Contextualizing Public Health Interventions in Eliminating Endemic Diseases: New Lessons From a Review of Sri Lanka’s Success in Eliminating Malaria

Abstract

Malaria remains a major global public health issue, demanding significant resources from governments, health organizations, and international organizations toward its elimination as an endemic disease. In 2016, Sri Lanka achieved the remarkable feat of being declared “malaria free” by the World Health Organisation (WHO), after over a century of indigenous disease. To identify significant lessons of global importance in eliminating endemic malaria by reviewing literature on Sri Lanka’s successful elimination campaign. The history of malaria in Sri Lanka highlights the nation’s journey from widespread malaria prevalence to achieving malaria-free status in 2016. Key interventions, such as the establishment of the Anti-Malaria Campaign in 1911, the introduction of Dichloro-Diphenyl-Trichloroethane (DDT) in 1946, and the launch of a malaria eradication program in 1958, played crucial roles in controlling the disease. However, challenges such as insecticide resistance, environmental changes, and civil war periodically caused resurgences. The 21st century saw intensified efforts in surveillance, vector control, and community engagement, culminating in the elimination of indigenous malaria cases in 2012. Despite this success, the risk of reintroduction from imported cases remains, necessitating ongoing vigilance and preventive measures. The case study of Sri Lanka is remarkable, and can provide valuable insight for stakeholders involved in eradicating malaria, with the caveat that this case is further evidence of the differential nature of malaria transmission worldwide.