The World Health Organization (WHO) has certified Cape Verde as malaria-free, hailing it as a significant milestone in the fight against the disease. But much remains to be done.
The news that Cape Verde is malaria-free was received with great joy in the Portuguese-speaking country. For Prime Minister Ulisses Correia e Silva, the “historic moment” called for celebration, not only 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 will 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 the 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 multi-sectoral collaboration, malaria elimination is an achievable goal.”
The fight must go 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 re-establishment 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, without which elimination of malaria would not have been possible.”
The country’s National Director of Health, Angela Gomes, told DW that she was aware of the difficulties in keeping the disease out. Pesticide use, for instance, remained a concern, since mosquitoes are increasingly resistant.
The fight must also be persistent, she 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 explained: “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, WHO said, adding that country’s authorities kept up their vigilance against malaria during the COVID-19 pandemic.
To stem the tide of imported cases, diagnosis and treatment were provided free of charge to international travelers and migrants. “There is a risk of reintroduction because there are many countries, neighboring and beyond, that still have malaria. So, there could be importation of malaria,” WHO director-general Tedros cautioned.
Betting on vaccines
WHO is not relying on pesticides and awareness alone to fight a scourge which kills mostly the very young. Children under five 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, pre-qualified in July 2022, as a means to prevent malaria in children.
According to the UN, several African countries are introducing malaria vaccines into their routine immunization programs. For UNICEF chief Catherine Russell, this signaled “a new era in immunization and malaria control.”
While happy that progress has been made in combating malaria, experts like John Johnson with the NGO Doctors Without Borders 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,” he told the Associated Press. “This is not the vaccine that’s going to stop malaria.”
Neither of the malaria vaccines stop 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.
Cláudia Marques contributed to this article
Edited by: Benita van Eyssen
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