The countries of the Greater Mekong subregion-Myanmar, Thailand, Laos, Cambodia, and Vietnam-have set a target of eliminating all
Plasmodium falciparum malaria by 2025. Generous funding has been provided, principally by The Global Fund to Fight
AIDS,
Tuberculosis, and
Malaria, to achieve this objective and thereby prevent the spread of
artemisinin-resistant Plasmodium falciparum to India and Africa. As the remaining time to reach agreed targets is limited and future external funding is uncertain, it is important to be realistic about the future and spend what remaining funding is left, wisely. New, labour intensive, vertical approaches to
malaria elimination (such as the 1-3-7 approach) should not be promoted as these are unproven, likely to be ineffective, costly, and unlikely to be sustainable in the most remote areas where
malaria prevalence is highest. Instead, the focus should be on reducing the
malaria burden more rapidly in the remaining localised high transmission foci with proven effective interventions, including
mass drug administration. Well supported community-based health workers are the key operatives in controlling
malaria, but their remit should be broadened to sustain the uptake of their services as
malaria declines. This strategy is a sustainable evolution, which will improve rural health care while ensuring progress towards
malaria elimination.