Swaziland on the Brink of Malaria Elimination

The news regarding the elimination of malaria was extremely positive in 2015. A World Health Organization (WHO)/UNICEF report concluded that the Millennial Development Goal target for malaria—to have halted and begun to reverse incidence of malaria—had been achieved convincingly, with a 37 percent drop in malaria cases and a 60 percent decline in deaths over the past 15 years. 

One example of that success is Swaziland, which is poised to eliminate malaria by the end of 2016, according to the country’s National Malaria Control Programme (NMCP). If the country achieves malaria elimination, it will be the first country in southern Africa to achieve zero local cases.

While Swaziland’s strong surveillance and response system and program management accounts for much of its success, the Malaria Elimination Initiative (MEI), a project of our Global Health Group under the direction of Sir Richard Feachem, has played a key supporting role.

As a long-time partner of Swaziland’s NMCP, MEI has been involved in Swaziland since 2008, providing technical assistance to help the country shift from malaria control to malaria elimination, and in 2011 helped develop a successful proposal to the Global Fund to Fight AIDS, Tuberculosis and Malaria to mount a campaign to wipe out malaria.

MEI has collaborated on research to improve the country’s active case detection program and is now conducting research that will help determine malaria programming as the country reaches for the national elimination goal.

In addition, MEI’s development of user-friendly, real-time disease risk maps will enable health workers to better target malaria interventions. In partnership with Google Earth Engine, the MEI is also developing an automated risk-mapping platform capable of using individual case or health facility level data. Preliminary results show that the risk maps have extremely good predictive accuracy, identifying the areas of the country in which cases are most likely to arise and therefore require targeted interventions.

While Swaziland’s elimination program is robust, Feachem warns that cross-border measures need to be strengthened. “For many eliminating countries, including Swaziland, close collaboration with neighboring countries is key to success,” said Feachem.

“If malaria knows no borders, then neither should our efforts to eliminate the disease. Swaziland’s surveillance and response is unparalleled in the region; however persistent imported malaria cases from endemic neighboring countries, particularly southern Mozambique, mean that a regional approach is essential for realizing our goal of a malaria-free southern Africa.”

Indeed, Swaziland’s leadership recognizes that it will not be able to achieve malaria elimination alone, but must also rely on its neighbors to drive down malaria. In this effort, Swaziland has played a leading role in the Elimination 8 (E8), for which MEI provides financial and technical support. E8 is a regional initiative that provides a platform for joint planning and negotiation towards strategies that mutually reinforce the eight southern African country members’ individual and shared elimination strategies. These regional initiatives, in addition to new tools, will accelerate elimination efforts in countries, like Swaziland, that are paving the way for global eradication of malaria.