Shrinking the Malaria Map

UCSF Global Health Group’s Malaria Elimination Initiative (MEI)

Americas

Goal

Although there is no region wide goal, Mesoamerica and Hispaniola have a goal to eliminate malaria by 2020.

Overview

The Americas have made remarkable progress in reducing malaria in the past two decades, and are often predicted to be the next malaria-free region in the world. In the 10 malaria-eliminating countries in this region, cases have declined by 91% since 2000. In South America, both Argentina and Paraguay have initiated the WHO malaria-free certification process. Central America is making remarkable progress, too. While the burden remains highest in the island of Hispaniola (Dominican Republic and Haiti), new support from donors, including the Global Fund to Fight AIDS, TB and Malaria, is helping the region accelerate towards elimination by 2020.

Further strengthening these efforts, health ministers from across the America’s adopted a new strategy for malaria elimination in 2016. The Plan of Action for Malaria Elimination 2016-2020, approved by the Pan American Health Organization (PAHO), encourages countries in the region to intensify efforts to eliminate and prevent reintroduction. The Plan has set targets of reducing malaria cases by an additional 40%, implementing elimination efforts in 18 of the 21 endemic countries in the region, and attaining malaria-free status in at least four countries. With this new strategy, efforts to fight malaria will have a particular focus on high –risk geographies, such as the Amazonian basin, and vulnerable populations, including miners, migrants, and laborers. These efforts are sure to help the region reach its elimination goal.  

[green]
Malaria-free >3 years
[blue]
Malaria-free < 3 years
[magenta]
Eliminating malaria
[pink]
Controlling malaria
8
Eliminating countries in this region
Reported malaria cases in 10 malaria-eliminating countries in the Americas
Reported malaria cases in 10 malaria-eliminating countries in the Americas
P falciparum transmission limit (2010)
P falciparum transmission limit (2010)
P vivax transmission limit (2010)
P vivax transmission limit (2010)

Regional collaborations

Elimination of Malaria in Mesoamerica and Island of Hispaniola

The Elimination of Malaria in Mesoamerica and Island of Hispaniola (EMMIE) regional grant is funded by the Global Fund and is aimed at accelerating malaria elimination in nine countries: Belize, Costa Rica, Dominican Republic, El Salvador, Guatemala, Haiti, Honduras, Nicaragua, and Panama. The $10-million, 3-year EMMIE grant uses an innovative cash-on-delivery funding mechanism that focuses on paying the participating countries for a successful predefined reduction in malaria cases. The EMMIE grant supports the goal of malaria elimination in Mesoamerica by 2020.

Amazon Malaria Initiative

The Amazon Malaria Initiative (AMI) supports countries in the Amazon basin and Central America to prevent and control malaria through regional collaboration. Countries share evidence-based best practices and technical assistance on issues of common concern. The AMI was launched in 2001 with support from the U.S. Agency for International Development (USAID), based on the notion that malaria transcends international borders. In conjunction with the Amazon Network for the Surveillance of Antimalarial Drug Resistance and several other partners, AMI works with a regional network of countries and technical partners to strengthen prevention; diagnosis; antimalarial medicine quality, efficacy, access, and use; surveillance systems; vector surveillance and control; and communication. 

Malaria Zero

Malaria Zero is an alliance of partners working to eliminate malaria from the island of Hispaniola – including Dominican Republic and Haiti - by 2020. Led by the U.S. Centers for Disease Control and Prevention (CDC), Malaria Zero partners coordinate efforts to build and implement an evidence-based action plan. Beyond the initial funding provided by the Bill & Melinda Gates Foundation, an additional $80 to $100 million is needed for island-wide implementation. Elimination of malaria from Hispaniola will demonstrate the feasibility of the approach and inspire other countries in the Americas to accelerate their elimination efforts.

Challenges to elimination

Cross-border and rural-to-urban migration

Many low-transmission countries in this region share borders with politically and economically unstable areas that tend to have more malaria transmission. Migrants travel across borders seeking refuge or seasonal work, and are often less likely to seek malaria treatment. For example, more than 250,000 undocumented Guatemalans now live in Mexico and are often thought to contribute to Mexico’s remaining malaria transmission, which persists along its border with Guatemala. In countries such as Belize and El Salvador, a large percentage of laborers are seasonal agricultural workers, who pass throughout Central America during the harvest season. Within country borders, such as in Nicaragua, people living in rural areas with higher transmission often go to the nearest city to seek treatment, which can perpetuate the spread of malaria in and among cities. The MEI has an innovative program of research to help national malaria programs identify and support mobile populations. 

Sustained financial and political commitment

Latin America has sustained low levels of malaria transmission for many years, and these countries are well aware of the challenges in focusing adequate attention on a disease that hardly exists anymore. As cases have declined, countries have had difficulty with maintaining high-level commitment or financial resources for elimination; therefore, retaining skilled staff to maintain a robust surveillance and response system has become challenging. The new EMMIE grant helps countries galvanize national and regional political commitment for malaria elimination, and provides financial incentives to get to zero.