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Paul Russell’s Man’s Mastery of Malaria (1), written in 1955, opens with these wistful words: “While keeping in mind the realities, one can nevertheless be confident that malaria is well on its way toward oblivion. Already as a malariologist, I feel premonitory twinges of lonesomeness, and in my own organization I am now a sort of ‘last survivor’.” However, Russell was misguided in thinking that the possibilities that had opened up with Ronald Ross’s discovery of the life cycle of the malaria parasite in 1897 (not to mention his remarkable attempts thereafter to understand the dynamics of infection through a simple mathematical model) were to be realized so soon. We are still struggling to conquer malaria, but now have at our disposal some very sophisticated methods of attacking the mosquito vectors, such as with bacterial larvicides and entomopathogenic fungi; new drugs like artemisinin have replaced those to which the parasite has become resistant, and candidate malaria vaccines are reaching a new stage of maturity. An important question to pose at this stage is how some of these control strategies will combine in their impact and, in PNAS, Artzy-Randrup et al. (2) warn that bednets and vaccines may interact in ways that either make the situation a whole lot better (synergistically) or actually much worse (antagonistically), depending on which stage of the malaria life cycle the vaccine targets. Malaria has a complex life cycle and vaccines are now being developed to attack it at both its pre-erythrocytic stages and erythrocytic (blood) stages, as well as those that are specifically tailored to prevent onward transmission (Fig. 1). It is broadly envisaged that blood-stage vaccines will mainly impact on disease severity rather than infection, whereas pre-erythrocytic …

Mastering malaria: What helps and what hurts