In January 2024 WHO announced that it has certified Cabo Verde as a malaria-free country, describing it as a “significant achievement in global health”. Certification of malaria elimination is WHO’s official recognition that a country has shown with “rigorous, credible evidence” that the chain of indigenous malaria transmission has been interrupted nationwide for at least 3 consecutive years. The country must also demonstrate the capacity to prevent the re-establishment of transmission. As the third country certified in the WHO African Region, Cabo Verde joins 43 countries and 1 territory that have been awarded the status; Mauritius and Algeria are the other two African Region countries.
“Malaria burden is the highest on the African continent, which accounted for approximately 95% of global malaria cases and 96% of related deaths in 2021.”
Journey to elimination
Cabo Verde is an archipelago of 10 islands in the Central Atlantic Ocean, and has “faced significant malaria challenges”, with “severe epidemics” in densely populated areas. Previous efforts resulted in malaria elimination in 1967 and 1983. However, “lapses in vector control” led to a return of the disease.
WHO indicates that the “journey to malaria elimination has been long”, receiving a “boost” in 2007 with the inclusion of this objective in the national health policy. From 2009 to 2013 a strategic malaria plan “laid the groundwork for success” with an emphasis on expanding diagnosis, early and effective treatment, and reporting and investigating all cases. Diagnosis and treatment were provided to international travellers and migrants to “stem the tide of imported cases” from mainland Africa.
In 2017, the country “turned an outbreak into an opportunity”, identifying key problems and responding with improvements. When the COVID-19 pandemic struck, the country “safeguarded progress” by improving the quality and sustainability of vector control and diagnosis and strengthening malaria surveillance.
Collaboration was “pivotal” in this success, and WHO recognises that the inter-ministerial commission for vector control was “key to elimination”.
“The collaborative effort and the commitment of community-based organisations and NGOs demonstrate the importance of a holistic approach to public health.”
A testament
WHO Director-General Dr Tedros Adhanom Ghebreyesus “salute[s] the government and people of Cabo Verde”, recognising their “unwavering commitment and resilience in their journey to eliminating malaria”.
“WHO’s certification of Cabo Verde being malaria free is testament to the power of strategic public health planning, collaboration, and sustained effort to protect and promote health.”
With this step in the “global fight”, Dr Tedros is hopeful that “with existing tools, as well as new ones including vaccines, we can dare to dream of a malaria-free world”. Indeed, WHO invites the rest of the world to take inspiration from this achievement.
“As Cabo Verde celebrates this monumental achievement, the global community commends its leaders, healthcare professionals, and citizens for their dedication to eliminating malaria and creating a healthier future for all.”
In particular, this will be a “beacon of hope for the African Region”, suggests Dr Matshidiso Moeti, WHO Regional Director for Africa.
“It demonstrates that with strong political will, effective policies, community engagement, and multisectoral collaboration, malaria elimination is an achievable goal.”
Positive development
WHO states that this certification will have positive effects for development on “many fronts” for Cabo Verde. For example, systems and structures that were built for malaria elimination have bolstered the health system and can now be used against other mosquito-borne diseases, like dengue fever.
Travellers from non-malaria endemic regions can travel to the islands of Cabo Verde “without fear of local malaria infections” or the “potential inconvenience of preventative treatment measures”. Thus, with more visitors there will be a “boost” to socio-economic activities for the country, in which tourism accounts for roughly 25% of GDP.
Prime Minister, Ulisses Correia e Silva, is glad that the challenge the country has overcome is being recognised.
“The certification as a malaria-free country has a huge impact, and it’s taken a long time to get to this point. In terms of the country’s external image, this is very good, both for tourism and for everyone else.”
An inspiration and a call to action
Peter Sands, Executive Director of the Global Fund, reflected that the “extraordinary accomplishment” is a “beacon of hope at a time when climate change threatens to slow down our progress” in malaria efforts.
“What’s now crucial is that we do not lower our guard, and help Cape Verde sustain this achievement and prevent reintroduction of malaria. With this aim in mind, we will continue to fund vector control interventions and ensure quality case management and disease surveillance through strengthening health systems for yet another three years.”
Director of the Malaria Programme at the Bill & Melinda Gates Foundation is Philip Welkhoff, who states that “Cabo Verde has proven that with the right tools”, countries in Africa can “achieve dramatic progress against malaria”.
“As the malaria community celebrates this victory, let it also serve as a call to action for urgent, sustained efforts and collaboration in the pursuit of malaria eradication and a world where no one suffers from this disease again.”
Dr Michael Adekunle Charles, CEO of RBM Partnership to End Malaria stated that the achievement is a “testament to the perseverance of its people and health systems”.
“This milestone is not only a victory for Cabo Verde, but also for the global community as we strive to eliminate malaria worldwide. Yet, with global cases now 16 million higher than before the pandemic, we must not waiver in our commitment to invest in, implement, and innovate new strategies and tools.”
CEO of Asia Pacific Leaders Malaria Alliance, Dr Sarthak Das, is inspired by the success of malaria elimination.
“This achievement is a living example, which demonstrates what remains possible in public health, even amidst the challenging landscape of today. Our heartfelt congratulations to our friends in this archipelago of the Central Atlantic for this momentous achievement; we look forward to countries in Asia Pacific joining them in malaria free status.”
We will explore malaria elimination efforts in greater detail at the Congress in Washington this April; will you join us there? If not, do subscribe for more updates!
