The news that Cape Verde is malaria-free was received with great joy. Prime Minister Ulisses Correia e Silva said the "historic moment" called for celebration — and not just because of the positive impact on the health of the population.

"In a country where tourism is a main source of revenue, the elimination of malaria also eliminates constraints on mobility" and could potentially attract more visitors, he said.

Cape Verde, an archipelago of 10 islands in the central Atlantic Ocean, faced severe epidemics in densely populated areas before it implemented targeted interventions. It has become the third African nation to be declared malaria-free, after Mauritius and Algeria.

A lethal scourge

Malaria kills hundreds of thousands of people in Africa every year. The World Health Organization (WHO) estimates that the mosquito-borne disease killed 608,000 people worldwide and infected 250 million in 2022. The African continent is the most gravely affected by malaria, with 95% of global cases and 96% of deaths related to the disease in 2021, according to WHO.

On January 10, WHO said it was very concerned by a worsening crisis in Ethiopia, with "outbreaks of malaria, measles, leishmaniasis and dengue," in several parts of the country, according to Director-General Dr. Tedros Adhanom Ghebreyesus, himself a former Ethiopian health and foreign minister.

In Cape Verde, later that week, WHO was happy to be the harbinger of good news. The archipelago's achievement was "a beacon of hope for the African region and beyond," said Matshidiso Moeti, the organization's regional director for Africa. "It demonstrates that, with strong political will, effective policies, community engagement and multisectoral collaboration, malaria elimination is an achievable goal.

Fight goes on

The certificate of elimination is granted when a country shows rigorous and credible evidence that the chain of transmission of malaria by Anopheles mosquitoes has been interrupted throughout the national territory for three consecutive years. A country must also demonstrate the ability to prevent the reestablishment of transmission.

Tedros warned that more needs to be done to keep Cape Verde malaria-fee. "It will require continued investment in Cabo Verde's strong primary health system," he said, "without which elimination of malaria would not have been possible."

The country's National Director of Health, Angela Gomes, told DW that she is aware of the difficulties in keeping the disease out. Pesticide use, for instance, remains a concern as mosquitoes are increasingly resistant. 

The fight must also be persistent, Gomes said. Insecticide spraying eliminated malaria in Cape Verde in 1967 and, again, in 1983. But lapses in the eradication campaign led to the return of the disease. 

Raising awareness

A system has now been put in place to enable quick diagnoses and detection of threats, Gomes said: "We will carry out research to improve our performance in the fight against mosquitoes. And, obviously, we will have to invest in community interventions in terms of communication and raising awareness."

Eliminating malaria became a national objective in Cape Verde in 2007, leading to a strategic malaria plan from 2009 to 2013. It focused on expanded diagnosis, early and effective treatment, and the reporting and investigating of all cases, according to the WHO. Authorities have kept up their vigilance against malaria during the coronavirus pandemic, the WHO noted.

To stem the tide of imported cases, diagnosis and treatment were provided for free to international travelers and migrants. "There is a risk of reintroduction because there are many countries, neighboring and beyond, that still have malaria," Tedros said. "So there could be importation of malaria."

Betting on vaccines

WHO is not relying on pesticides and awareness alone to fight a scourge that kills mostly the very young. Children younger than 5 accounted for 80% of malaria deaths in Africa in 2020.

Three weeks ago, WHO announced the inclusion of the R21 malaria vaccine in its list of "pre-qualified vaccines," a requirement to enter the distribution programs of humanitarian organizations such as the United Nations Children's Fund (UNICEF) or the GAVI Vaccine Alliance. It recommended its use along with the RTS,S/AS01, which was prequalified in July 2022, as a means of preventing malaria in children.

According to the UN, several African countries are introducing malaria vaccines into their routine immunization programs. UNICEF chief Catherine Russell said this signaled "a new era in immunization and malaria control."

Though they express optimism that progress has been made in combating malaria, public health professionals warn against relying too much on preventive shots. "This is one more tool we will now have, but it's not going to replace bed nets and spraying insecticides," John Johnson, the emergency coordinator of Doctors Without Borders, told The Associated Press. "This is not the vaccine that's going to stop malaria."

Neither of the malaria vaccines stops transmission, so immunization campaigns alone won't be enough to prevent epidemics. Efforts to curb the disease are also being complicated by increasing reports of resistance to the main drugs used to treat malaria and the spread of invasive mosquito species.

Source: DW 

BDST: 1030 HRS, JAN 16, 2024
MN