Egypt declared malaria-free

A huge milestone in disease prevention...
25 October 2024

Interview with 

Jane Carlton, Johns Hopkins Bloomberg School of Public Health

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The World Health Organisation has certified Egypt as malaria-free. It marks a significant milestone for Africa’s third most populous nation, which is home to more than 100 million people. I've been speaking about the implications with Jane Carlton who is the director of the Malaria Research Institute at the Johns Hopkins Bloomberg School of Public Health…

Jane - It's actually one of the big three infectious diseases, which includes HIV/AIDS and TB. And malaria itself is really a tropical disease, so it's found in parts of South America, Southeast Asia, but in particular in countries in Sub-Saharan Africa. And there it causes about 600,000 deaths each year and about 250 million cases each year. So it's really a significant global public health burden.

Chris - And how long has Egypt been struggling with it?

Jane - Actually, for hundreds and hundreds of years, it's been known that Egypt has struggled with malaria because there have been studies looking and identifying the malaria parasite DNA in mummies from ancient Egyptian times. And so we know that, for example, some of the famous pharaohs died of malaria. And in fact, in the 1940s malaria cases in Egypt really surged to over 3 million per year. And this was mainly due to population displacement during World War II and also due to the construction of the Aswan Dam, which was in the 1960s. So it's been a significant burden in that country for many, many years.

Chris - And what manoeuvres or measures have Egypt gone through in order to try to bear down on it? And why is this now finally succeeded?

Jane - The sorts of measures that countries use to try and decrease the malaria burden are pretty common from country to country. It will include trying to drain some of the swampy areas of the country, and those are the prime mosquito breeding grounds. So mosquitoes transmit the malaria parasite. It's actually the malaria parasite that gives you malaria, not mosquitoes, but in order to stop what they call the transmission chain, what you want to do is to try and decrease the number of mosquitoes or stop mosquitoes from biting people. So if you can stop them from breeding through, getting rid of many bodies of standing water, which is where they like to breed, that's one step in the right direction.

Chris - And the box that's been ticked here is that they have eliminated malaria transmission in Egypt. This is a temporary thing though, presumably. It could come back if any of those pressures or any of those measures are allowed to lapse and the mosquitoes regain a toehold, the disease gets back into the population, presumably we're back to square one.

Jane - It is a bit like that unfortunately. In order to be certified malaria free by the World Health Organization, which is a United Nations institution, a country has to be malaria free for three consecutive years. And that basically means that there can't have been any malaria cases that were transmitted through mosquito-borne bites in that country. So Egypt has already been under scrutiny to make sure it can maintain this for the past three years and going forward, as actually has been mentioned by the World Health Organization, they will continue to need to be vigilant and on the lookout for any increases. And that's because mosquitoes don't know borders. Mosquitoes can fly from one country to the next. And so if the surrounding countries roundabout Egypt have malaria too, then of course that can be brought into Egypt. So there will continue to be what we call surveillance measures, both for the mosquitoes and also for infected people in Egypt to really try and keep the lid on the disease resurging.

Chris - Are we at risk of, or is Egypt at risk of, jumping out of the frying pan and into the fire? Having got rid of malaria, could there not be other diseases hot on its heels that do quite like the urban environment, the high population density that countries like Egypt, as Africa's third most populous nation, and also Cairo, very heavily densely populated, could end up with other diseases? I'm thinking things like dengue spread by different kinds of mosquitoes that really flourish in urban settings.

Jane - That's very true, but it's not that if you get rid of malaria, something else will pop up in its stead. Dengue, a different species of mosquito, not the same one that transmits malaria parasites, it's not going to sort of jump into the niche as we call it, of malaria. The good news is that the methods that we try and use to decrease the mosquito population, and some of those can be quite sophisticated actually. From things like stopping the mosquitoes from breeding, through inserting a gene into its genome, through other basic types of methods such as spraying areas with insecticide. Those sorts of measures won't only decrease the mosquito population that transmits the malaria parasite, but also those mosquitoes that transmit dengue too. So in fact, it's good news all round, I think for other diseases which are transmitted by so-called vector-borne diseases.

Chris - And is it good news for other African countries that haven't yet achieved what Egypt has, but can they take their lead from what they're doing and try to emulate it?

Jane - Yes, it is, of course, very good news. I should say though, that these methods are used by many countries. Sometimes it's just a numbers game and a time game as well. And then how many resources are available in order to be able to roll out these methods of control as we call them. But certainly, yes, I think every time a country is certified as malaria free, there's a sort of sigh of relief among all of the other malaria countries because we're really starting to make an impact on the burden. And so a total of, I think, 44 countries have now been granted malaria-free status. But in fact, that leaves another 85 or so countries that still have a big malaria problem. So it's those countries that we'll really be focusing on in the next few decades.

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