El Salvador certified as malaria free by WHO

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

El Salvador has now become the first country in Central America to receive a malaria elimination certification by 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 a favorable geography for malaria.

“Malaria has afflicted humanity for millennia, but countries like El Salvador are living proof and inspiration for all countries that we can dare to dream of a future without malaria,” said Dr. Tedros Adhanom Ghebreyesus, Director-General of WHO .

Malaria elimination certification is awarded by WHO when a country has proved beyond any reasonable doubt that the indigenous transmission chain has been interrupted across the country for at least the past three consecutive years.

With the exception of an outbreak in 1996, El Salvador has steadily reduced its malaria burden over the past three decades. Between 1990 and 2010, the number of malaria cases decreased from more than 9,000 to 26. The country has not registered any indigenous cases of the disease since 2017.

“For decades, El Salvador has been working hard to eliminate malaria and the human suffering it generates,” said Dr. Carissa F. Etienne, Director of the Pan American Health Organization (PAHO), WHO regional office for the Americas . “Over the years, El Salvador has dedicated the human and financial resources necessary to succeed. This certification today is an achievement that saves lives in the Americas ”.

El Salvador is the third country to have achieved malaria-free status in recent years in the WHO Region of the Americas, after Argentina in 2019 and Paraguay in 2018. Seven countries in the region were certified from 1962 to 1973. Globally, one a total of 38 countries and territories have reached this milestone.

The Salvadoran Minister of Health, Dr. Francisco José Alabi Montoya, said: “The people and government of El Salvador, together with their health professionals, have been fighting malaria for decades. Today we celebrate this historic achievement of having El Salvador certified as free of malaria. ”

El Salvador’s path to elimination

Efforts to combat malaria in El Salvador began in the 1940s with the mechanical control of the malaria vector – the mosquito – through the construction of the first permanent marsh drains, followed by indoor spraying 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”, recorded malaria cases and interventions. The data, inserted in health information systems by vector control personnel, allowed strategic and targeted responses across the country.

In the late 1960s, progress slowed as mosquitoes developed resistance to DDT. An expansion in the country’s cotton industry is believed to have fueled a further increase in malaria cases. Throughout the 1970s, there was a sudden increase in migrant workers on cotton farms in coastal areas close to mosquito breeding sites, in addition to the discontinued use of DDT. El Salvador experienced a resurgence of malaria, peaking at almost 96,000 cases in 1980.

With the support of PAHO, the United States Centers for Disease Control and Prevention (CDC) and the United States Agency for International Development (USAID), El Salvador has successfully refocused its malaria program, which has led to a better targeting resources and interventions based on the geographical distribution of cases. The government also decentralized its network of diagnostic laboratories in 1987, allowing cases to be detected and treated 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 included major improvements in the budget and coverage of primary health care, as well as maintaining the vector control program as a technical leader in malaria interventions, contributed to El Salvador’s success.

Country leadership and consistent funding

The government of El Salvador recognized from the outset that consistent and adequate domestic financing would be crucial to achieving and maintaining its health-related goals, including malaria. This commitment has been reflected for more than 50 years in national budget lines.

Despite reporting his last malaria-related death in 1984, El Salvador maintained its domestic investments in malaria. In 2020, the country continued to have 276 vector control teams, 247 laboratories, nurses and doctors involved in case detection, epidemiologists, management teams and personnel and more than 3,000 community health workers. As part of El Salvador’s commitment to maintain zero cases, the national malaria budget was and will be preserved, even during 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 having the potential to eliminate malaria by 2020. With support from WHO and PAHO, officials from the national program of El Salvador participated from global events to meetings that bring together countries that eliminate malaria to share innovations and best practices.

Although most of the funding for malaria came from internal resources, El Salvador’s elimination effort benefited from external donations provided by the Global Fund.

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

PAHO provided technical support throughout El Salvador’s anti-malaria campaign, from control to elimination and prevention to the restoration of the disease. El Salvador’s success is an important 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, including malaria, by 2030 .

Note to the editor

Global and regional trends

Contracted through infected mosquito bites, malaria remains a leading cause of death in the world, with more than 200 million cases and 400,000 malaria-related deaths reported each year. Approximately two-thirds of fatalities occur among children under the age of five.

In 2019, the Americas reported 723,000 confirmed cases of malaria, compared to almost 1.2 million cases in 2000. The total number of malaria deaths 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 malaria transmission in some countries. Despite the increase, advances against malaria continue. In 2020, Belize completed two years without indigenous malaria transmission, and by the end of 2020, 10 countries and territories reported less than 2,000 cases in 2019.

Facebook Live

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