11. Conclusions

Malaria control has improved with the redoubling of efforts and financial resources in recent years, but existing tools will lose their effectiveness over time. The best long-term strategy to address the malaria scourge is its elimination and ultimately eradication, but existing tools are insufficient for this purpose. This gap has been recognized by the WHO Roadmap for Malaria Vaccines that specifically calls for vaccines that can be used for elimination [56]. TBVs prevent human-to-mosquito transfer of parasites and hence are well-suited for use in elimination and eradication programs. Development of TBV has been hindered by the nature of the target antigens, which have been difficult to express in proper conformation and are poorly immunogenic, as well as the dearth of resources dedicated to their development. However, increasing attention to elimination by policy makers and funding agencies has reignited interest in this research area, and improved platforms for vaccine expression and delivery have yielded promising new TBV candidates that have in some cases advanced to field trials. Collaborative multidisciplinary teams are now rising to the task of testing TBVs in the field, which also require specialized facilities to measure transmission-blocking activity of vaccines. Regulatory issues will need to be addressed as TBVs are developed and implemented, particularly because these products are designed to benefit the community and not the individual directly. However, vaccines have been essential for eliminating or eradicating other infectious agents, and TBVs could be a vital component of a multipronged effort to eradicate malaria from the face of the earth.
