South-East Asia accelerating efforts to eliminate malaria across the region

Health ministers from the South-East Asia Region and development partners gathered last week in Geneva to celebrate the achievement of malaria elimination in the Maldives and Sri Lanka. The event, co-hosted by the two countries alongside the 70th World Health Assembly, provided a platform to share best practices, strategies and lessons learned, with a view to accelerating progress across the Region.

While important gains in malaria control have been reported in many countries, more work is needed to eliminate the disease region-wide. Speaking at the event on 22 May, Dr Poonam Khetrapal Singh, WHO Regional Director for South-East Asia, said: “This is a public health problem that WHO South-East Asia faces that just cannot be ignored. More than 230 million people in the region are still at high risk of malaria – close to a quarter of the world’s population.”

Malaria-free Maldives

Maldives was the first country in the Region to drive malaria cases to zero. The government launched an intensive national malaria control programme in 1966 after surveys found that in some areas up to 50% of young children were infected with malaria parasites. Using a community-based approach, the country was able to successfully scale up the delivery of malaria prevention tools across its chain of 1192 islands.

The last locally-acquired malaria case was recorded in Maldives in 1984 and the country has remained free of malaria to this day. Over the last 3 decades, Maldives has employed robust surveillance measures and a rapid response system to prevent reintroduction and re-establishment of the disease. The country was officially certified by WHO as malaria-free in 2015.

Elimination in Sri Lanka

Sri Lanka achieved a dramatic reduction in its malaria burden in the mid-20th century – from 2.8 million cases in 1946 to just 17 cases in 1963. However, control measures were relaxed and the disease came roaring back. Major epidemics of malaria were reported in the 1980s and 1990s and, by 1999, the country reported more than 250 000 confirmed cases of the disease.

At the turn of the century, Sri Lanka significantly stepped up malaria vector control, surveillance and treatment interventions. A further expansion of interventions was made possible through grants from the Global Fund. By 2007, Sri Lanka had just under 200 indigenous cases of malaria and the last locally-acquired case of the disease was reported in 2012. This achievement was realized despite the challenges posed by a protracted 30-year internal armed conflict. Sri Lanka was officially certified as malaria-free by WHO in September 2016.

At last week’s event in Geneva, Ministers of Health from the Maldives and Sri Lanka attributed their successes, in part, to strong political commitment, robust policies and evidence-based strategies, a deeply committed group of partners, and coordination at every level – including from communities. The two ministers expressed their appreciation to the SEARO Regional Director, Dr Khetrapal Singh, the Director-General of WHO, Dr Margaret Chan, and the Executive Director of the Global Fund, Dr Mark Dybul, for their support in helping countries become malaria-free.

A regional commitment

In recent years, the South-East Asia Region has turned the tide in its malaria response. Between 2010 and 2015, the regional rate of estimated malaria cases and deaths fell by 54% and 46%, respectively. Asked whether malaria will be eliminated across the region by 2030, Dr Khetrapal Singh said: “We have every reason to be hopeful.”

Ministers of health and representatives of member countries of the WHO South-East Asia Region attended the event on 22 May. The Ministers of Health of Sri Lanka and Maldives passed wooden batons to representatives of the other countries, symbolizing that the Region is moving onward in its malaria fight.

Bhutan is next in line for elimination, with the goal of reaching zero indigenous cases as early as 2018. Nepal and Timor Leste are expected to eliminate malaria by 2020. The remaining countries in the Region with ongoing transmission have robust national malaria elimination strategies and are making steady progress.

“Malaria has been around for millennia,” said Dr Dybul, speaking at the event. “We can actually eliminate it from the planet – that’s pretty extraordinary. And you all are setting the pace and will show us how to do it.”

Certification of malaria elimination is the official recognition by WHO of a country’s malaria-free status. WHO grants this certification when a country has proven, beyond reasonable doubt, that the chain of local transmission of all human malaria parasites has been interrupted nationwide for at least the past 3 consecutive years.