentina-certified-malaria-free-by-who|title=Algeria and Argentina certified malaria-free by WHO|website=www.who.int|access-date=2021-11-26|archive-date=2021-11-26|archive-url=https://web.archive.org/web/20211126175642/https://www.who.int/news/item/22-05-2019-algeria-and-argentina-certified-malaria-free-by-who|url-status=live}}</ref> El Salvador and China were declared malaria-free in the first half of 2021.<ref><!-- Eliminating malaria: 21 countries, a common goal -->{{cite Q|Q108595589}}</ref><ref name="World Health Organization-2021b"><!-- From 30 million cases to zero: China is certified malaria-free by WHO -->{{cite Q|Q108595181}}.</ref>

Regional disparities were evident: [[Southeast Asia]] was on track to meet WHO's 2020 goals, while Africa, Americas, Eastern Mediterranean and West Pacific regions were off-track.<ref name="WHO-2020"/>  The six [[Greater Mekong Subregion]] countries aim for elimination of [[Plasmodium falciparum|''P. falciparum'']] transmitted malaria by 2025 and elimination of all malaria by 2030, having achieved a 97% and 90% reduction of cases respectively since 2000.<ref name="WHO-2020"/> Ahead of [[World Malaria Day]], 25 April 2021, WHO named 25 countries in which it is working to eliminate malaria by 2025 as part of its E-2025 initiative.<ref>{{cite Q|Q108595714}}<!-- Zeroing in on Malaria Elimination: Final report of the E-2020 initiative--></ref>

A major challenge to malaria elimination is the persistence of malaria in border regions, making international cooperation crucial.<ref>{{cite web|url=http://www.bbc.com/future/story/20190925-the-race-to-stamp-out-malaria-along-the-bhutan-india-border|title=The tiny kingdom fighting an epidemic|vauthors=Ro C|date=26 September 2019|website=BBC Future|access-date=2019-09-30|archive-date=2019-10-08|archive-url=https://web.archive.org/web/20191008121056/http://www.bbc.com/future/story/20190925-the-race-to-stamp-out-malaria-along-the-bhutan-india-border|url-status=live}}</ref>

In 2018, WHO announced that Paraguay was free of malaria, after a national malaria eradication effort that began in 1950.<ref>{{cite web|url=https://www.who.int/news-room/detail/11-06-2018-who-certifies-paraguay-malaria-free|title=WHO certifies Paraguay malaria-free|date=11 June 2018|publisher=[[World Health Organization]]|access-date=17 June 2018|archive-date=15 June 2018|archive-url=https://web.archive.org/web/20180615064837/http://www.who.int/news-room/detail/11-06-2018-who-certifies-paraguay-malaria-free|url-status=live}}</ref>

In March 2023, the WHO certified Azerbaijan and Tajikistan as malaria-free,<ref name="WHO-2023a">{{Cite web |url=https://www.who.int/news/item/29-03-2023-who-certifies-azerbaijan-and-tajikistan-as-malaria-free/ |title=WHO certifies Azerbaijan and Tajikistan as malaria-free |date=2023-03-29 |access-date=2023-06-22 |publisher=[[World Health Organization]] |archive-date=2023-06-21 |archive-url=https://web.archive.org/web/20230621145120/https://www.who.int/news/item/29-03-2023-who-certifies-azerbaijan-and-tajikistan-as-malaria-free |url-status=live }}</ref> and Belize in June 2023.<ref name="WHO-2023b">{{Cite web |url=https://www.who.int/news/item/21-06-2023-belize-certified-malaria-free-by-who |title=Belize certified malaria-free by WHO |date=2023-06-21 |access-date=2023-06-22 |publisher=[[World Health Organization]] |archive-date=2023-06-21 |archive-url=https://web.archive.org/web/20230621210912/https://www.who.int/news/item/21-06-2023-belize-certified-malaria-free-by-who |url-status=live }}</ref>  Cabo Verde, the latest country to eradicate Malaria, was certified in January 2024, bringing the total number of countries and territories certified malaria-free to 44.<ref name="WHO-2024">{{Cite web |url=https://www.who.int/news/item/12-01-2024-who-certifies-cabo-verde-as-malaria-free--marking-a-historic-milestone-in-the-fight-against-malaria |title=Who declares Cape Verde free of malaria |date=2024-01-12 |access-date=2024-01-13 |publisher=[[World Health Organization]] |archive-date=2024-01-12 |archive-url=https://web.archive.org/web/20240112232222/https://www.who.int/news/item/12-01-2024-who-certifies-cabo-verde-as-malaria-free--marking-a-historic-milestone-in-the-fight-against-malaria |url-status=live }}</ref> In October 2024, the WHO certified Egypt to be malaria-free.<ref>{{cite web|url=https://www.aljazeera.com/news/2024/10/20/historic-egypt-declared-malaria-free-by-the-world-health-organization|title='Historic': Egypt declared malaria free by the World Health Organization|work=[[Al Jazeera]]|date=20 October 2024|access-date=21 October 2024}}</ref>

===Potential eradication of malaria by year 2050===
Experts say that malaria could be eliminated as wild disease of humans by the year 2050.  World class experts (41 of them) in fields such as malariology, biomedicine, economics and health policy advocated more funding, a central data repository for dealing with local outbreaks of malaria, and training the workers needed to carry out the plan.  Details are published in ''The Lancet''.  The report refers to current knowledge, recent research and financial matters to describe a respectable plan.<ref>Malaria could be eradicated by 2050, say global experts| https://www.bmj.com/content/366/bmj.l5501</ref>  
 
The number of countries in which malaria was endemic was reduced from 200 to 86 in the years from 1900 to 2017.  A further reduction by another 20 countries occurred by 2020.  In light of the indication of possible practical accomplishment, countries and regions are planning further progress.  Through the use of optimal diagnostic techniques, effective treatment and vector reduction the world should be nearly free of malaria by 2050.  This will require technical improvements in organizational efficiency and more money.<ref>MALARIA ERADICATION WITHIN A GENERATION| https://live-malariaeradicationcommission.pantheonsite.io/sites/default/files/overview-brief-english.pdf</ref>