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Duration of Attack Measures in a Malaria-Eradication Program

In most malaria-eradication programs the consolidation phase begins with cessation of spraying, even in the presence of a small reservoir of parasites, which should not be above 0.1 per 1,000 population per year. The writer believes that in highly endemic zones in the tropics, or in areas of great potentiality for transmission subject to continuous importation of cases, such procedure does not end in eradication. He thinks that the slow progress made in so many tropical programs, and the frequent setbacks experienced by most of them is the natural consequence of the method adopted. Several examples in support of this opinion are presented. What has happened in the last 10 years must be looked on as lessons. The amount of money already spent, because of the failures experienced in many programs, is probably much more than that which would have been required to maintain spraying during the 3-year period after the last indigenous case, needed to confirm eradication, as suggested by the writer. During these 3 years active case detection is used only as an evaluation activity and not to eliminate residual cases. This decreases considerably the cost of surveillance.