"Remarkable solutions to impossible problems": lessons for malaria from the eradication of smallpox

Area of Science:

• Global Health
• Infectious Disease Control
• Public Health Policy

Background:

• Malaria elimination and eradication require international coordination, political and community engagement, efficient structures, innovation, and well-managed programs.
• Lessons from past disease eradication programs, particularly smallpox, can inform current malaria control strategies.

Purpose of the Study:

• To review smallpox eradication literature and identify strategies addressing challenges relevant to malaria eradication.
• To evaluate how the smallpox program managed international support, coordination, funding, domestic and community engagement, strategy development, and program management.

Main Methods:

• A comprehensive literature review of 118 publications on smallpox eradication programs.
• Analysis focused on how smallpox programs overcame challenges pertinent to malaria eradication efforts.

Main Results:

• Eradication may succeed through coordinated national programs with international facilitation, emphasizing flexible, problem-solving staff and avoiding bureaucracy.
• Smallpox utilized a hybrid strategy, integrating basic health services with targeted functions, and employed data-driven resource allocation, lessons applicable to malaria programs.
• Engagement with the private sector and communities proved crucial for sustainability and reach in smallpox eradication.

Conclusions:

• Malaria eradication feasibility is uncertain, similar to smallpox before its success.
• Strengthening malaria program management, measurement, and operations is vital.
• Developing flexible international mechanisms for sharing experiences, tools, and financing is essential for increasing the chances of malaria eradication.