Policy support for malaria control programs is a key aspect of the MMC. Our work addresses malaria elimination in diverse contexts and transmission zones, currently focusing on three key geographies in different regions of the world: Cambodia (Greater Mekong Subregion), Haiti (Mesoamerica), and Zambia (sub-Saharan Africa). The MMC works with governments and partners in each of these countries to identify and address pressing questions around malaria elimination, meeting periodically with national malaria control programs and their collaborators to discuss these questions and to present results that can help inform policy and strategy.
Haiti and the Dominican Republic, which together share the island of Hispaniola, are the last locations in the Caribbean with endemic malaria. Haiti is an important part of efforts toward eradication on the island, as many cases of malaria in the Dominican Republic are believed to be imported from Haiti. Low levels of antimalarial resistance, alongside the fact that malaria is caused primarily by just one parasite species (P. falciparum), make elimination feasible in the near future. However, the island also faces some unique challenges such as weakened health system infrastructure, including malaria surveillance, due to repeated natural disasters and rough terrain. In recent years, the governments of both Haiti and the Dominican Republic have committed to eliminating malaria in Hispaniola by 2020 and making the Caribbean an entirely malaria-free region. The MMC is working with the Malaria Zero alliance, composed of the Haiti Ministry of Public Health and Population and collaborating partners, to advance its aim to accelerate elimination of malaria on Hispaniola.
Cambodia presents a complex picture when it comes to malaria epidemiology: there are large variations in transmission across the country due to ecological diversity and human migration patterns, different vector species that exhibit specific behaviors, and varying levels of prevalence of four parasite species (P. falciparum, P. vivax, P. malariae, and P. ovale). Cambodia is of particular concern for eradication efforts due to an additional complicating factor: it has been the site of the repeated emergence of drug-resistant strains of malaria. As such, understanding how malaria can be eliminated in Cambodia has important implications for informing elimination efforts elsewhere. In recent years the government has made substantial progress in reducing the burden of malaria and has committed to eliminating P. falciparum malaria by 2020 and P. vivax malaria by 2025. The MMC is working with the Cambodia National Malaria Control Program to help inform strategies for achieving these goals.
In Zambia, malaria is endemic across the whole country but with extreme variations in prevalence from district to district, from very low levels of transmission in some areas to very high in others. Malaria in Zambia is caused by four parasite species (P. falciparum, P. vivax, P. malariae, and P. ovale), though the vast majority of infections are from P. falciparum. Successful control efforts have reduced the burden of malaria substantially in certain parts of the country, and the goal is now elimination across the whole of Zambia by 2021. The vast heterogeneity of transmission means that different approaches will be required in different areas, and understanding the issue of immunity in populations repeatedly exposed to malaria is also important for these efforts. The MMC is working in collaboration with the Zambia National Malaria Elimination Center and its collaborators (notably the Malaria Elimination and Control Partnership in Africa, or MACEPA, within PATH) to help troubleshoot questions around malaria elimination.