Modeling resource allocation strategies for insecticide-treated bed nets to achieve malaria eradication

Elife. 2024 Feb 8:12:RP88283. doi: 10.7554/eLife.88283.

Abstract

Large reductions in the global malaria burden have been achieved, but plateauing funding poses a challenge for progressing towards the ultimate goal of malaria eradication. Using previously published mathematical models of Plasmodium falciparum and Plasmodium vivax transmission incorporating insecticide-treated nets (ITNs) as an illustrative intervention, we sought to identify the global funding allocation that maximized impact under defined objectives and across a range of global funding budgets. The optimal strategy for case reduction mirrored an allocation framework that prioritizes funding for high-transmission settings, resulting in total case reductions of 76% and 66% at intermediate budget levels, respectively. Allocation strategies that had the greatest impact on case reductions were associated with lesser near-term impacts on the global population at risk. The optimal funding distribution prioritized high ITN coverage in high-transmission settings endemic for P. falciparum only, while maintaining lower levels in low-transmission settings. However, at high budgets, 62% of funding was targeted to low-transmission settings co-endemic for P. falciparum and P. vivax. These results support current global strategies to prioritize funding to high-burden P. falciparum-endemic settings in sub-Saharan Africa to minimize clinical malaria burden and progress towards elimination, but highlight a trade-off with 'shrinking the map' through a focus on near-elimination settings and addressing the burden of P. vivax.

Keywords: epidemiology; eradication; funding allocation; global health; malaria; mathematical modeling; none; optimization.

MeSH terms

  • Africa South of the Sahara / epidemiology
  • Humans
  • Insecticide-Treated Bednets*
  • Malaria* / epidemiology
  • Malaria* / prevention & control
  • Malaria, Falciparum* / epidemiology
  • Malaria, Falciparum* / prevention & control
  • Malaria, Vivax* / epidemiology
  • Malaria, Vivax* / prevention & control