Elimination is a big word and eradication is an even bigger one.

Countries certified malaria-free by WHO Eliminating Malaria report. (taken from http://www.who.int/malaria/publications/atoz/eliminating-malaria/en/)

What does eradication even mean?

Eradication refers the reduction of an infectious disease’s prevalence in the global host population to zero.
Elimination refers to a regional reduction of an infectious disease’s prevalence in the host population to zero, usually referring to countries.

In terms of malaria, eradication is the goal and why wouldn’t we want that. No more malaria. One of the United Nation’s Sustainable Development Goals (SDGs) is to eradicate malaria in a bid to improve health and well-being. In recent history, we have only successfully eradicated one pesty infectious disease, smallpox, from humans and another (rinderpest) from livestock.

But eradication is simpler said than done. So, the aim is currently to tackle small battles and win those. Let’s take a look at how we are doing so far. Since 1955, a total of 27 countries have been certified to have eliminated malaria. In the recent times between 2007 and 2015, 5 countries have been certified to be malaria free. In 2014, 13 countries reported 0 locally-transmitted cases of malaria.


According to WHO’s 2016 report for Malaria Elimination, the rate of progress of elimination is dependent on the countries’ national health system, the level of investment in malaria control and a number of other factors including biological determinants, the environment and the social, demographic, political and economic realities of that country.

From the numbers above, we can see that we are steadily making progress. In fact, WHO has highlighted countries which are potentially able to eliminate local transmission of malaria by 2020. This list includes, China, South Africa, Algeria, Botswana and Malaysia to name a few.

Turkmenistan, a case study

Ashgabat, famously called the White City for its marble-laden buildings. (photo taken from http://www.iikss.com/en/index.php/route/news_det/MzUzMA/Ashgabat_is_Turkmenistan%E2%80%99s_white_marble_city_of_love)

Turkmenistan, one of the five countries which recently was certified to have malaria eliminated in 2012. Interestingly, Turkmenistan is one of the Central Asian countries where malaria was eliminated in the 1960s only to have it return in the wake of the break-up of the former Union of Soviest Socialist Republics (USSR). Ashgabat is the capital city. Turkmenistan is largely desert with hot and arid weather. The temperature exceeds 40°C from May to September. They have a population of over 5.1 million as of 2009 and the country itself is classified as a “lower middle income country” with a gross national income per capita of US$ 7490.

The country designed vector controls to:

  1. Reduce life span of female mosquitos through indoor residual spraying
  2. Reduce larval density through larvivorous fish or layering oil over stagnant water
  3. Reducing human vector-contact through use of mosquito nets.

Interestingly, mosquito nets have been made locally for generations and widely used and more modernly made insecticide-treated nets have not been promoted in the country.

Additionally, in recent years, the living standards in Turkmenistan have improved. Better housing and the use of air-conditioning (by about 50% of households, even in the villages) are believed to have contributed to a reduction in the number of cases as well as the risk of infection.

The Turkmenistan Government also actively aimed to increase the community awareness and participation in malarial prevention practices. After the malaria rates dropped, surveillance and control activities were sustained to ensure that this time, the disease was eliminated for sure.

Turkmenistan’s case show that there are risks if we are not careful after elimination. This case also highlights the importance of funding for malaria activities, even in the absence of cases. What is important to note is that not every countries’ methods will work. However, it is our hope that seeing a country go through the process that we can encourage others to invest in countries which are still endemic to aid the process and bring better health to all in need.

References:

  1. Dowdle, W. R. (1998). The principles of disease elimination and eradication. Bulletin of the World Health Organization, 76(Suppl 2), 22–25. <https://www.cdc.gov/mmwr/preview/mmwrhtml/su48a7.htm>
  2. United Nations, 2016. Sustainable Development Goals, Geneva http://www.un.org/sustainabledevelopment/health/
  3. World Health Organisation, 2016. Eliminating Malaria, Geneva [accessed 22 February 2017], http://www.who.int/malaria/publications/atoz/eliminating-malaria/en/
  4. World Health Organisation, 2012. Eliminating malaria: case study 1. Achieving elimination in Turkmenistan. University of California, San Francisco. [accessed 22 February 2017], http://www.who.int/malaria/publications/atoz/9789241504300/en/
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