The role of mathematical modelling in malaria elimination and eradication (Comment on: Can malaria be eliminated?)

For many countries, as Professor Greenwood points out, the answer to his question is a resounding ‘yes’.1 Perhaps the more pertinent question is, with so many more interventions now available, ‘how?’. The two most important new tools that have been added to our malaria control arsenal since the 1950s are artemisinin combination therapies and insecticide-treated bed nets. These are most likely to be effective when used together, in combination with indoor residual spraying where there are suitable vectors. The problem we are faced with is a lack of experience of using such an elimination strategy on a large scale, leading to a lack of data, particularly on the best way to roll out ACTs. In the past, mass screening and treatment, mass drug administration and large-scale replacement of first-line therapies have all been attempted, with varying degrees of success. In the context of newly arisen artemisinin resistance and the diminishing effectiveness of the pyrethroid insecticides, particular care must be taken to preserve the effectiveness of these compounds for as long as possible, whilst achieving maximum impact in a wide variety of epidemiological settings.