52 of the 103 countries that had active malaria transmission in 2000 are on track to meet the target of reducing its incidence by 75% The year 2015 has arrived—the year which the United Nations, the international community and world heads of state set as the target for the Millennium Development Goals (MDG). Three of the 8 MDGs were directly related to health, the fourth, fifth and the sixth: to reduce child mortality, to improve maternal health, and to combat HIV/AIDS, malaria and other diseases. The last of these (6.C) proposed, among other specific targets, to “have halted by 2015 and begun to reverse the incidence of malaria and other major diseases.” We can say that this goal has been achieved since 52 of the 103 countries that had active malaria transmission in 2000 are on track to meet the target of reducing its incidence by 75%, a goal also established by the World Health Assembly in 2005.
Nonetheless, malaria is still a serious health problem that affects large areas of the world, especially in sub-Saharan Africa and among two particularly vulnerable social groups: children and pregnant women. Thanks to the increase in available resources and new tools, we have witnessed dramatic advances in the fight against this disease over the last decade. Even so, the evidence shows that once control efforts are relaxed the situation will again deteriorate. Therefore, the only sustainable solution in the long term is the complete elimination from a given territory of the parasite that causes malaria.
Mesoamerica and the Caribbean could be the first region in the world to eliminate malaria In recent years, more and more countries and regions have decided to take the decisive step and envisage eliminating the disease from their territory. These include the Association of Southeast Asian Nations, which recently adopted the target of eliminating malaria in Asia Pacific by 2030, and the countries of southern Africa, which have come together in the Elimination Eight group.
The Mesoamerican region, together with the Dominican Republic and Haiti—the only two countries in the Caribbean with active malaria transmission—have also begun to work towards elimination. In a formal declaration, signed in June 2013 by health ministers and other representatives from Mexico, Belize, Guatemala, Honduras, El Salvador, Nicaragua, Costa Rica, Panama, Haiti, and the Dominican Republic, they pledged to eliminate malaria from the region by 2020.
Malaria interventions are highly cost-effective investments that offer some of the highest yields in the field of public healthThat declaration was possible because the evidence confirms that the elimination of malaria from Mesoamerica and the Caribbean is a feasible and achievable goal, provided that appropriate strategies are used, sufficient funding is available, and the necessary mechanisms for coordination and governance are set up to bring together the efforts not just of the countries involved, but also of the main international partners.
Mesoamerica and the Caribbean could be the first region in the world to eliminate malaria. Besides being a huge achievement in itself, the elimination of malaria from this region would be the first step in launching the goal of eliminating the disease throughout the Americas, an area that, in the last decade, has reduced malaria by about 70%—the best result achieved in the world—and it has historically been a leader in public health in general, and in particular in the elimination of diseases, including smallpox, polio and measles.
The region enjoys many advantages that will help to support malaria elimination, including robust health and surveillance systems in almost all of the countries involved, the fact that it is the only area in the world where malaria parasites are still susceptible to chloroquine—an extremely safe and effective antimalarial drug—and an accumulated experience that has made possible the dramatic reduction in transmission in recent years.
Strong political commitment, solid funding and increased multi-sectoral collaboration are all essential if we are to move forward and achieve the goal of eliminating malaria from the regionAt the same time, there are currently several windows of opportunity for obtaining financial support for malaria elimination. In 2014, the Global Fund to Fight AIDS, Tuberculosis and Malaria approved a regional grant of $10 million to support the malaria elimination effort in the region. This has strengthened regional cooperation networks, and particularly the ongoing work in malaria of the Regional Coordination Mechanism, which works under the auspices of the Council of Ministers of Health of Central America and the Dominican Republic (COMISCA). In 2014 , as part of this renewed effort, the Bill & Melinda Gates Foundation awarded just over $1.5 million in grants to the Clinton Health Access Initiative (CHAI) to provide technical support to Central America countries and to Haiti and the Dominican Republic in support of their malaria elimination programmes.
Malaria interventions are highly cost-effective investments that offer some of the highest yields in the field of public health. In countries where the disease is endemic, measures to reduce and eliminate malaria are increasingly seen as a high-impact investment that generates considerable returns for public health, helping to alleviate poverty, improve equity, and contribute to overall development.
In short, strong political commitment, solid funding and increased multi-sectoral collaboration are all essential if we are to move forward and achieve the goal of eliminating malaria from the region.
Despite the current favourable circumstances and encouraging developments in recent years, it is difficult to generate political interest in the issue when other serious health problems come to the fore, such as the recent epidemics of dengue fever and Chikungunya. Moreover, Central America has other social problems that pose a major challenge for the development of the area. Even so, the elimination of malaria must be set as a strategic priority in the region so that we can seize this historic opportunity.
1 Resolution WHA58.2 on malaria control (WHO).