In recent years, the countries of Central and South America have committed significant funds and intensified political efforts towards the shared goal of malaria eradication. Among other financiers, the World Banks Booster fund has allowed many countries to provide anti-malaria provisions to much larger numbers of the population. In countries such as Costa Rica, El Salvador and Belize where there are good health systems in place and transmission rates are low it is an entirely feasible possibility to eradicate malaria in the coming years.
History of Malaria Distribution
In the early 19th century, malaria was present in most countries, including those in the northern hemisphere. It was estimated that over 90% of the world’s population lived within areas affected by malaria. The map of distribution reached as far as northern Russia and included most of the southern hemisphere. It was not until the late 19th century, when there were significant changes in agriculture and housing, that malaria was eradicated from Northern European countries and North America.
Since then, there have been several eradication programmes supported and launched by the World Health Organisation with varying success. The introduction of chloroquine and DDT led to the eradication of malaria from 37 countries by 1980.
In the late 20th century, growing antibiotic resistance caused an increase in malaria cases worldwide and consequently there was a new drive to deploy preventative equipment to affected areas and treat cases with combination therapies.
The Latest in Malaria Eradication
In 2016 the World Health Organisation introduced an initiative known as E-2020, listing 21 countries with the potential to eradicate malaria by 2020. Of these nations, Paraguay has been the first to report malaria eradication reporting no indigenous cases since 2012.
The director general of the WHO released a statement earlier this week praising Paraguay’s excellent elimination and prevention strategy. “It gives me great pleasure today to certify that Paraguay is officially free of malaria.”
In general, Central and South America are making a lot of progress. The incidence has fallen in 15 of the 21 named countries since 2013, with 8 of those having reduced numbers by over 50%.
This significant achievement is a great example to the other nations to show that the goal of eradication is entirely possible and potentially imminent.
A Potential setback for Costa Rica
Despite being named as one of the World Health Organisations (WHO’s) E-2020 countries in 2016, on Monday 11th June, Costa Rica reported a health alert due to a rapid rise in the number of detected cases of malaria. So far in 2018, there have been 21 confirmed cases of the disease with almost half of those coming in just one week.
The majority of the reported cases have come in the northern territories of Costa Rica and the president has released a statement urging for the early detection of cases and implementation of isolation.
A statement from the Costa Rican Government suggests they are increasing efforts to overcome the problem, “Our country is prepared for an adequate treatment and diagnosis, the alert seeks to be more aggressive with early detection, in order to prevent cases from spreading”
Other Success Stories
Both Argentina and Uzbekistan have reported no indigenous cases of malaria since 2011 and are both set to be certified malaria free by the end of 2020.
In September 2016, Sri Lanka was officially certified malaria free after reporting no new cases for the preceding three years. Sri Lanka are only the second country in South-East Asia to achieve this title. 2016 also saw Kyrgyzstan receive certification.
Globally, we have made progress. Between 2010 and 2016 there have been seven more countries that have reduced their malaria cases to under 10,000 per year.
Prevention is key to malaria eradication
In order to successfully reduce cases of malaria, each confirmed case of malaria must give rise to <1 in the course of an infection. Early detection by surveillance and rapid treatment is essential to achieve this. Health systems and access in all transmission areas must therefore be improved so the entire population has access to facilities. This must include tourist, refugees and temporary citizenship alongside national citizens.
Nationalised committees and registers can help with the distribution of trained personnel to at risk areas and this must include joint efforts at international borders. Elimination programmes can usually be commenced once a country has reduced its malaria cases to below 100 per 100000 population in any year. This goal is still a fairly long way off for most sub-saharan African nations.
The mass distribution of insecticide-treated mosquito nets is the most effective way at reducing transmission of malaria infection. Estimates suggest that just over 50% of the sub-saharan African population are utilising this method. Reinvigorated efforts are clearly needed in this region after Nigeria, Rwanda and the Democratic Republic of Congo saw increases in their number of malaria cases in the last two years.