Moving toward the global goal of malaria elimination will require major efforts to address four critical gaps in training: front-line field workers, entomologists, research scientists, and malaria-sensitive health system managers, policymakers, and leaders.
Malaria elimination depends on front-line field workers who will take various actions in controlling the mosquito vector, preventing human contact with infected mosquitoes, assuring the availability and effective use of malaria diagnostic tools, and providing malaria treatment to infected persons. Managing this complex portfolio of malaria interventions in low-resource settings is a major challenge in malaria-endemic countries. Front-line workers need to be trained in how to use the different kinds of technologies in changing disease settings: bed nets treated with long-lasting insecticides, indoor residual spraying, larvicides to use on mosquito breeding sites, diagnostics to determine whether someone is infected with the parasite, and the right medicines to treat infected people. Moving toward malaria elimination requires the use of these technologies, combined in different packages depending on the local transmission conditions and able to respond to changing conditions. Effective training of front-line workers is the first major challenge confronted by all malaria endemic countries; without it, progress will be elusive.
The second major gap in malaria training is entomologists—people who understand the biology and behaviour of mosquitos. Basic research is needed to understand the emergence of mosquito resistance to insecticides, but also to understand how the vector may respond to different interventions. Research is needed, for example, on when and where a particular mosquito is most susceptible to spraying, how a particular mosquito might respond to genetically modified mosquitoes, species diversity issues (e.g., responsiveness to interventions, outdoor biting, sensitivity to endectocides, vector capacity). Global warming may change the environments where mosquitoes live and alter the environmental susceptibility to malaria [5, 6]. Field-based and applied research on mosquitoes is also needed to translate basic knowledge into practical information that can be used in adjusting the strategies for malaria elimination in a specific environment. Various training courses have been organized on medical entomology and vector control by the World Health Organization (WHO) . These courses need to be digitalized to make them easily accessible globally and effective in training the expanded work force that is needed to help malaria endemic countries move toward elimination. This training gap is not limited to malaria, but affects the entire field of vector borne-diseases; the recent WHO Global Vector Control Response  identifies this gap as a key deficit.
The third gap is in research training: fundamental biological research, data science and applied tool development including drugs, vaccines and diagnostics, epidemiological research, and policy research. It will be critical for countries to have a cadre of researchers who can make fundamental discoveries, rapidly integrate new ideas, and use this knowledge to better inform decisions and policy-making, both short- and long-term. There is great opportunity in developing a network of researchers across the globe for contributions to knowledge generation and dissemination. The potential for innovation is greatest when researchers with different perspectives and backgrounds come together to solve a complex problem. The changing malaria landscape presents opportunities for innovation across multiple disciplines—from developing new tools to revisiting the design of clinical trial designs as the malaria endgame nears. A comprehensive research agenda has been developed by the Malaria Eradication Research Agenda (malERA) Refresh Process and this provides a framework for research training .
The fourth major training gap for malaria elimination is for managers and leaders in national health systems. Health managers responsible for multiple districts, at the regional or state level, need mechanisms to keep track of progress in malaria elimination and algorithms for adjusting control strategies to changing conditions. Smart phones offer an opportunity to create information collection and analysis systems that can provide summary information, analysis, and new data visualization and mapping tools for managers. Policy-makers at the national level will require training in how to monitor and evaluate progress and make adjustments in the package of malaria interventions as conditions change. In addition, managers and leaders need to design and implement effective mechanisms in government agencies to motivate and supervise the front-line workers who will do the work of malaria elimination, and provide them with a reliable supply chain of the needed technologies: bed nets, insecticides, diagnostic kits, and medication. These challenges are features of the health system writ large, but managers and leaders in national health systems will face extraordinary complexities as a result of malaria innovations and transitions in malaria strategy, and products. Solving these challenges will require focused and consistent hard work to make public systems work effectively and responsibly, especially in the difficult organizational environments often found in malaria endemic countries .
These four gaps in training for malaria elimination demonstrate the need for a trans-disciplinary approach. Moving forward with malaria elimination requires an understanding not only of human behaviour (for example, how psychology and economics affect the use of nets or the use of health services for diagnosis and treatment) but also mosquito behaviour (for example, which mosquitoes are most susceptible to indoor spraying and how they might be replaced by other mosquitoes that bite outside and during the day) and organizational behaviour (for example, how to manage partnerships between the public and private sectors or across different government ministries). Analysing the costs of different malaria interventions, and determining how to finance those expenditures from domestic and external funds, require both analytical and financial management skills. Training the right people in these skills will draw on a mixture of basic sciences, social sciences, and policy sciences—as often happens in public health.