As a scientist who has worked in malaria for more than 30 years, I can truthfully say the numbers are dramatic. Two years ago along the Lake Kariba districts in Zambia’s Southern Province, one in three children was infected with malaria. In some areas, every other person carried the parasite. Those numbers just dropped by 87 percent. In some villages, there is no sign of the disease at all.

This achievement is the result of an extraordinary partnership with the country of Zambia and an approach to malaria elimination that relies on trust. Called mass drug administration (MDA) by scientists and public health professionals, the approach was abandoned about 25 years ago. With it went the World Health Organization’s attempt to eliminate malaria in sub-Saharan Africa.

Now elimination is back on the agenda, and it appears MDA could be an important accelerator for achieving the cause after all.

Protecting humans - and mosquitoes:

To understand MDA you need to understand that malaria is the result of an intimate relationship between humans and mosquitoes. In other words, it’s a two-way street: people are as guilty of passing the malaria parasite to mosquitoes as they are to us.

To protect people, scientists have shortened the lives of mosquitoes with such tools as insecticide-treated bednets and indoor residual spraying. Now we must try to clear the malaria parasites from people so they don’t infect the remaining mosquitoes.

The problem with being asymptomatic:

Zambia’s Ministry of Health invited PATH to partner in their fight against malaria a decade ago. Together we witnessed a near ten-fold reduction in malaria rates in Zambia’s Southern Province using the best existing methods for malaria prevention and control.

But getting to zero means reaching the people who carry the infection without knowing they have it—they can carry two-thirds or more of all the infections. MDA involves treating everyone in a large area in the course of one month and a second round a month later. The idea is to rid people of the infection and protect mosquitoes from malaria-carrying humans.

So beginning in 2014, PATH’s Malaria Control and Elimination Partnership in Africa project (MACEPA) supported Zambia for a randomized controlled trial of MDA in Southern Province. By treating everyone in the designated trial villages, whether or not they had symptoms, we hoped to interrupt the cycle of transmission.

During earlier attempts at MDA, campaigns were designed and coordinated by experts from outside of the countries themselves. There was no plan for maintaining the low malaria levels that were achieved, so the parasite came bounding back.

More profound than giving a man the proverbial fish or even teaching him a skill is working side-by-side to jointly solve a complex problem. That’s what our partnership is all about. The Zambians we worked with, for example, knew far better than we how to engage with their communities. As a result, nearly 99 percent of individuals in the trial area participated. That’s the power of trust.

Next month, we will work together again to roll out MDA to the remaining population of Southern Province in need of this strategy, with the ultimate goal of taking it nationwide. MDA is an enormous effort, but it is time limited and the investment pays off quickly. There is palpable excitement in Zambia right now. I’ve heard people in villages say, “You took our malaria away. Thank you.”

MDA is a strategic, time-limited approach that must be part of a package that includes mosquito control, ready access to testing and treatment, strong information systems, and active surveillance. These other elements need to be in place before, during, and after the campaign.

PATH is indeed fortunate. We partner with more than a dozen countries working to end malaria. In Senegal and Ethiopia we tested variations of population-wide strategies for their particular malaria transmission settings. Our goal is to create a package of interventions that can be adopted and adapted across different geographies.