Trends in Parasitology
Volume 35, Issue 2, February 2019, Pages 163-171
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Review
A Historical Review of WHO Certification of Malaria Elimination

https://doi.org/10.1016/j.pt.2018.11.011Get rights and content

Highlights

The global strategies for fighting malaria have changed but the ultimate goal of eradication remains unchanged. Malaria elimination within a country is the pathway to achieve the ultimate eradication goal. Certification of elimination is an official recognition of an important public health achievement obtained by a country.

The concepts of elimination and eradication, and criteria for certification of malaria elimination, have evolved over years from experiences and lessons learnt. The majority of certified countries have managed to maintain malaria-free status, demonstrating the technical soundness of the criteria for certification.

Assessment of the absence of local transmission through surveillance has been satisfactory, but to operationalize the criterion for preventing re-establishment of transmission, or to assess the likelihood that malaria-free conditions can be maintained in a given system, is challenging.

A malaria-free world remains the vision of the global community. Malaria elimination within the territory of a country is a pathway to achieving the ultimate goal of eradication. Certification of malaria elimination in a country is the official recognition of this important achievement. The concepts of eradication and elimination, and criteria for certification of malaria elimination, have guided national programs in their efforts to achieve and maintain elimination. They have evolved from the experiences and setbacks of the global eradication program, and on the contemporaneous understanding of the concepts of achieving and maintaining elimination. WHO’s certification has been successful, with the majority of certified countries remaining malaria free, but to operationalize the criterion for preventing re-establishment of transmission remains challenging.

Section snippets

A Brief History

One year before the creation of the World Health Organization in 1948, the Expert Committee on Malaria was constituted and met in Geneva to discuss opportunities for malaria eradication (see Glossary). The concept was not new, as it had already been suggested back in 1917 that malaria eradication was feasible [1]. During the first decade of the 20th century, significant progress was seen in some parts of the world, particularly in Europe and North America. Over the past seven decades, the

Malaria Eradication since the Inception of WHO

Encouraged by the efficacy and the residual effect of the insecticide dichlorodiphenyltrichloroethane (DDT), and chloroquine as a safe and highly effective drug for treatment and prophylaxis, the Global Malaria Eradication Programme (GMEP) was launched in 1955 in the belief that, with the availability of these new tools, eradication was both technically feasible and a financially attractive proposition. The emergence of vector resistance to DDT, first reported in Greece in 1951, was also a

Evolution of the Concept of Eradication, Elimination, and Criteria for Certification

The GMEP defined malaria eradication as ‘the ending of the transmission of malaria and the elimination of the reservoir of infective cases in a campaign limited in time and carried out to such a degree of perfection that when it comes to an end, there is no resumption of transmission’ii. This concept of eradication reveals the difference in objectives between a control program and an eradication program. The definition of control, described as ‘the reduction of the disease to a prevalence where

The Evolution of the Procedures for WHO Certification of Malaria Elimination

Soon after the establishment of the GMEP, a WHO Study Group was convened to explore the practicability of maintaining a register of areas where malaria has been eliminatedx. This led to a resolution at the 13th WHA requesting ‘the Director-General to establish an official register listing areas where malaria eradication has been achieved, after inspection and certification by a WHO evaluation team’.

Guidance on the methodology for certification and registration was first provided in the 8th

Brief Summary and Update of the Official Register and Supplementary List

The official register of certified countries was created in 1960 to provide information on malaria-free countries [20]. It is restricted to those countries and territories that have eliminated malaria by specific measures and have been certified malaria free by the WHO. The updated list of the official register now includes 36 countries and territories (Table 1)xi. Uzbekistan is the most recently certified country. Argentina and Algeria are currently undergoing a process of certification.

Concluding Remarks

The goal of malaria eradication that dates back to the GMEP remains the vision of the WHO and the global malaria community. Malaria elimination within the territory of a country is a pathway to achieving the ultimate goal of global malaria eradication. Certification of malaria elimination officially recognizes an important public health achievement obtained by countries. Moreover, it builds confidence and sustains the momentum of global community in defeating this preventable and treatable

Glossary

Malaria elimination
interruption of local transmission (reduction to zero incidence of indigenous cases) of a specified malaria parasite species in a defined geographical area as a result of deliberate activities. Continued measures to prevent re-establishment of transmission are required [8]. Note: The certification of malaria elimination in a country will require that local transmission is interrupted for all human malaria parasites.
Malaria eradication
permanent reduction to zero of the

References (26)

  • L. Bruce-Chwatt

    Serioepidemiological evidence of eradication of malaria from Mauritius

    Lancet

    (1973)
  • F.L. Hoffman

    A Plea and a Plan for the Eradication of Malaria throughout the Western Hemisphere

    (1917)
  • S. Pattanayak

    Malaria paradigms in India and control strategies

    Indian J. Malariol.

    (1994)
  • World Health Organization

    World Malaria Report 2016

    (2016)
  • World Health Organization

    Global Technical Strategy for Malaria 2016–2030

    (2015)
  • World Health Organization

    World Malaria Report 2017

    (2017)
  • World Health Organization

    World Malaria Report 2018

    (2018)
  • Centers for Disease Control and Prevention

    Recommendations for the International Task Force for Diseases Eradication

    MMWR Morb. Mortal Wkly Rep.

    (1993)
  • World Health Organization (2017) A Framework for Malaria Elimination....
  • P. Yekutiel

    Problems of epidemiology in malaria eradication

    Bull. World Health Organ.

    (1960)
  • A. Lysenko

    Epidemiological indications for examination of the blood for malaria during the period of malaria prophylaxis

    Med. Parasitol. Parasit. Bolezni.

    (1965)
  • N.N. Duchanina et al.

    Malaria epidemiological surveillance

    (1983)
  • World Health Organization

    Malaria Microscopy Quality Assurance Manual

    (2016)
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