Potential of Artemisinin-Based Combination Therapies to Block Malaria Transmission

At the end of the 19th century, Ross’s observations of parasites in the midgut of mosquitoes artificially fed on the blood a patient with malaria heralded the beginning of our understanding of the transmission of malaria and the dynamic interaction between the Plasmodium parasite and the Anopheles vector. The work by Ross and other early pioneers provided the rationale for aggressive control measures focused on reducing the access of mosquitoes to water, epitomized by major public health programs to drain marshes, and distribute bed nets. Early gains were boosted by major drug discovery programs during the Second World War and an expanding antimalarial pharmacopeia. Since 1945, 79 countries have eliminated malaria, with the proportion of the world’s population living in malaria-endemic regions falling from 70% to 50%. However, these achievements have been confounded by huge challenges, including the sustainment of major public health interventions, the propensity of plasmodia to evolve resistance to antimalarial drugs, and the ability of mosquitoes to evolve resistance to insecticides. The widespread use of partially effective treatment policies has haddevastatingconsequencesformalariaendemic regions, resulting in a rising