Malaria-free

Sri Lanka will likely be officially declared a malaria-free country this week by the World Health Organisation (WHO), signalling the culmination of a truly exceptional amount of work to save the country from a disease that has affected millions over decades.  

According to the latest estimates from WHO, there were 214 million new cases of malaria worldwide in 2015. The African region accounted for most global cases of malaria (88%), followed by the South-East Asia region (10%) and the Eastern Mediterranean region (2%). In South Asia only the Maldives has managed to be declared malaria-free. 

In 2015, there were an estimated 438 000 malaria deaths worldwide. Most of these deaths occurred in the African Region (90%), followed by the South-East Asia region (7%) and the Eastern Mediterranean region (2%).

Between 2000 and 2015, malaria incidence rates (new malaria cases) fell by 37% globally, and by 42% in Africa. During this same period, malaria mortality rates fell by 60% globally and by 66% in the African region.

Other regions have achieved impressive reductions in their malaria burden. Since 2000, the malaria mortality rate declined by 72% in the region of the Americas, by 65% in the Western Pacific region, by 64% in the Eastern Mediterranean region, and by 49% in the South-East Asia region. For the first time, the European region reported zero indigenous cases of malaria in 2015.

Sri Lanka went from about 5.5 million cases in 1934-1935 to fewer than 20% in the early 1960s, thanks to its aggressive malaria program. Prematurely assuming that the job was done, the Government scaled the program back. By 1969, the country was battling a devastating and deadly resurgence of over half a million cases. 

Since 2000, Sri Lanka has again made malaria a priority, building a strong program to combat it. The country’s last recorded local malaria case came more than three years ago. Maintaining momentum is essential to realising a malaria-free world. Just as strong immunisation programs keep measles and other vaccine-preventable diseases at bay, strong, well-funded malaria programs are critical to ending the transmission of malaria and preventing its reintroduction.

Sri Lanka’s achievement in malaria is even more impressive given that about 80% of resources have to be supplied by local governments and it has to be maintained for decades at a time.   

The Government has already pledged to continue the monitoring program to ensure that Sri Lanka remains malaria free. Cabinet recently allocated Rs.300 m to combat the disease in 2017 and has committed to current levels of recurrent expenditure with 10% increments in subsequent years.

They have also pledged to ensure that these allocations do not compete with other disease control programs. The gains far outweigh the required investment for prevention of re-introduction of malaria.  As the estimated cost of prevention of malaria reintroduction program was Rs.1.7 billion in 2015, the per capita cost is Rs. 85.50 giving a 13 to 1 return on investment. 

International funding for Sri Lanka will end in December 2018 and adequate financial allocations need to be guaranteed to bridge the deficit that will arise due to the termination of this funding. Now the most important thing is keeping the win.