Clinton Health Access Initiative, 383 Dorchester Ave, Suite 400, Boston, MA, 02127, USA.
Malar J. 2019 Sep 23;18(1):323. doi: 10.1186/s12936-019-2956-y.
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.
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.
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.
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.
消除疟疾并最终实现根除，需要国际间的协调方法；需要政治人物、社区和资助者的持续参与；需要高效的组织结构；需要创新和新工具；还需要管理良好的规划。当各国政府和全球疟疾界寻求实现这些目标时，他们的努力应该借鉴其他疾病消除和根除规划的大量过往经验，包括迄今为止唯一成功根除人类病原体的规划：天花。
对天花文献进行了回顾，以评估天花规划如何应对七个挑战，这些挑战可能会影响疟疾根除工作，包括为根除工作提供国际支持、协调世界各地流行国家的规划和促进研究、确保充足的资金、在国家一级为疟疾规划建立国内支持、确保社区的大力支持、确定最有效的规划策略，以及有效地管理国家消除规划。
对 118 篇描述天花规划如何克服这些挑战的出版物进行了审查，结果表明，作为一系列个别国家规划的根除工作可能会取得成功，每个国家规划都针对当地问题制定了当地解决方案，但世界卫生组织和其他国际实体在促进和协调这些工作以及鼓励新创新方面发挥着重要作用。描述天花经验的出版物表明，在克服无数意外挑战时，避免繁琐的官僚主义，同时雇用具有技术和运营背景的灵活、解决问题的员工非常重要。天花的混合策略是利用基本卫生服务，同时保持某些单独的功能，以确保可见性、明确的目标和强有力的管理，这与当前的疟疾方法一致。天花根除工作成功地采用了数据驱动的策略，将资源集中到最需要的地方，而不是试图在所有地方实现大规模覆盖，这对于使用现有工具寻求普及覆盖的疟疾规划来说是一个潜在的有用经验。最后，天花规划的经验表明，与私营部门和受影响社区的密切合作有助于提高当今疟疾规划的可持续性和覆盖范围。
疟疾根除是否可行仍不清楚，但在实现根除之前，天花根除是否可行也不清楚。为了提高成功的机会，疟疾规划应寻求加强规划管理、衡量和运作，同时建立灵活的国际经验、工具和融资共享方式。
