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Credit: CC0 Public Domain
Cape Verde has been certified without malaria by the World Health Organization.
The archipelago to the west of Senegal consists of 10 islands and has a population of over 500,000 people. It’s the third country in Africa to be declared free of malaria, after Mauritius (in 1973) and Algeria (in 2019).
This brings the total of malaria-free countries in 43 worldwide.
Achieving malaria-free certification is no mean feat. As experts in malaria prevention and control, we explain Cape Verde’s long journey to eradicate the disease that has killed over 600,000 people worldwide 2022.
How Cape Verde achieved its goal
Malaria, endemic since the settlement of the previously uninhabited islands in 15th centuryaffected all 10 islands before 1950.
During 1940s, malaria was a serious health threat. Severe outbreaks resulted in more than 10,000 cases and 200 deaths annually until targeted interventions were implemented.
The country was close to eliminating malaria twice but these gains were not sustained.
Indoor residual spraying with DDT it was done on every island until nationwide transmission ended in 1967. The residual effect of the insecticide helped kill mosquitoes for a longer period of time. Larvicide, use of chemicals to target mosquito larvae in breeding areas and detection of active cases were also carried out.
Indoor residual spraying campaigns ceased in 1969. The result was a repetition of local transmission on Santiago Island in 1973, followed by a large outbreak in 1977.
The second malaria eradication effort began in 1978 and resulted in the cessation of transmission in 1983. Case numbers were maintained at lowest levels since 1989, limiting malaria to the islands of Santiago and Boa Vista. But from 2006rising cases threatened tourism.
A political decision was made to step up eradication efforts at the national level. This led to a change in the country’s national health policy in 2007.
The focus was on comprehensive diagnosis, early and effective treatment and management of all cases.
Cape Verde was on track to eliminate malaria, but in 2017 recordedworse malaria outbreak“since 1991 with 423 cases.
The outbreak prompted an adjustment in strategy. ONE refocusing on vector control, targeting affected neighborhoods and communities prone to malaria infection, prevented the increase in cases. The transmission was successfully interrupted for four years.
Process to get Malaria Free Certified
WHO reported 249 million malaria cases and 619,000 malaria-related deaths worldwide in 2022.
The African region accounted for 94% of all cases and 96% of all deaths.
Achieving malaria-free status underscores the determination and commitment of a nation. Countries must meet strict WHO criteria to achieve this goal. First, it must exist zero natives (locally) transmitted cases of malaria for at least three consecutive years.
Second, a country must demonstrate that it has the capacity to prevent the reintroduction of disease transmission.
Only then can countries request certification by WHO, in collaboration with regional offices to develop a certification plan and timetable.
If a country fails, it can reapply after three years.
To maintain malaria-free status, countries must continue to prevent transmission and submit annual reports to WHO.
Predictions for the next countries to make the leap
WHO E-2025 initiative focuses on 25 countries with a goal of elimination by 2025.
Belize achieved elimination in 2023. Malaysia reported zero local transmission for the fifth consecutive year, while East Timor and Saudi Arabia achieved two consecutive years without local transmission (2021 and 2022). If maintained, they may soon be declared malaria-free. For the first time, both Bhutan and Suriname reported zero indigenous cases in 2022.
In the African region, several countries reported significant reductions in indigenous transmissions in 2022. These included Botswana (43.5%), Eswatini (57.6%) and South Africa (31.3%). Comoros saw a doubling of cases in the same year. Sao Tome and Principe saw a 46% increase.
Despite efforts of the countryextreme climate events and cross-border movements may have an impact on transmission or recurrence.
Acquiring certification is important and Cape Verde’s success will lead to positive development in the country.
THE TOURISM plays an important role in the country’s economy. It accounted for a significant share of the country’s pre-COVID GDP (24%), formal employment (10%) and the majority of foreign investment. The malaria-free status may potentially attract more visitors to the country.
The infrastructure created to eliminate malaria has strengthened the country’s health system. This may be beneficial against other mosquito-borne diseases such as Dengue feverwhich also affects tourism.
A country’s “personal” milestone can help advance global efforts to eliminate malaria. Cape Verde’s achievement is a call to action for the malaria community not to give up. We must push harder to end malaria for good.