There are hurdles to clear before malaria elimination can be achieved. A supplement published in Malaria Journal features a series of articles reviewing the many aspects of the research agenda for global malaria elimination.

One of the supplement's reviews charts the progress that has been made in the development of malaria vaccines intended for eradication, rather than clinical disease prevention. Elimination requires a different vaccine strategy, since success will depend on killing all parasites in the community in order to completely stop transmission. According to the Editor-in-Chief of the journal, Marcel Hommel, "Nobody believes that elimination will be easy to achieve and it will undoubtedly require sustained, high level funding and political commitment for many years".

Another review explains how, where transmission of malaria is intense, even highly effective interventions that reduce mortality may have little noticeable effect on the clinical pattern of malaria. Due to the fact that some types of malaria can remain hidden in a reservoir of asymptomatic carriers, mass treatment of all people in an area is required for elimination to be successful. Sadly, one of the dugs used, primaquine, has serious side effects and more evidence is required on its safety in this context.

The situation is not entirely bleak, however. The combination of mass distribution of mosquito nets and nationwide distribution of artemisinin-based combination therapies has resulted in substantial declines in malaria cases and deaths in a number of countries. According to Hommel, "A general pattern is emerging, that malaria incidence is decreasing worldwide and this is now actually being documented by reliable data".

The production of this supplement has been made possible by generous sponsorship from the Foundation for the National Institutes of Health (FINH), FIND and the Wellcome Trust. "We are delighted to be part of this supplement that reviews the challenges that must be faced in the fight to eliminate and eradicate malaria, and describes recent successes as well as new biomedical approaches that offer additional promise against this dreadful disease", noted Amy McGuire Porter, Executive Director, Foundation for the National Institutes of Health.