El Salvador becomes first malaria-free country in Central America

A worker of the Salvadorean Ministry of Health fumigates to reduce the presence of mosquitos (Source: Keystone).

El Salvador has officially been declared malaria-free after no reports of new indigenous cases of the disease since 2017, the World Health Organization (WHO) says.

The country is the first in Central America to achieve the WHO’s malaria-free certification status and third in the Americas overall after Argentina in 2019 and Paraguay in 2018.

WHO director-general Dr.Tedros Adhanom Ghebreyesus said countries like El Salvador “are living proof and inspiration” for all countries striving to eliminate the parasitic disease.

Around half of the world's population is at risk of malaria, particularly those living in lower-income countries and in the Americas, 765,000 cases were reported in 2018.

The positive news also highlights the strides made despite the coronavirus’ effects on health systems worldwide, said the RBM Partnership to End Malaria, formerly Roll Back Malaria Partnership, a Geneva-based organisation of over 500 health-worker groups, researchers and organisations working to end malaria.

“This tells us that the global malaria map is shrinking… And today we actually have more malaria endemic countries that are close to elimination than there are high-burden malaria endemic countries,” Xenya Scanlon, strategic communications partnership committee manager at the RBM Partnership told Geneva Solutions.

What it takes to become certified. Globally, 38 countries and territories have achieved malaria-free status - a WHO certification they can apply for when there have been no local cases for three consecutive years.

Certification is different from elimination “in that a country can only be certified, if it has proven beyond reasonable doubt that it has had zero local malaria transmission for three years or more,” said Scanlon.

China for example has had no indigenous malaria cases for the third year and has also made the formal request for certification. Also, in 2019, Belize and Cabo Verde reported zero indigenous malaria cases for the first time since 2000.

Since the start of the pandemic El Salvador has reported 59,866 confirmed cases and 1,861 coronavirus deaths, yet even with challenges posed to the health systems the country managed to successfully maintain zero malaria cases.

“El Salvador’s remarkable commitment to achieve and maintain zero malaria—even against the backdrop of the Covid-19 pandemic—can serve as an inspiration to other countries on their journey to elimination,” Dr Abdourahmane Diallo, chief executive officer of the RBM Partnership said.

Global picture. Malaria is one of the world’s leading killers, with more than 200 million cases and over 400,000 deaths each year, despite being preventable and curable if diagnosed early. It also takes its economic toll, cutting economic growth rates by as much as 1.3 per cent in countries with high burden rates, according to WHO figures.

Even still, global goals have encouraged the continuous shrinkage of the malaria map, said Scanlon. “For instance, in 2015, the World Health Assembly adopted the global technical strategy for malaria, and that strategy has milestones for the years, 2020, 2025 and 2030. And according to that strategy we should be making gains in terms of the numbers of countries that are malaria free,” she added. According to the World Malaria Report 2020, 1.5 billion malaria cases and 7.6 million malaria-related deaths have been averted since the year 2000.

A 15-year strategy adopted by the World Health Assembly in 2015 set targets hoping to reduce the global malaria cases and mortality rates by at least 90 per cent by 2030. To achieve this there must be an “absolute commitment to reaching zero and staying at zero as seen in the case of El Salvador,” said Scanlon.

“For decades, El Salvador has worked hard to wipe out malaria and the human suffering that it generates,” said Dr. Carissa F. Etienne, director of the Pan American Health Organization (PAHO), WHO’s regional office for the Americas. “Over the years, El Salvador has dedicated both the human and financial resources needed to succeed. This certification today is a life-saving achievement for the Americas.”

Local, regional and global collaboration. As a member of the E-2020 initiative – a group of 21 countries identified in 2016 as having potential to eliminate malaria by 2020, El Salvador consistently worked to achieve this status. National efforts in tackling the disease have paid off even as funding for the global malaria fight plateaued in recent years.

The country deployed over 5,000 community volunteers and vector control staff dedicated to closely monitoring and preventing the re-emergence of malaria. This community-based approach was complemented by collaboration with neighbouring countries to help prevent malaria from crossing country borders.

Covid-19 pandemic and the malaria response. The latest news can be seen as a positive trend, however, as Covid-19 continues to spread, adding additional challenges to essential health systems worldwide, tackling malaria remains a priority.

Looking at malaria and coronavirus together is extremely important Scanlon said. “To fight malaria is to strengthen health systems and make countries more resilient and prepared for any emerging health threats.”

Modelling analysis carried out at the start of the pandemic estimated that disruptions to malaria campaigns and access to treatment could have seen the worst case scenario of malaria deaths doubling, in just one year, she added.

Despite the pandemic’s posed threats, most malaria prevention campaigns still went ahead without major delays. “We were really humbled and incredibly impressed to see that by the end of 2020 90 per cent of all campaigns including the distribution of bed nets were successful…thanks to unprecedented mobilisation by countries and their global and regional partners such as the WHO and Global Fund,” Scanlon added.

However, the full impact of Covid-19 on the malaria response is yet to be felt as even moderate delays could mean thousands of young lives lost, Scanlon said, as projections show that even 10 per cent of disruptions translates into 19,000 additional deaths.

This should however not take away from the fact that El Salvador achieved this, with other countries hopefully following suit soon.

Sharing the good news, El Salvador’s Minister of Health, Dr Francisco José Alabi Montoya, said: “The people and the government of El Salvador, together with its health workers, have fought for decades against malaria. Today we celebrate this historical achievement of having El Salvador certified malaria free.”