1. Overview of Malaria in the Americas

2. History followed different courses for different peoples because of differences among peoples’ environments, not because of biological differences among peoples themselves. Diamond, J.M. (2005) Guns, Germs, and Steel: the fates of human societies.

3. Environments Ecological Social Economic Political Technological

4. Reflections November 6 th 1880: Laveran 1898: Ross, Grassi, Bastianelli, Bignami Cinchona bark: Fever – Quechua Indians Peru 17 th Century “Jesuit bark” - Rome 19 th Century Malaria throughout Americas 1902 – Malaria health problem – PAHO II World War – new antimalarials, DDT Successes – Americas including Caribbean 1955 – Global Eradication Program

5. Malaria Strategies and Goals Global Malaria Eradication Strategy – Mexico 1955 Global Malaria Control Strategy – Amsterdam 1992 Roll Back Malaria Initiative – 1998 U.N. Millennium Development Goals - 2000

6. Interventions Diagnosis (Microscopy, Rapid Diagnostic Tests) Treatment (Distinct parasites, Drug Resistance) Reduction Man – Mosquito contact (distinct mosquitoes, Insecticide resistance, Housing, Management breeding sites, Mosquito nets, etc.) Epidemiologic analysis, Operational research Community, other sector involvement Health systems – transfer of responsibility but reduced technical capability

10. Source: Annual Country Reports to PAHO

11. Challenges Change structure health institutions and systems; Accessibility, availability health services Orientation articulation / integration primary health care Recruitment, training, continuity technical personnel Sustainability - surveillance, epidemiologic assessments, operational research Use scientific evidence to adapt interventions and policies Multiple sector participation, particularly civil society and communities Migration within and between countries Burden reduction – “call to arms” – elimination