The Stability of Malaria Elimination

When the Global Malaria Eradication Programme (GMEP) was launched in 1955 (1, 2), all malaria-endemic countries outside of Africa were (or would soon be) eliminating malaria (3). The GMEP's design was based on a theory of malaria transmission dynamics and control that has become the standard for malaria elimination decisions today (4-6). When financial support for the GMEP collapsed in 1969, participating countries were caught at different stages of progress toward elimination (1). Examining their fate in the decades that followed provides a natural experiment that tests the theory. With a rise in funding (7) and renewed interest in eradication (8, 9), there is now a need to revisit the lessons learned from the GMEP. We identify changes in the epidemiology of malaria when elimination is reached that could explain its stability and discuss how this calls for a reassessment of strategies for eradication.