Together We Can End Malaria in the Americas

By Chris Elias and Carissa F. Etienne, Director, Pan American Health Organization

The following was originally published in El Pais on November 30, 2018.

For decades, the Americas Region has led the world in eliminating infectious diseases that were once major scourges to society. The region was the first to eliminate smallpox transmission in 1971, and this achievement was followed by the elimination of polio in 1994 and rubella in 2015.

These successes occurred because many countries of this Region committed to utilizing a primary healthcare (PHC) approach to effectively respond to the health needs of communities.

A PHC approach prioritizes investment in the first level of care, where comprehensive, quality health services such as vaccinations, maternal and newborn care, and family planning are provided. A strong first level of care also serves as the backbone for effective disease surveillance and reporting. They are essential to building safeguards against other mosquito-borne diseases such as dengue, chikungunya, Zika, and yellow fever that threaten our collective health and prosperity. Further, they can play a key role in wiping out what was once one of the Region’s deadliest diseases – malaria.

A century ago, malaria was a leading cause of death in nearly every nation on earth. Then scientists discovered that malaria was caused by a parasite transmitted by mosquitoes. This soon led to the development of effective treatment and prevention tools. By 2000, nearly half of the United Nations’ member states had eliminated the disease within their borders.

Today, we are closer than ever to eliminating malaria from the Western Hemisphere. Earlier this year, the World Health Organization certified Paraguay as malaria free. We expect that Argentina and El Salvador will follow soon. Other nations have made great progress as well. For example, Belize, Costa Rica and Suriname have recorded fewer than 100 indigenous cases in 2017. Ecuador and Mexico are included in a list of 21 countries, which have the potential to eliminate malaria within the next few years.

But as we approach elimination, there is a new danger: Governments that are confident the end is near could relax their efforts. 

History shows that when countries take their eyes off malaria, malaria bites back. We have seen this recently with countries in crisis in our region. Breakdowns in primary healthcare delivery and extensive flows of migrants have led to a dramatic rebound in malaria incidence that threatens control efforts in several nations. And the longer it takes to eliminate malaria, the more likely it is that resistance to our most effective drugs and insecticides will emerge. It has happened before with chloroquine, and it could happen with current artemisinin treatments.

Following the release of the World Health Organization’s latest World Malaria Report, which shows that global progress has slowed, we urge all countries of the Americas to commit to ridding our region of malaria once and for all.

Many countries in Central and South America are already providing good models for how to wage the fight. They are scaling up their efforts to control and eliminate malaria with support from non-profit partners and other global development institutions. In 2015, Haiti and Dominican Republic launched the Malaria Zero Alliance, a binational elimination program with support from PAHO, CDC, the Carter Center and other partners. USAID has also been supporting PAHO on the implementation of a technical cooperation agenda for the Plan of Action for Malaria Elimination, 2016-2020. 

And in 2018, the Inter-American Development Bank and various partners launched the Regional Malaria Elimination Initiative (RMEI) – to help Belize, Costa Rica, the Dominican Republic, El Salvador, Guatemala, Honduras, Nicaragua and Panama scale up effective surveillance, prevention and treatment on the road to elimination by 2022.

These efforts could also be accelerated by innovations in diagnosis, treatment and vector control, such as the introduction of what could be a revolutionary new treatment for P. vivax malaria, which accounts for nearly 75 percent of all malaria cases in the region. While the current treatment for vivax requires pills administered over 7-to-14 days on a very specific schedule, a new treatment has shown the potential to completely cure vivax with a much simpler dose.

Today, we have an opportunity to do something that was once thought impossible – we can end malaria for good. One out of 10 people in the Americas Region is still at risk of contracting malaria, but if we work together, we can create a future where no one has to suffer or die from this completely treatable and preventable disease ever again.