Venturing house-to-house, setting and baiting traps, and crisscrossing rural communities, the Sri Lankan Anti-Malaria Campaign stays one step ahead of its foe—the mosquito. Analyzing the tiny insects, the team knows when the mosquitoes emerge each day, whom they bite, where they live, and what they might carry. From rural outposts, workers feed data into a national surveillance system of the bugs that spread the disease.
Thankfully, most of the mosquitoes collected today aren’t actually carrying the malaria parasite. After centuries of suffering its devastating effects, Sri Lanka has nearly eliminated the disease. Just over a decade ago, in 1999, Sri Lanka faced more than 260,000 malaria cases. But today, careful surveillance and vector control—combined with blood testing, treatment, widespread prevention efforts, and community education—have helped tamp down the disease to the point where there has not been one indigenous case since October 2012. Continued monitoring helps make sure it doesn’t return.
A Challenging Path
Malaria was dealt a heavy blow in Sri Lanka just after the turn of this century, with a renewed national focus and the arrival of support from the Global Fund to Fight AIDS, Tuberculosis and Malaria, the single largest funder of malaria control worldwide. The Ministry of Health’s Anti-Malaria Campaign and their nongovernmental partners led aggressive education, prevention, and surveillance programs, sending infection rates plummeting throughout much of the country.
In 1963, the country’s malaria situation was similarly under control, after a big spraying campaign, At the time, a mere 17 cases were recorded across the island. The country started relaxing, and everybody thought malaria was over. The epidemic came roaring back.Dr. W.M.T.B. Wijekoon
This success is even more impressive given that a nearly three-decades long civil war continued to rage. With limited access to conflict zones, malaria elimination—which requires island-wide coordination—seemed out of reach.
Dr. W.M.T.B. Wijekoon ran the Anti-Malaria Campaign in rural northern districts of Sri Lanka during the war. It was far from an easy path; both he and his wife suffered from malaria at various points. But under his leadership, the number of infections in the area decreased substantially.
“In 1983, I began treating a lot of malaria cases. In 1985, I moved to the most northern – and most rural – part of the district, about 60 km away from the ancient capitol of Anuradhapura,” said Dr. Wijekoon. “I was the only medical doctor in charge of an area of about 50,000 people. I was treating about 200 malaria cases per day.”
When the war ended in 2009, many of the nation’s remaining malaria cases were among soldiers, refugees, and others affected by the violence. Today, four years later, the country is folding former conflict zones into its broader successes against malaria. Resources are aimed at the highest risk areas, and the Global Fund and other donors are helping rebuild facilities, train health workers, and improve data collection.
The Global Fund has collaborated closely with Sri Lanka, providing much-needed resources and aiding in its success against the disease. However, Sri Lanka knows all too well that even brief interruptions in malaria programs can lead to rapid and dramatic resurgence. Despite great progress and scientific advances, gains are fragile and can be easily lost.
“In 1963, the country’s malaria situation was similarly under control, after a big spraying campaign,” explained Dr. Wijekoon. At the time, a mere 17 cases were recorded across the island. “The country started relaxing, and everybody thought malaria was over. The epidemic came roaring back.”
Building upon gains and maintaining elimination requires a sustained effort. Though this is not the first time the country has tried to tame this epidemic, it is determined to make it the last.
“We’ve worked to get back to those same low levels. With the Global Fund, we were able to scale up our programs dramatically all across the country, bringing us to this pre-elimination stage,” said Dr. Wijekoon.
A successful Global Fund replenishment this fall—a time when the organization invites donors to invest in fighting malaria, tuberculosis and HIV/AIDS worldwide—will help more communities and countries make and sustain these kinds of gains in health. Sri Lanka is but one example to remind us that the Global Fund’s support for health today is an investment in a brighter, healthier tomorrow.