El Salvador is the first Central American country to achieve this status, third in all of the Americas in recent years
El Salvador today became the first country in Central America to be awarded a certification of malaria elimination by the World Health Organization (WHO). The certification follows more than 50 years of commitment by the Salvadoran government and people to ending the disease in a country with a dense population and geography hospitable to malaria.
“Malaria has afflicted humankind for millennia, but countries like El Salvador are living proof and inspiration for all countries that we can dare to dream of a malaria-free future,” said Dr.Tedros Adhanom Ghebreyesus, WHO Director-General.
Certification of malaria elimination is granted by WHO when a country has proven, beyond reasonable doubt, that the chain of indigenous transmission has been interrupted nationwide for at least the previous three consecutive years.
With the exception of one outbreak in 1996, El Salvador steadily reduced its malaria burden over the last three decades. Between 1990 and 2010, the number of malaria cases declined from more than 9000 to 26. The country has reported zero indigenous cases of the disease since 2017.
“For decades, El Salvador has worked hard to wipe out malaria and the human suffering that it generates,” said Dr. Carissa F. Etienne, Director of the Pan American Health Organization WHO’s regional office for the Americas. “Over the years, El Salvador has dedicated both the human and financial resources needed to succeed. This certification today is a life-saving achievement for the Americas.”
El Salvador is the third country to have achieved malaria-free status in recent years in the WHO Region in the Americas following Argentina in 2019 and Paraguay in 2018. Seven countries in the region were certified from 1962 to 1973. Globally, a total of 38 countries and territories have reached this milestone.
El Salvador’s Minister of Health, Dr. Francisco José Alabi Montoya, said: “The people and the government of El Salvador, together with its health workers, have fought for decades against malaria. Today we celebrate this historic achievement of having El Salvador certified malaria-free.”
El Salvador’s road to elimination
El Salvador’s anti-malaria efforts began in the 1940s with mechanical control of the malaria vector – the mosquito – through the construction of the first permanent drains in swamps, followed by indoor spraying with the pesticide DDT. In the mid-1950s, El Salvador established a National Malaria Program (CNAP) and recruited a network of community health workers to detect and treat malaria across the country. The volunteers, known as “Col Vol,” registered malaria cases and interventions. The data, entered into health information systems by vector control personnel, allowed for strategic and targeted responses across the country.
By the late 1960s, progress had slowed as mosquitoes developed resistance to DDT. An expansion in the country’s cotton industry is thought to have fueled a further rise in malaria cases. Throughout the 1970s, there was a surge of migrant laborers on cotton estates in coastal areas near mosquito breeding sites, in addition to discontinued use of DDT. El Salvador experienced a resurgence of malaria, reaching a peak of nearly 96 000 cases in 1980.
With the support of PAHO, the US Centers for Disease Control and Prevention (CDC), and the US Agency for International Development (USAID), El Salvador successfully reoriented its malaria program, which led to improved targeting of resources and interventions based on the geographic distribution of cases. The government also decentralized its network of diagnostic laboratories in 1987, allowing for cases to be detected and treated more rapidly. These factors and the collapse of the cotton industry led to a rapid decline of cases in the 1980s.
The 2009 health reform, which included important improvements on budget and coverage of primary health care, as well as maintenance of the vector control program as the technical leader in malaria interventions, contributed to El Salvador’s success.