Safeguarding malaria control gains in Africa through 'species sanitation' and structural resilience

To maintain effective malaria control, endemic countries must reinforce their short-term commodity-based approaches with sustainable, longer-term strategies. In Africa, where only a few highly-efficient Anopheles vectors drive most malaria transmission, we propose a two-tier strategy to safeguard control gains. First, aggressively pursue an expanded interpretation of species sanitation by targeting ecological vulnerabilities of primary vectors to suppress or eliminate them. Second, gradually build structural resilience through improved housing and environmental management. Future innovations, like gene-drive mosquitoes and longer-lasting vaccines, could further amplify impact and enhance resilience in poor communities. This layered strategy must rest on human-centred policies, increased domestic funding, cross-sector partnerships and resilient health systems, anchored in longer-term planning beyond the usual 5-year cycles. Ultimately, countries could preserve control gains, despite limited external financing.