Sri Lanka Defeats Malaria and Reaches Zero Cases

The elimination of malaria in Sri Lanka is a public health success story 80 years in the making. After an extraordinary battle with this life-threatening disease, Sri Lanka received WHO certification for having eliminated malaria in September 2016.

“At the peak of Sri Lanka’s most devastating outbreak in 1935, over 1.5 million cases of malaria were recorded, resulting in 80 000 deaths. These are astonishing figures, especially when you consider that Sri Lanka’s population was about 6 million people at the time,” said Dr Jacob Kumaresan, WHO Representative to Sri Lanka.

Following the launch of WHO’s Global Malaria Eradication Programme in 1955, Sri Lanka embarked on its own malaria eradication strategy in 1957 and almost achieved success.

“Sri Lanka came so close to eliminating malaria. In 1963, just 17 cases were detected for the entire year. This was the lowest disease burden ever recorded in Sri Lanka. But as a consequence of the incredible success of the malaria programme, political and financial support wavered,” said Dr Kumaresan.

Within a few short years malaria made a rapid and deadly comeback. By 1970, the number of malaria cases soared to one million and despite intensified control efforts by the Anti-Malaria Campaign (AMC) it took another five decades to recover the lost ground.

AMC health workers were critical to this process, often risking their own health and safety by travelling to high-risk areas to study infected mosquitoes.

“If we learned of a case of malaria we would search for the patient’s house and trap the infected mosquitoes in the surrounding areas. We had to spend days, sometimes weeks in the jungle, without passable roads,” said Mr Daya Widanapathirana, an entomological assistant, who worked with the AMC for 39 years.

“We would set up traps for the mosquitoes; but sometimes we were the bait ourselves. We often got fever, we sometimes got malaria too,” explained Mr Widanapathirana.

During the 1990s, the AMC recalibrated their strategy, moving from mosquito control to parasite control. “That’s how we differ to other countries. We have gotten rid of malaria by eliminating the parasite, not the vector. We have also focused on early diagnosis, prompt treatment, intensive disease surveillance, entomological surveys, health education, rigorous community engagement and research, all in a highly coordinated manner,” explained Dr Risintha Premaratne, former director of the AMC.

The switch in strategies combined with enhanced support from key partners such as WHO led to further success in the struggle to eliminate malaria. “WHO has been our partner throughout our development and progress, contributing greatly to our strategies, providing technical advice and training, and supporting our rollback of malaria initiatives. We have also had extensive support from our partners Global Fund Against AIDS, TB & Malaria (GFATM) among others,” acknowledged Dr Risintha.

By 2008, the country recorded less than 1000 cases of malaria per year, enabling Sri Lanka to target elimination. The last indigenous case of malaria was recorded in October 2012. After 3 years of maintaining zero cases of indigenous malaria, Sri Lanka received WHO certification for having eliminated malaria in 2016.

“We are achieving something that has never been done before in the known history of Sri Lanka. We are very proud of that,” said Dr Risintha.

However, the memories of malaria’s resurgence during the 1960s loom large in the minds of all those working on malaria control. Preventing re-introduction of malaria is the next big challenge for the country to avoid history repeating itself. A high level of vigilance is needed given Sri Lanka’s high vulnerability to malaria transmission with importation a major threat.

The Anti-Malaria Campaign is working closely with security forces, airport authorities and international partners to screen high-risk populations entering the country to prevent importation of the disease. WHO is firmly committed to support the Ministry of Health, Nutrition and Indigenous Medicine to keep Sri Lanka malaria free and maintain its hard-earned elimination status.