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Sri Lanka has not reported a local case of malaria since October 2012. If it can remain malaria-free for one more year, the country will be eligible to apply to the World Health Organization for malaria-free certification. This remarkable success was achieved rapidly and largely during a protracted civil war. As recently as the year 2000, Sri Lanka had over 100,000 cases of malaria.
The Malaria Elimination Group, an independent international advisory group on malaria elimination, has gathered this week in Colombo for its ninth meeting to celebrate Sri Lanka’s achievements. At the end of deliberations, the Group signed the Colombo Declaration on Eliminating Malaria to affirm continued assistance to Sri Lanka and to call upon the Government to sustain financial and human resources needed to maintain the gains.
This week’s Malaria Elimination Group meeting brought together representatives from Ministries of Health of malaria-endemic countries in Asia and Africa, the World Health Organization, and international health donors including the Bill & Melinda Gates Foundation, the Global Fund to Fight AIDS, Tuberculosis and Malaria, the Australian Department of Foreign Affairs and Trade, and the US President’s Malaria Initiative.
The participants learned from Sri Lanka’s hard-earned progress since the 1960s when the country nearly eliminated malaria, but then suffered a catastrophic resurgence. The Malaria Elimination Group is convened by the Global Health Group at the University of California, San Francisco (UCSF).
Following implementation of intensive malaria control measures between 1946 and 1963, Sri Lanka succeeded in virtually eliminating malaria from the country. Malaria became invisible to Sri Lanka’s communities, politicians and national leaders. Unfortunately, with only a few cases left and competing development and health priorities, the country did not sustain the Anti-Malaria Program in the 1960s. The consequence was disastrous—Sri Lanka suffered a deadly malaria resurgence, going from 17 cases in 1963 to over half a million cases in 1969.
This week’s Malaria Elimination Group meeting highlighted the crossroads that Sri Lanka is at once again: deciding whether to maintain adequate resources and vigilance to achieve and sustain malaria freedom, or to risk a second resurgence by losing focus on the benefits of the prevention of malaria re-introduction.
Sir Richard Feachem, KBE, FREng, DSc (Med), PhD, chair of the Malaria Elimination Group and director of the UCSF Global Health Group, underscored the main theme of the Colombo Declaration on Eliminating Malaria and the importance of maintaining the gains made in Sri Lanka: “I am honoured and proud that, for the first time in my life, I am visiting a malaria-free Sri Lanka. This is a huge achievement, and the Ministry of Health and Anti-Malaria Campaign are to be congratulated. Representatives from 17 countries have travelled to learn from Sri Lanka’s success. But there is still work ahead: although local transmission of malaria has ended, Sri Lanka continues to face a serious risk of re-importation from neighbouring countries. It is critical that the government sustain its human and financial investments in malaria elimination – including a robust surveillance system – to hold the line and keep the country free of the disease.”
Today, the threat of re-emergence of malaria in Sri Lanka is driven by travellers—both Sri Lankan nationals and foreigners—who carry the disease after being in other malaria-ridden countries, such as India or Pakistan. Strong surveillance systems, multi-sector engagement and rapid follow-up and response on every imported case will be critical to ensure that these isolated infections do not spread.
The Malaria Elimination Group meeting and the Colombo Declaration on Eliminating Malaria underscore that with strong vigilance and commitment, Sri Lanka can safeguard its malaria achievements and create a healthier, united and economically successful future.
