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"Remarkable solutions to impossible problems": lessons for malaria from the eradication of smallpox.
Malar J 2019; 18(1):323MJ

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.

Authors+Show Affiliations

Clinton Health Access Initiative, 383 Dorchester Ave, Suite 400, Boston, MA, 02127, USA. jcohen@clintonhealthaccess.org.

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

31547809

Citation

Cohen, Justin M.. ""Remarkable Solutions to Impossible Problems": Lessons for Malaria From the Eradication of Smallpox." Malaria Journal, vol. 18, no. 1, 2019, p. 323.
Cohen JM. "Remarkable solutions to impossible problems": lessons for malaria from the eradication of smallpox. Malar J. 2019;18(1):323.
Cohen, J. M. (2019). "Remarkable solutions to impossible problems": lessons for malaria from the eradication of smallpox. Malaria Journal, 18(1), p. 323. doi:10.1186/s12936-019-2956-y.
Cohen JM. "Remarkable Solutions to Impossible Problems": Lessons for Malaria From the Eradication of Smallpox. Malar J. 2019 Sep 23;18(1):323. PubMed PMID: 31547809.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - "Remarkable solutions to impossible problems": lessons for malaria from the eradication of smallpox. A1 - Cohen,Justin M, Y1 - 2019/09/23/ PY - 2019/08/12/received PY - 2019/09/11/accepted PY - 2019/9/25/entrez PY - 2019/9/25/pubmed PY - 2019/9/25/medline KW - Elimination KW - Eradication KW - History KW - Malaria KW - Smallpox SP - 323 EP - 323 JF - Malaria journal JO - Malar. J. VL - 18 IS - 1 N2 - 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. SN - 1475-2875 UR - https://www.unboundmedicine.com/medline/citation/31547809/"Remarkable_solutions_to_impossible_problems":_lessons_for_malaria_from_the_eradication_of_smallpox_ L2 - https://malariajournal.biomedcentral.com/articles/10.1186/s12936-019-2956-y DB - PRIME DP - Unbound Medicine ER -