El Salvador certified as malaria-free by the WHO

El Salvador is the first Central American country to achieve this status, the third year in all the Americas in recent years

El Salvador today became the first country in Central America to receive a malaria eradication certification from the World Health Organization (WHO). The certification follows more than 50 years of commitment by the Salvadoran government and people to end the disease in a country with a dense population and geography that is hospitable to malaria.

“Malaria has plagued mankind for centuries, but countries like El Salvador are proof and inspiration to all countries that we can dare to dream of a malaria-free future,” said Dr. Tedros Adhanom Ghebreyesus, director of the WHO, said.

Malaria elimination certification is granted by the WHO if a country has proven beyond reasonable doubt that the chain of indigenous transmission has been disrupted nationwide for at least the past three consecutive years.

With the exception of one outbreak in 1996, El Salvador has gradually reduced its malaria force over the past three decades. Between 1990 and 2010, the number of malaria cases decreased from more than 9000 to 26. The country has not reported any indigenous cases of the disease since 2017.

“For decades, El Salvador has worked hard to eradicate malaria and the human suffering it causes,” said Dr. Carissa F. Etienne, director of the Pan-American Health Organization (PAHO), WHO’s regional office for America, said. “Over the years, El Salvador has devoted the human and financial resources needed to succeed. This certification is a life-saving achievement for the Americas today. ‘

El Salvador is the third country to achieve malaria-free status in the WTO region in the United States in recent years, after Argentina in 2019 and Paraguay in 2018. Seven countries in the region were certified from 1962 to 1973. Worldwide, a total of 38 countries and areas have reached this milestone.

El Salvador’s Minister of Health, Dr Francisco José Alabi Montoya, said: ‘The people and the government of El Salvador, together with its health workers, have been fighting malaria for decades. Today we celebrate this historic achievement that El Salvador is malaria free. ”

El Salvador’s Road to Elimination

El Salvador’s anti-malaria efforts began in the 1940s with the mechanical control of the malaria vector – the mosquito – through the construction of the first permanent drains in swamps, followed by injection with the pesticide DDT. In the mid-1950s, El Salvador established a National Malaria Program (CNAP) and recruited a network of community health workers to detect and treat malaria across the country. The volunteers, known as ‘Col Vol’, registered malaria cases and interventions. The data, incorporated by vector control personnel into health information systems, enabled strategic and targeted responses across the country.

By the late 1960s, progress slowed as mosquitoes developed resistance to DDT. It is suspected that an expansion in the country’s cotton industry has fueled a further increase in malaria cases. During the 1970s, there was a boom in migrant workers on cotton estates in coastal areas near mosquito breeding grounds, in addition to the discontinued use of DDT. El Salvador experienced a revival of malaria, reaching a peak of nearly 96,000 cases in 1980.

With the support of PAHO, the US Centers for Disease Control and Prevention (CDC) and the US Agency for International Development (USAID), El Salvador successfully reoriented its malaria program, leading to a better focus on resources and interventions on the ground. of geographical distribution. of affairs. The government also decentralized its network of diagnostic laboratories in 1987 so that cases could be detected and processed more quickly. These factors and the collapse of the cotton industry led to a rapid decline in cases in the 1980s.

The 2009 health reform, which includes significant improvements in the budget and coverage of primary health care, as well as the maintenance of the vector control program as the technical leader in malaria interventions, contributed to El Salvador’s success.

Country leadership and consistent funding

The government of El Salvador realized early on that steady and adequate domestic funding would be crucial to achieve and maintain its health objectives, including malaria. This commitment has been reflected in national budget lines for over 50 years.

Despite the fact that his last malaria-related death was reported in 1984, El Salvador maintained its local investments in malaria. In 2020, the country continued to rely on 276 vector control staff, 247 laboratories, nurses and physicians involved in case detection, epidemiologists, management teams and staff, and more than 3,000 community health workers. As part of El Salvador’s commitment to uphold no cases, national budget for malaria has been and will be maintained, even through the pandemic.

Global and regional initiatives

El Salvador is a member of the WHO Global “E-2020” initiative – a group of 21 countries identified in 2016 as the potential to eradicate malaria by 2020. With the support of WHO and PAHO, the national El Salvador program staff participated in meetings bringing together malaria-eliminating countries to share innovations and best practices.

Although most funding for malaria comes from domestic sources, El Salvador’s elimination effort has benefited from external grants provided by the Global Fund.

In 2019, El Salvador joins the Regional Malaria Elimination Initiative (RMEI), organized by the Inter-American Development Bank with PAHO technical leadership and the participation of the Council of Ministers of Health of Central America (COMISCA). US countries, the Dominican Republic, Mexico and Colombia in a joint effort to eliminate malaria.

PAHO provided technical support throughout the El Salvador anti-malaria campaign, from control to elimination to disease recovery prevention. The success of El Salvador is a major contribution to the PAHO Elimination Initiative, a collaborative effort between governments, civil society, academia, the private sector, and communities to eliminate more than 30 communicable diseases and related conditions in the Americas by 2030, including malaria, to eliminate.

Note to the editor

Global and regional trends

Malaria remains one of the world’s leading killers, with more than 200 million cases and 400,000 deaths related to malaria reported annually. About two-thirds of deaths among children are younger than five years.

As of 2019, the United States reported 723,000 confirmed cases of malaria, compared to nearly 1.2 million cases in 2000. The total number of deaths from malaria fell by 52% in the same period – from 410 to 197. Since 2015, the region has seen a 66% increase in cases, mainly due to increased transmission of malaria in some countries. Despite the increase, progress against malaria continues. In 2020, Belize completed two years without the transmission of indigenous malaria, and by 2020, ten countries and territories in 2019 reported fewer than 2,000 cases.

Facebook Live

Experts from El Salvador’s Ministry of Health, PAHO and WHO experts will comment on El Salvador’s path to certification during a Facebook Live session on Friday 26 February at 11 EST. Simultaneous translation into English will be provided. Go to Facebook to participate