COMMENTARY - MALARIA CONTROL IN THE 1990S

In May 1955 the Eighth World Health Assembly adopted a Global Malaria Eradication Campaign based on the widespread use of DDT against mosqui tos and of antimalarial drugs to treat malaria and to eliminate the pa rasite in humans. As a result of the, Campaign, malaria;was eradicated by 1967 from all developed countries where the disease was endemic an d large areas of tropical Asia and Latin America were freed from the r isk of infection. The Malaria Eradication Campaign was only launched i n three countries of tropical Africa since it was not considered feasi ble in the others. Despite these achievements, improvements in the mal aria situation could not be maintained indefinitely by time-limited, h ighly prescriptive and centralized programmes. Also, vector resistance to DDT and of malaria parasites to chloroquine, a safe and affordable drug, began to affect programme activities. A Global Malaria Control Strategy was endorsed by a Ministerial Conference on Malaria Control i n 1992 and confirmed by the World Health Assembly in 1993. This strate gy differs considerably from the approach used in the eradication era. It is rooted in the primary health care approach and calls for flexib le, decentralized programmes, based on disease rather than parasite co ntrol, using the rational and selective use of tools to combat malaria . The implementation of the Global Strategy is beginning to have an im pact in several countries, such as Brazil, China, Solomon Islands, Phi lippines, Vanuatu, Viet Nam and Thailand. The lesson from these areas is clear: malaria is being controlled using the tools that are current ly available. The challenge is now to apply these tools among vulnerab le individuals and groups experiencing high levels of morbidity and mo rtality, particularly in sub-Saharan Africa, for which long-term inves tments are required.