As we prepare for malaria eradication, it is essential to anticipate the challenges we will confront during the endgame. The Lancet Commission on Malaria Eradication is in the midst of identifying critical challenges that will need to be addressed for global eradication. These may include scientific and technical challenges to eradication, such as high transmission and insecticide/drug resistance, as well as political, financial, and operational challenges, including inequity of access to healthcare access, humanitarian crises, and funding gaps.
As the Commission refines the global challenges to be confronted, preliminary insights can be gained by taking a deep dive on Rwanda, a country that achieved > 75% decline of malaria morbidity and mortality from 2000 to 2011, but has seen upsurges of malaria in the recent years. As with many countries, Rwanda’s experience illustrates the need to understand major drivers on malaria resurgence; there is need for effective surveillance strategies to monitor progress, and there is a need to inform the most appropriate mix of malaria control interventions. Beyond Rwanda, as we progress towards malaria eradication, there is need for countries to identify major challenges, taking into account critical factors including programmatic, environment, climate, migration and regional cooperation.