The World Health Organization (WHO) has officially declared Sri Lanka a malaria-free country, in what they’ve called a “remarkable public health achievement” in a statement released Monday.
Sri Lanka is only the second country in the WHO’s southeast Asia regional category to be certified as malaria-free, joining the Maldives. Certification, according to the WHO’s website, is granted to nations who have “proven, beyond reasonable doubt, that the chain of local malaria transmission by Anopheles mosquitoes has been interrupted nationwide for at least three consecutive years.” After 3.5 years of no recorded locally transmitted cases, Sri Lanka will now be added to the WHO’s “Register of areas where malaria elimination has been achieved.”
The WHO lauded Sri Lanka’s strategy as “unorthodox, but highly effective” in a “tough” journey to elimination.
“In the mid-20th century [Sri Lanka] was among the most malaria-affected countries,” said WHO Regional Director Poonam Khetrapal Singh. “[This achievement] signifies the great leaps that can be made when targeted action is taken. It also demonstrates the importance of grass-roots community engagement and a whole-of-society approach when it comes to making dramatic public health gains.”
This strategy by Sri Lanka’s anti-malaria campaign specifically targeted the parasite, not just the mosquito, through mobile malaria clinics, surveillance, health education and community engagement. After decades of civil war that wore down the country’s health-care infrastructure, strategies like the mobile clinics have provided expeditious treatment, reducing the “parasite reservoir” and likelihood of further transmission.
Sri Lanka’s history with malaria has had its share of ups and downs. The country was astonishingly close to eliminating malaria in 1963, when the its anti-malaria campaign helped drop the recorded number of cases to 17, only six of which were locally transmitted, or indigenous, according to Malaria Journal. With elimination on the horizon, the campaign halted insecticide spraying throughout Sri Lanka except along the barriers of jungle regions.
But within months, cases began to appear with renewed intensity, resulting in more than 400,000 cases, according to a University of California San Francisco country profile. Around the same time, the mosquitoes in Sri Lanka began to exhibit resistance to certain pesticides for the first time. Malaria continued to plague the country for the next several decades until the anti-malaria campaign shifted its tactics in the 1990s, and with the help of grants, was able to drop the number of recorded cases to fewer than 1,000 cases a year by 2006.
Since October 2012, there have been zero indigenous cases recorded.
The WHO said that Sri Lanka’s success “should be a springboard to further public health gains in the country and the southeast Asia region as a whole.” Already, media from neighboring countries, like India, are taking note of Sri Lanka’s success to influence their own strategies for fighting recent surges in other vector-borne diseases like dengue and chikungunya.
With 214 million new cases of malaria reported by the WHO in 2015, and the southeast Asia region accounting for 10 percent of that total – second only to the African region – Sri Lanka’s achievement is certainly commendable.