“Cape Verde's certification as a malaria-free country is a historic milestone because it is the first country in the last 50 years here in sub-Saharan Africa to achieve this feat.”
Filomena Gonçalves, the country's Minister of Health, has reasons to speak in these terms, breaking into a big smile from her office in Praia, the capital, in a video conference with this newspaper.
Since last January 12, this nation of 10 islands in the Atlantic, with just under 600,000 inhabitants, has received official recognition from the World Health Organization (WHO) as a country that has managed to eliminate the disease from its territory.
To do this, applicants must have gone three years without registering cases and in Cape Verde no one has fallen ill with malaria since 2018.
Malaria increased in 2022 relative to pre-pandemic levels, with Africa bearing the greatest burden of infection, especially the sub-Saharan region.
According to the latest data from the WHO, that year there were 249 million cases in the world, of which 94% (233 million) were recorded on the continent.
Of the 608,000 deaths in 85 countries, 95% (580,000) were African;
eight out of ten were children under five years old.
“Cape Verde's success is the latest in the global fight against malaria and conveys hope that, with existing tools and new ones, such as vaccines, we can dare to dream of a future without malaria,” notes the Director-General of the WHO, Tedros Adhanom Ghebreyesus, in a statement.
The archipelago will no longer need to acquire any of the two recently approved immunizations available against this disease.
But Gonçalves asks for “solidarity” from the international community to guarantee access to immunizations by “brotherly and neighboring countries,” in which “people die from malaria every day.”
And he reasons: “It makes no sense for some countries to protect and isolate ourselves.
“This is what the pandemic has taught us.”
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“The keys to success,” says Gonçalves, “are government commitment, strong community involvement, national and international collaboration, as well as development partners, and continuous innovation in control and prevention strategies.”
All this, added to the “permanent and unfinished construction of a robust health system.”
The strong pillars of this formula, continues the president, are prevention and education.
“Success depends on the behavior of every Cape Verdean citizen and every person who has visited our country.”
In practice, the country has deployed a health screening system at entry points (air and sea) and provided free testing and treatment to international travelers and migrants.
The
Anopheles
mosquito , transmitter of the
Plasmodium
parasite that causes the infection, is still present on its islands, which means that an imported case could become a local outbreak, explains Gonçalves.
But with antimalarial medications, infectious agents are quickly removed from the bloodstream.
With this, not only is the patient cured and complications and even death are prevented, but transmission to other people is minimized by reducing the infectious reservoir.
We will only be calm when we see the end of malaria in the other countries of our continent
“Among countries in the global south, a cross-border surveillance strategy is essential.
Cape Verde has managed to eliminate malaria, but we will only be calm when we see the end of the disease in the other countries of our continent,” says the minister.
In Africa, only two other countries have managed to obtain and maintain “malaria-free” certification in the last half century: in the North, Algeria, in 2019;
and in the sub-Saharan subregion, Mauritius, in 1973. To follow in their footsteps and learning from the good practices of this country with which it shares being an island State, in 2007, Cape Verde included the elimination of the infection in its national health policy. .
The strategic plan consisted of expanding diagnosis, early treatment and the registration and investigation of all cases.
For a decade, authorities kept transmission at bay with between zero and 30 cases monthly, of which more than half (58%) were foreigners;
But between July and October 2017, a large epidemic outbreak occurred, with 423 local patients.
The last indigenous case was reported in January 2018. “It was from a family here in Praia,” recalls Gonçalves.
In addition to the example of Mauritius, Cape Verde “learned from its own mistakes,” comments the minister.
The country had already eliminated malaria in 1967 and 1983, "however, subsequent negligence in vector control led to a resurgence of the disease," notes the WHO in the announcement on January 12.
“There is a saying that says that the third time is the charm.
This time we are not overconfident, we have learned a lot and, at a time when the priority on the world agenda is health security, we believe that we are prepared to maintain this great victory,” says Gonçalves.
To maintain its new status, the country's plan is to maintain “strict surveillance,” especially with regard to the detection of imported cases and the control of mosquitoes to prevent eventual spread among the local population.
Climate change is a threat to the fight against diseases transmitted by insects.
Variations in temperatures and increasingly frequent floods favor the proliferation of vectors.
“There are many diseases that are re-emerging with greater force, including malaria.
Scientists have warned that this has to do with increasingly warmer climates, and Cape Verde is vulnerable due to our geographical location,” the minister analyzes.
“We will continue to apply existing protocols.
We will not let our guard down.
We will invest a lot in the permanent training and qualification of our staff,” she assures.
Gonçalves considers that the effort to keep Cape Verde on the list of 43 countries and one territory certified by the WHO since 1955 is “a responsibility”, as it sends a message of hope to the rest of the nations.
“Other countries will see that it is possible to defeat it by putting people at the center of all political decisions.”
Just as Cape Verdeans learned from the experiences of others “with humility,” the Minister of Health offers to “establish partnerships” with all those who believe that her knowledge can be useful to them.
The Prime Minister of Cape Verde, Ulisses Correia e Silva (left), receives the malaria-free country certificate from the director general of the World Health Organization (WHO), Tedros Adhanom Ghebreyesus (right), in Praia, Santiago Island, Cape Verde, January 12, 2024. ELTON MONTEIRO (EFE)
The most important impact of this achievement is that “it improves the quality of life of the population and reduces the burden of morbidity,” emphasizes the minister.
But other advantages are not lost on her.
“It will have a significant impact on our economic development, increasing productivity, reducing health costs, attracting more investments and strengthening tourism, which is one of the pillars of our economy.”
The sector represents approximately 25% of the GDP and now travelers will know the country is a safe destination, and they will enjoy its exuberant nature without fear of contracting malaria and without the need to take prophylactic medication that is very aggressive to the body.
“But the benefit is not only material, monetary;
There is another intangible,” she clarifies.
“Today the world press talks about Cape Verde as an example of good news;
I wish we could be providing good news to the international press every day.”
According to the latest UN report on the achievement of the 17 UN Sustainable Development Goals, Cape Verde is making positive progress in number three, related to health.
The data proves it.
Life expectancy is 80.7 years for women and 73.4 for men, representing an increase of 24.6 and 18.7 years, respectively, since 1970. The goal of reducing maternal mortality to rates Below 70 deaths per 100,000 live births has already been achieved.
With an average of 53.9 deaths per 100,000 live births, “it is the only country in West Africa” that has achieved this, the authors of the review highlight.
It is also the only one in the region that has achieved compliance in terms of reducing infant mortality and expanding complete immunization rates, which is 98%.
Regarding infectious diseases, in addition to the elimination of malaria, Cape Verde has reduced the incidence of tuberculosis from 52 cases to 34 per 100,000 inhabitants between 2015 and 2020. And the prevalence of HIV, from 0.6%, “ is low compared to the regional and even the global one,” the document indicates.
“We are a small country, we have few inhabitants and we have many challenges, but when we are together, organized and determined, we can make history like this moment,” concludes the Minister of Health proudly.
Now, you can think about the next challenge: non-communicable diseases.
Specifically, Gonçalves' cabinet has proposed improving mental health care for Cape Verdeans.
“We are going to reevaluate the way we manage healthcare.
We seek greater humanization.
Professionals must have the ability to put themselves in the shoes of people who need health services.
We ask ourselves: how would we like to be served?
I believe that it is possible to give more and better.
Our goal is to make people healthier, physically, mentally and spiritually, and, therefore, happier.
For this reason, we have declared 2024 the year of mental health in Cape Verde.”
-Have you detected a deterioration?
― Cape Verde is neither better nor worse than any other country on the planet.
Mental health is one of the World Health Organization's priorities for any country and it has recommended that we pay special attention to it.
We want to take care of the best thing we have, polish our diamond so that it shines: the people.
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