Biodiversity of malaria ecosystems, challenges for control: When human diversity is forgotten

Malaria has been affecting human beings since ever through a great biodiversity of transmission contexts, and only recently this vector-borne parasitic disease was controlled and eliminated due to the progress in the knowledge of the pathogens, the mosquito vectors and the transmission cycles, but also technological advances in diagnostic, prevention and control tools targeting both the parasite and the vector. Within the past 150 years malaria was eliminated from all temperate countries of the northern hemisphere, and this success triggered the belief that human malaria could be eradicated with simple tools such as environmental management, impregnated nets and treatments. But this did not happen, and a resurgence of malaria burden started about 50 years ago, affecting mostly sub-Saharan Africa. Consequently, a strong worldwide mobilization after the 2000s was followed by a new decline of malaria incidence and a strong decline in malaria mortality, but the diversity of the transmission contexts did not allow the continuation of declined incidence. Further, this situation was concomitant with a great upsurge on mobility of human populations due to different reasons. Malaria control is now at crossroads where access to health is the main driver of the disease. Reaching the hard to reach and mobile populations will be essential to continue the progress on malaria control.