On World Malaria Day, experts look at how Europe became malaria-free and how other regions can accomplish the same feat.
Just in time for World Malaria Day, the World Health Organization (WHO) announced last week that Europe is officially malaria-free.
While the mosquito-borne parasite has been absent from most of the continent since 1975, it has lingered in countries along the border between Europe and Asia.
In 1995, Turkey, Georgia, Tajikistan, and seven other nations in the area reported more than 90,000 cases of the disease. That number is now zero, WHO officials say.
Europe is the first region to completely eliminate malaria, WHO biologist Elkhan Gasimov, Ph.D., told Healthline.
He attributed the success to a combination of political commitment, financial resources, and heightened surveillance of new cases.
The announcement means that malaria is not currently being spread within the region, although new cases can show up and even spread. That’s because the mosquitoes are still present and travelers can bring the disease from other parts of the world.
“The European region has been declared malaria-free on the basis of the present situation and the likelihood that elimination can be maintained. This means that we cannot afford to drop our guard on this disease,” Dr. Nedret Emiroglu, Ph.D., WHO’s deputy director in the division of communicable diseases, said in a press release.
“Experience shows that malaria can spread rapidly, and, if Europe’s countries are not vigilant and responsive, a single imported case can result in a resurgence of malaria,” Emiroglu noted.
While malaria today is considered mostly a tropical disease, it was once prevalent all over the world, including Western Europe and the southern U.S.
Its shrinking range has been largely attributed to the destruction of swampy mosquito breeding grounds, although strengthened public heath infrastructure also played a role.
Similarly, access to medical care was essential in the recent elimination of malaria from Eurasia, Gasimov said.
Unlike many places in Africa where malaria persists, every community in Europe has access to doctors and nurses and has basic equipment for diagnosing and treating the disease.
“The country could be poor but still the infrastructure could be there,” he said.
This year, the theme of World Malaria Day is “End Malaria for Good,” reflecting the renewed commitment of many nonprofits and governments to battling the disease worldwide.
But getting rid of the disease in Africa, where 90 percent of the hundreds of thousands of annual malaria deaths are reported, is still out of reach.
“Africa is generally in a different situation in terms of far more suitable ecological conditions for malaria transmission, mosquito species that are far more efficient at spreading malaria, weaker health systems, poorer populations. Each of which make malaria elimination more of a challenge,” malaria researcher Andy Tatem told Healthline in an email.
“However, it does offer hope to see that a huge region that once supported malaria transmission … is now malaria free thanks largely to human intervention. Someday soon hopefully this will be a reality for Africa too with sufficient investment in control methods.”
Some of the strategies employed in Europe are transferrable to Africa, Gasimov said.
That includes political collaboration across borders.
But on-the-ground methods will vary considerably given the prevalence of the disease, he said.
An example is the distribution of insecticide-treated nets. In Europe, their distribution was targeted to pregnant women and children. In Africa, they must be made widely available.
Ignoring regional differences and using a one-size-fits-all approach is considered by some historians to have led to the failure of the mid-century
The program was discontinued in 1969 and was followed by the somewhat less sweeping campaign Roll Back Malaria in 1998. In 2007, the Gates Foundation surprised many by announcing a new effort to eradicate the disease.
Dr. Kenrad Nelson, a professor of epidemiology at Johns Hopkins University, told Healthline that global eradication of malaria is unlikely given the tools at our disposal today.
It’s a complicated disease to deal with because it can be traced to five different germs, some of which can remain in the body for years, he said.
WHO officials admit that additional research and technology will be necessary to rid the rest of the globe of malaria.
The Gates Foundation’s strategy relies on such developments as creating a medicine capable of wiping out the parasite in the body, finding and treating asymptomatic people, and developing improved insecticides.
When it comes to emerging, spreading threats like Zika and dengue, the key lesson that will be taken from Europe’s success with malaria is mosquito control and vigilant surveillance of new cases, Gasimov said.
However, the diseases are spread by different species of mosquitoes that behave differently from one another, he said, so many of the same strategies will not apply.