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How Sri Lanka, Once One of the Worst-Infected in the World, Got Rid of Malaria

In the 1950s, Sri Lanka was considered one of the countries worst affected by malaria. As many as 92,000 cases a year were reported in 1953, and in the 1930s the country faced a massive epidemic of over 500,000 cases. That’s why it was a huge milestone when, in 1963, it managed to reduce the number of cases to just 17.

But its success was short-lived. A lack of funding, surveillance, and prevention efforts allowed malaria back into the country. Cases spiked into the millions as early as 1968, and Sri Lanka had to redouble its efforts to crack down on the vector-borne disease.

This time, its success seems to have stuck. On Monday, the World Health Organization announced that the country had gone three and a half years without an indigenous case of malaria.

The achievement was deemed “truly remarkable,” and a “testament to the courage and vision of its leaders” by Dr. Poonam Khetrapal Singh, who is the regional director of the WHO for Southeast Asia.

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The milestone is impressive considering the island’s tropical climate, which made it particularly fertile to mosquito populations. It receives four times as much rainfall as its nearest neighbor, India, which is still at risk for the disease.

Not to mention that public health officials had to work around a 29-year civil war. Just two years after it ended in 2009, Sri Lanka recorded just 124 locally acquired cases.

So how did they get to where they are now?

Sri Lanka used adaptive strategies, such as using mobile malaria clinics and insecticide-treated nets, that allowed the program to work around zones of conflict, according to a study by the Global Health Group.

“Sri Lanka is showing the world how to eliminate malaria,” said Sir Richard Feachem, the group’s director.

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Singh also cited the importance of a collective approach to screening for malaria.

“It demonstrates the importance of grassroots community engagement and a whole-of-society approach when it comes to making dramatic health gains,” said Singh.

Perhaps most important in Sri Lanka’s battle against malaria, though, is it’s unconventional public health strategy.

In the 90s, Sri Lanka transitioned to a more responsive policy by targeting the parasite itself rather than broadly curbing mosquito populations. At the time, the policy was noted for its unorthodoxy, said the WHO.

But it was the unorthodox that proved to be effective, as Sri Lanka is the second of 11 nations in the region to be declared malaria-free. It follows the Maldives, also an island nation, which hasn’t reported a case of malaria since 1982. The Maldives were officially declared malaria-free by the WHO this past December.

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Sri Lanka will now look to replicate its success on dengue fever, of which 37,500 cases have been reported this year. The WHO has stated its hope for Sri Lanka “to be a springboard to further public health gains” in the region. In 2015, Southeast Asia accounted for 10% of the world’s malaria cases.

Last May, the United Nations agency set goals for 2030 in its Global Technical Strategy. The goals prioritize reducing malaria incidence cases by 90% as well as ensuring that now malaria-free countries, like Sri Lanka, remain that way.

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