Kyrgyzstan certified to be malaria-free

Europe is the first WHO region to interrupt indigenous malaria transmission

In April 2016, WHO declared that the European Region had achieved an important milestone: all 53 countries in the region had interrupted the chain of indigenous malaria transmission for at least 1 year.

Countries that maintain zero locally-acquired malaria cases for at least three consecutive years are eligible to apply for a certification of malaria elimination by WHO. This process is voluntary and can be initiated only after a country has submitted an official request to WHO; it involves field assessments by independent consultants and rounds of expert reviews.

Today, the Republic of Kyrgyzstan received the official WHO certification of malaria elimination. Globally, a total of 32 countries and territories have received this WHO certification, including 19 countries in the European Region.

The case of Kyrgyzstan

Malaria was eliminated in Kyrgyzstan in 1961 through large-scale campaigns. But after maintaining a malaria-free status for more than 25 years, the country reported several imported cases of the disease, mainly from Afghanistan. By 1986, local transmission of the disease had again taken root.

In the early 1990s, as Kyrgyzstan transitioned to independence from the Soviet Union, the opening of borders facilitated the free movement of citizens, including visitors from malaria-endemic countries. A financial collapse led to steep cuts in funding for the national health system. Weak malaria surveillance and an acute shortage of anti-malaria drugs and insecticides created favourable conditions for disease transmission.

In 2002, Kyrgyzstan faced a major malaria epidemic following a massive influx of Kyrgyz labourers returning from neighbouring malaria-endemic countries. More than 2700 cases of P. vivax malaria were reported that year alone (Figure 1).

Strategies employed

Kyrgyzstan’s Ministry of Health led a targeted effort to quell the epidemic, with technical and financial support from WHO, the U.S Agency for International Development (USAID), the Global Fund to Fight AIDS, Tuberculosis and Malaria, the Agency for Technical Cooperation and Development (ACTED), Medical Emergency Relief International (MERLIN) and other development partners.

By 2003, the country had achieved a sharp reduction in malaria cases. The epidemic was swiftly contained through a number of anti-malarial interventions. National surveillance systems for detecting and investigating malaria cases were strengthened. Confirmed cases were treated promptly, preventing onward transmission of the disease.

Key vector control measures were expanded, such as indoor residual spraying and the use of larvicides, especially in rice fields. Community engagement in malaria control and prevention contributed to this success, as did improved inter-sectoral and cross-border collaboration.

By 2010, Kyrgyzstan reported just three locally-acquired cases of mosquito-borne malaria transmission and, in 2011, zero indigenous cases. Kyrgyzstan started the elimination certification process in 2013.

The Government of Kyrgyzstan has established a comprehensive and adequately funded plan of action to guard against the reintroduction of malaria transmission through 2018 and beyond.

Malaria elimination in Europe

In 1975, the WHO European Region was considered malaria-free. By the 1980s and early 1990s, malaria transmission had again taken hold in the Caucasus, the Central Asian republics and, to a lesser extent, the Russian Federation. Turkey saw a particularly steep increase in malaria cases in the 1990s following an influx of Iraqi refugees during the First Gulf War; in 1994, the country reported a peak of 84 000 cases of the disease (Figure 2).

By 2000, control efforts had succeeded in greatly reducing the malaria burden across the European Region. In 2005, only 5000 cases of malaria were reported region-wide; the goal of malaria elimination was within reach. Ten years later, the European Region was the first to report zero indigenous cases of malaria.

The European Region remains exposed to imported cases of malaria, particularly along the border between Afghanistan and Tajikistan. Maintaining zero cases will require sustained political commitment and constant vigilance. Any new cases of the disease must be promptly identified and treated. Health and surveillance systems should be strengthened to ensure that any resurgence is rapidly contained.

Global elimination targets

At a UN General Assembly meeting in September 2015, world leaders unanimously adopted the Sustainable Development Goals (SDGs), a new 15-year global development framework. “Ending malaria epidemics” by 2030 is a target of SDG 3; WHO interprets this as achieving the goals of the Global Technical Strategy for Malaria 2016-2030.

This Strategy, endorsed by the World Health Assembly in May 2015, sets ambitious but achievable global targets for malaria control and elimination. These include:

• Reducing malaria case incidence by at least 90% by 2030;

• Reducing malaria mortality rates by at least 90% by 2030;

• Eliminating malaria in at least 35 countries by 2030;

• Preventing a resurgence of malaria in all countries that are malaria-free.

The Strategy was the result of an extensive consultative process that spanned 2 years and involved the participation of more than 400 technical experts from 70 Member States.