Cabo Verde, a group of 10 islands in the Central Atlantic Ocean, was declared malaria-free in January. This milestone makes it one of the 43 countries and territories globally recognised with this certification by the World Health Organization (WHO).

Cabo Verde is only the third country in the WHO African region to be certified malaria-free in the past 50 years, following Mauritius in 1973 and Algeria in 2019.

The African continent bears the heaviest malaria burden, with around 95% of global malaria cases and 96% of malaria-related deaths occurring there in 2021, according to WHO. The most affected are impoverished rural communities, where children under five and pregnant women suffer the most, according to the Global Fund.

The latest World Malaria Report revealed that there were approximately 608,000 malaria deaths worldwide in 2022. Additionally, the number of malaria cases saw a significant increase in Pakistan, Ethiopia, Nigeria, Uganda, and Papua New Guinea compared to the previous year.

Cabo Verde’s certification means that the transmission of malaria by local Anopheles mosquitoes has been stopped across the country for at least three years. Additionally, the government has shown it can effectively prevent malaria from returning.

So, how did Cabo Verde achieve success?

On Wednesday, Cabo Verde’s Minister of Health, Filomena Mendes Gonçalves, shared five steps for malaria eradication that worked for her country: strong political engagement; surveillance and rapid response; a multi-sectoral approach, where the government worked closely with the community; international partnerships with organisations such as WHO and the Global Fund; and diligence – once the disease appears eradicated, a plan to prevent re-establishment is required.

Cabo Verde eliminated malaria after implementing a strategic plan from 2009 to 2013, focusing on expanded diagnosis, effective treatment, and increased surveillance, According to WHO. To prevent imported cases, free diagnosis and treatment were offered to international travellers and migrants.

In 2017, the country improved its response to an outbreak, achieving zero Indigenous cases for three consecutive years. During the COVID-19 pandemic, Cabo Verde maintained progress by enhancing vector control, malaria diagnosis, and surveillance, particularly at entry points and high-risk areas.

Impact of climate change

Cabo Verde’s story took centre stage at an opening discussion on the third day of the Geneva Health Forum. The event, run in collaboration with the International Federation of Pharmaceutical Manufacturers and Associations (IFPMA) and on the margins of the 77th World Health Assembly, focused on vector-borne diseases, including neglected tropical diseases, exacerbated by climate change and other environmental factors.

Last week, WHO and Reaching the Last Mile published a major review in the Transactions of the Royal Society of Tropical Medicine and Hygiene, analysing 42,693 articles on climate change and vector-borne diseases. The study found that rising temperatures and changing weather patterns alter the spread of these diseases, posing significant health risks and straining healthcare systems. As mosquitoes and other disease vectors expand their range, the report showed, the risk of these diseases reaching new, unprepared areas increases.

Samal, a father from Nepal, contracted visceral leishmaniasis (black fever) in 2022. He became so ill that he lost 15 kilograms and was unable to work for three months. Samal lost nearly 100,000 Nepalese Rupees as a farmer and woodcutter, equivalent to three months’ wages.

His nephew and brother also caught the disease. Fortunately, Samal received treatment and survived. However, as Thoko Elphick-Pooley, executive director of Uniting to Combat NTDs and Co-Chair of the G7 Taskforce on Global Health, explained, “Many are not so lucky.”

Nepal, a village in the foothills of the Himalayan Mountains, sits about 1,300 meters above sea level. Historically, temperatures seldom rose above 30 degrees Celsius. Today, they regularly soar past that mark, bringing with the heat many new diseases like black fever, which thrive in dark and humid environments.

“Nepal is now breeding grounds for sandflies,” which causes black fever, Elphick-Pooley said. “If untreated, it is fatal in over 95% of cases. Samal’s story shows the catastrophic impact of climate change on individuals, families, communities, and entire countries.”

Climate change has dealt a blow to Nepal’s fight against black fever, said Elphick-Pooley. The country, which had seen cases plummet from 2,200 to under 300 in ten years and was on track to eliminate the disease, must now postpone its goal of eradication.

Countless other countries are experiencing a similar phenomenon, facing a rise in diseases from dengue to malaria. Pakistan reported a staggering 900% increase in dengue cases following severe flooding, as revealed at the United Nations Climate Change Conference last year.

Authorities, even in affluent European nations, are now on high alert for dengue outbreaks, with health agencies warning that threats will soon emerge in the southern United States and previously unaffected regions of Africa.

The WHO and Reaching the Last Mile report indicated that better evidence was needed to understand the link between climate change and these diseases. It also noted a lack of evidence tied to mitigation and adaptation.

But Elphick-Pooley said that “while generating more and better evidence is critical, we cannot let gaps in evidence stop us from moving. We cannot stand still while waiting for better evidence; we must act based on what we know now. We are already seeing the impacts of climate change. This is urgent.”

She called on health leaders to develop new treatments, disease management, and prevention strategies to advance a disease-elimination agenda.

“We already know how to treat or prevent many of the 21 NTDs. let’s do it,” Elphick-Pooley said.

Malaria in the United States

The link between climate change and vector-borne diseases has even alerted the U.S. Department of Health and Human Services.

Loyce Pace, assistant secretary for global affairs in the department, said the country has been having the conversion “about our friends in Brazil who are facing a crisis.” She said Brazil’s floods are not only producing hundreds of thousands of climate refugees but precipitating additional waterborne diseases “in a way that is absolutely putting these constraints not only on the public health system” but on the people.

Moreover, the Centers for Disease Control and Prevention (CDC) identified a handful of locally acquired mosquito-transmitted malaria in Texas and Florida last year. Locally acquired mosquito-borne malaria has not occurred in the United States since 2003.

“These mosquitoes are getting smarter,” Pace said. “They’re getting better at what they do. They’re showing up in places they’re not supposed to, like Maryland, down the street from Washington, D.C.. This is happening in real time. This is not a tomorrow problem. This is a problem today.”

She said the U.S. is prepared to take a one-health approach and called on other countries to do the same.

“It’s not hopeless, right? We have this problem in front of us, but we absolutely do have the solutions we need to deploy,” Pace said. “I trust that we can get it done together.”

Image Credits: Maayan Hoffman.