Writing the next chapter in the fight against malaria
Last September, after a decades-long battle with malaria, Sri Lanka was officially declared free of the disease. This was an extraordinary feat given that the country had suffered more than 20 years of a bloody civil war and faced a devastating tsunami in 2004.
But Sri Lanka’s success isn’t just significant for one country — its story is indicative of the exciting global progress that’s being made in stopping the scourge of malaria. Hopes are high that another 21 countries will follow in Sri Lanka’s footsteps by the end of the decade. Put in clear terms — a 17-year-old now lives in a world where half as many people die from malaria than the year she was born, and the trendline is moving in the right direction.
What better time than World Malaria Day to consider recent successes, and how they inform the next chapter in the fight to end malaria. Of course, there will be new and old challenges on the path ahead. But we can learn from what’s happening in Sri Lanka and other countries making incredible progress, notably Swaziland and Brazil, to understand how to turn the page.
In Sri Lanka, sheer political will was an essential driving force. The country faced a 25-year-long civil war that ravaged its economy and infrastructure. Yet, throughout the conflict, the government continued to prioritize health systems funding and worked with multi-lateral donors for resources and expertise. The network built to combat malaria was so strong that even after the 2004 tsunami, local authorities maintained malaria surveillance and prevention programs, preventing an outbreak of malaria in its aftermath.
Data from the robust malaria surveillance systems was used to create targeted response plans. The government set up a nationwide malaria reporting system, and tested blood samples drawn in public health centers. The Ministry of Health used this data to identify the areas of highest need, and responded by deploying mobile malaria clinics. These clinics allowed over 3,000 health workers to reach displaced and at-risk populations.
In sub-Saharan Africa, the region that shoulders 90 percent of global malaria cases, all eyes are now on Swaziland. Hopes are high that the country will soon follow Sri Lanka in eliminating malaria.
If Swaziland succeeds, it won’t be because of luck. Ten years ago its government committed to a new strategic plan focused on eliminating malaria, making it one of the first countries in Africa to set a goal of ending the disease.
Importantly, Swaziland recognized that it couldn’t defeat malaria by only treating active cases — they needed to block transmission. So they adopted a new strategy. With the support of a Global Fund grant, they bought rapid diagnostic tests (RDTs) that health workers now take house to house to test a person’s blood on the spot. While there, the health workers collect blood samples for further laboratory analysis, allowing them to more thoroughly find and treat every new case of malaria.
Swaziland also needed to consider its neighbors. That’s why the country worked with malaria control and elimination programs across the region, such as the Elimination Eight (E8), a collaborative effort to end malaria in four countries by 2020 that is now led by Swaziland’s Minister of Health, and the African Leaders Malaria Alliance (ALMA).
Halfway across the world, Brazil has also adopted targeted strategies that have proven to be remarkably effective. This has included the creation of 3,500 malaria outposts throughout the country that ensure even the most remote communities have access to diagnosis and treatment. The national government also decentralized its malaria program, giving funding to municipalities to create their own tailored response to malaria.
Beyond improving delivery of existing malaria tools, Brazil’s government has been a global leader in research and development. Emerging challenges to efforts to end malaria, including new disease outbreaks, threaten to slow progress. To stay ahead of these challenges, Brazil’s Ministry of Health forged a cooperative agreement with the Oswaldo Cruz Foundation and Drugs for Neglected Diseases initiative Latin America. It united the three groups around efforts to develop new drugs to treat tropical diseases, including malaria, making Brazil one of the first developing countries to lead on this type of innovative initiative.
The stories from these three countries show what’s possible when political will is matched with regional and international collaboration, adequate resourcing and alignment with best practices for control and elimination. New tools and strategies are still needed to overcome real and present challenges — including the emergence of antimalarial drug resistance and insecticide resistance. Overall funding has plateaued, and existing aid commitments are in question. This is the time that commitments need to be held, even increased, to ensure progress since 2000 isn’t eroded.
The stories of Sri Lanka, Swaziland and Brazil are why I’m more optimistic than ever that we can continuing making significant progress today. Learning from them will help us write this next chapter in the fight against malaria, and end the disease for good.
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