The World Health Organization (WHO) has officially certified Cape Verde as malaria-free, marking a major milestone in the global fight against the mosquito-borne disease. Cape Verde is the fourth African country to achieve this status, joining Algeria, Morocco and Mauritius.
Key details
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On January 12th, 2024, WHO declared Cape Verde free of malaria transmission after finding no locally-acquired cases for over 3 consecutive years. This makes Cape Verde the 3rd country in Sub-Saharan Africa to eliminate malaria.
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Cape Verde reported its last indigenous case of malaria in September 2018 on the Santiago island. Since then, the country intensified its malaria surveillance and control efforts.
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The certification was announced by WHO Director-General Dr Tedros Adhanom Ghebreyesus at an award ceremony held in Cape Verde. He congratulated the government and people of Cape Verde for this historic public health achievement.
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WHO estimates that between 2000-2020, interventions against malaria saved over 1.1 million lives and prevented close to 1 billion malaria cases globally. However, progress against malaria has stalled in many countries since 2015.
Background
Malaria is an acute febrile disease caused by Plasmodium parasites transmitted through the bite of infected Anopheles mosquitoes. It continues to be a major global public health problem, with 229 million cases and 409,000 deaths reported in 2019 according to WHO estimates. Approximately 95% of deaths occur in Africa, especially among children below 5 years.
Cape Verde consists of 10 islands located 385 miles off the coast of West Africa with a population of about 560,000. Malaria has historically been endemic in Cape Verde, at varying levels of transmission intensity across different islands. The main parasite species have been P. falciparum and to a lesser extent, P. malariae and P. vivax.
Control and elimination efforts
The Government of Cape Verde adopted a malaria elimination strategy in 2007 with support from international partners like the Global Fund, WHO and UNICEF. This built on years of effective malaria control efforts. Key interventions over the past decade included:
- Large-scale distribution of long-lasting insecticide treated nets (LLINs)
- Indoor residual spraying (IRS) campaigns
- Robust disease surveillance, monitoring and evaluation
- Access to malaria diagnosis using rapid diagnostic tests (RDTs) and microscopy
- Treatment with Artemisinin-based combination therapies (ACTs)
- Case investigation and classification
These measures led to a gradual but consistent decline in malaria burden over the years as shown:
| Year | Reported malaria cases |
|---|---|
| 2010 | 3,402 |
| 2015 | 259 |
| 2018 | 16 (last indigenous case) |
Elimination validation
WHO malaria elimination certification requires that a country proves the interruption of indigenous transmission for at least 3 consecutive years. Cape Verde successfully passed this assessment after reporting no locally-originated cases since September 2018.
The certification process included verification of Cape Verde’s surveillance system and infection control measures. WHO also reviewed Cape Verde’s emergency response capacity to identify and contain any future imported cases or re-establishment of transmission through tourism, migration or other factors.
Impact and significance
This certification of malaria-free status is an inspiration for Africa especially at a time when global progress against malaria has leveled off. It demonstrates that malaria can be defeated even in countries with limited resources through well-coordinated action and long-term commitment from all partners.
For Cape Verde itself, malaria elimination is expected to produce substantial health and socioeconomic benefits. Reduced disease burden will improve productivity and ease pressure on the healthcare system. The malaria-free label could boost tourism in Cape Verde which comprises over 20% of the nation’s GDP. It also sets the stage for Cape Verde to join the ranks of high and upper middle-income countries in the long run.
Calls for reinvigorated action
While celebrating Cape Verde’s milestone, Dr Tedros emphasized that global gains against malaria are fragile with worrisome resurgences observed in some locales. He called for reinvigorated action to put the world back on track to reach internationally agreed targets which aim to reduce malaria case incidence and death rates by 90% by 2030.
Cape Verde also faces risks and must remain vigilant by maintaining robust surveillance and response capacity. With globalization, economic factors and climate change, potential reestablishment of malaria transmission cannot be ruled out. Continued financial and technical support from Cape Verde’s partners will be key to preserve its elimination status.
Ultimately, Cape Verde demonstrates malaria can be beaten through access to life-saving tools and well-coordinated action even with constrained resources. Only redoubled efforts across programmatic areas will enable more African nations to follow in Cape Verde’s footsteps and end malaria for good. The journey to eradication is long but eliminating malaria starts with individual countries pushing past barriers to get over the finish line. Cape Verde now becomes a trailblazer lighting the way forward on Africa’s malaria-free path.
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