Rolling Back a Malaria Epidemic in South Africa

1076 Amid the dire statistics showing a deadly resurgence of malaria, a notable success has been scored in South Africa. In KwaZulu–Natal province, malaria cases increased from about 600 in 1991–1992 to more than 30,000 by 1999–2000 [1]. Then, after household spraying with DDT was implemented, and the new antimalarial combination artemether-lumefantrine (AL) was widely deployed (Figure 1), cases declined by more than 99% over the next three years. A paper in PLoS Medicine by Barnes et al. [2] examines the implementation and effi cacy of AL during the KwaZulu–Natal crisis. They conclude that vector control and widespread use of artemisinin-based combination therapy (ACT) such as AL may confer similar benefi ts in other African countries. Could the adoption of these policies salvage the Roll Back Malaria Initiative that was formed in 1999 to halve malaria deaths by 2010 [3], but which was recently lamented as “dysfunctional” for its inaction in the face of rising malaria morbidity and mortality rates [4]?