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Malaria: Beaten in Europe but not out

Malaria cases in Europe have dropped from over 90,000 in 1995 to zero in 2015, due to high political commitment, improved surveillance systems, better mosquito control, strengthened communication and community involvement and greater collaboration across borders. In 2005, when there were around 5000 cases, 10 affected countries in the European region agreed to shift their focus from malaria control to elimination, and this was the turning point. This is a major milestone in Europe’s public health history.

But it has to be mentioned that still 97 countries in the world had ongoing malaria transmission in 2015 and about 3.2 billion people are at risk of malaria. According to the latest WHO estimates, released in December 2015, there were 214 million cases of malaria in 2015 and 438 000 deaths. Sub-Saharan Africa continues to carry a disproportionately high share of the global malaria burden. In 2015, the region was home to 88 per cent of malaria cases and 90 per cent of malaria deaths.

The achievement of zero indigenous malaria cases in the WHO European Region is extraordinary but fragile. The Region is prone to continual importation of cases from endemic regions, with the threat of re-establishment of transmission. Maintaining zero cases in the European Region will require sustained political commitment, resources and constant vigilance. Any new cases of the disease must be promptly identified and treated. Health systems should be strengthened to ensure that any resurgence is rapidly contained.

In 1955, the Eighth World Health Assembly agreed “that the World Health Organisation should take the initiative, provide technical advice, and encourage research and coordination of resources in the implementation of a programme having as its ultimate objective the worldwide eradication of malaria”. On this basis, WHO launched the Global Malaria Eradication Programme, which was highly successful in eliminating malaria from several regions of the world. In Europe, this programme was very successful and in some areas level of vigilance went down and as a consequence the disease was gradually able to re-establish itself in some areas. War and conflict made it easier for the parasite to spread unchecked and the movement of people from areas where malaria is endemic to areas where it had been eradicated also allowed it to regain a foothold. After the first Gulf War, many thousands of Iraqis fled to Turkey for example.

Now is not the time to reduce spending on interventions that we know reduce the spread of malaria, whether that be control of malaria vectors or surveillance of cases. Countries that have benefited from the Global Fund to fight AIDS, TB and Malaria, need to ensure that spending doesn’t plummet now that the programme is at the end and the funds have stopped. We know that countries like Tajikistan – the last to eliminate malaria – may struggle since the Global Fund contributed around 80 per cent of their investment, which has now fallen dramatically. In Georgia, however, when the Global Fund malaria project came to the end, the government’s own investment went up to ensure that the programme remained viable.

There is much more work to do but if we remain vigilant and the political will remains, malaria will be kept out of Europe for the long term.

Dr Elkhan Gasimov
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