Getting to zero: WHO holds global forum to accelerate malaria elimination progress

31 March 2017

Mother and baby in Nepal
A mother and her child during a visit to a health clinic. Nepal figures among the 21 countries that could eliminate malaria by 2020.
WHO/ Christopher Black

Senior representatives from national malaria control programmes around the world recently gathered in Geneva to share knowledge and best practices towards a common goal: “Getting to zero” by the year 2020. The global forum, convened by WHO from 16–17 March, provided a platform to review country-level progress towards elimination and devise strategies for the way forward.

“We have 45 months to eliminate malaria in 21 countries," said Devanand Moonasar, Director of South Africa’s National Department of Health, who chaired the opening session. "We need action, and the time for action is now.”

E-2020 initiative

According to WHO estimates, an increasing number of countries are moving towards malaria elimination. In 2000, an estimated 13 countries had fewer than 1000 cases of malaria; by 2015, 33 countries had achieved this milestone. Similarly, the number of countries with fewer than 100 cases of malaria, and with fewer than 10 cases of the disease, has increased sharply since 2000.

In April 2016, WHO identified 21 countries with the potential to achieve zero indigenous cases of malaria by 2020. The analysis, published on World Malaria Day, was based on trends in malaria case incidence between 2000 and 2014; the declared malaria objectives of affected countries; and the informed opinions of WHO experts in the field.

Together, these 21 countries represent the “E-2020”. The recent 2-day meeting in Geneva included representatives from 20 of these countries, along with WHO staff and invited observers.

‘Every day now counts’

“You are the countries that can lead the elimination agenda globally,” said Dr Pedro Alonso, Director of the Global Malaria Programme, speaking at the forum on 16 March. “If you succeed, you will represent the biggest boost seen in the fight against malaria in many years."

Every day, every week and every month now counts.

Dr Pedro Alonso, Director of the Global Malaria Programme

He noted that reaching elimination in all E-2020 countries would require a sense of urgency and purpose. “Every day, every week and every month now counts. We need to understand what the challenges and bottlenecks are, and how we can overcome them.”

To guide countries in this final effort, WHO has developed a new framework for malaria elimination with a set of tools and strategies for interrupting transmission and preventing re-establishment of the disease. Launched at the meeting on 16 March, the framework builds on and supersedes WHO’s 2007 guidance on elimination.

WHO’s 2017 elimination framework is fully aligned with the WHO Global Technical Strategy for Malaria 2016-2030. Eliminating malaria in at least 10 countries by 2020 is a key target of the global strategy.

Certification of elimination

Countries that maintain zero locally-acquired malaria cases for at least the past 3 consecutive years are eligible to apply for a certification of malaria elimination by WHO. A new, streamlined certification process is described in the 2017 elimination framework. WHO will establish a Certification of Elimination Panel tasked with verifying national elimination reports submitted by countries.

Two countries at the global forum reported several consecutive years of zero indigenous cases of malaria: Paraguay (since 2012) and Algeria (since 2014). Both are expected to request official certification of elimination from WHO in the coming months.

‘A real eye-opener’

Each E-2020 representative had an opportunity to present individual country progress towards elimination. Working groups enabled the sharing of experiences and lessons learned across countries and regions on a range of topics, from cross-border collaboration to case detection in low-transmission settings.

“The meeting helped strengthen our motivation to move toward elimination."

Dr Helene Hiwat, Coordinator of the National Malaria Control Programme in Suriname

Dr Helene Hiwat, Coordinator of the National Malaria Control Programme in Suriname, described the interactions with her counterparts from other malaria-eliminating countries, and the discovery of so many cross-cutting challenges, as “a real eye opener.” She explained: “The meeting helped strengthen our motivation to move toward elimination. It’s nice to know that support to reach that goal is available, and that we can build upon experiences of others."

‘Prepare your countdown to zero’

In his closing remarks at the meeting, Dr Ren Minghui, WHO Assistant Director General for HIV/AIDS, Tuberculosis, Malaria and Neglected Tropical Diseases, said: “When you return to your offices next week, whether in Bhutan, Saudi Arabia, Suriname, Timor-Leste, or any of the other E-2020 countries, prepare your countdown to zero.” He added: “Use the new framework to ensure your programmes are appropriately oriented towards the activities and strategies that will help you reach that goal.”

Dr Ren noted WHO would hold an annual global forum from here forward to review country progress towards elimination and uphold important milestones. Member countries reaffirmed their commitment to meeting their national goal of eliminating malaria by 2020 and accepted the invitation from WHO to present their progress each year at subsequent global forums.