1. What is a WHO malaria-free certification?
Certification of malaria elimination is the official recognition by WHO of a country’s malaria-free status. The certification is granted when a country has shown – with rigorous, credible evidence – that the chain of indigenous malaria transmission by Anopheles mosquitoes has been interrupted nationwide for at least the past three consecutive years. A country must also demonstrate the capacity to prevent the re-establishment of transmission.
The final decision on awarding a malaria-free certification rests with the WHO Director-General, based on a recommendation by the independent Technical Advisory Group on Malaria Elimination and Certification (TAG-MEC).
More information on WHO’s malaria-free certification process is available here.
2. How many countries been certified malaria-free in the WHO Eastern Mediterranean Region, and globally?
Egypt is the third country to be awarded a malaria-free certification in this region, after United Arab Emirates (2007) and Morocco (2010). With this announcement, a total of 44 countries and 1 territory have been certified malaria-free by WHO.
3. When was malaria first detected in Egypt?
Malaria has been traced in the country as far back as 4000 B.C., with genetic evidence of the disease found in Tutankhamun and other ancient Egyptian mummies. Cases were historically reported in human settlements near the Nile River, where conditions for breeding and survival of mosquito vectors of malaria were favorable.
4. When did the country’s malaria control effort first begin?
Early efforts to reduce human-mosquito contact in Egypt began in the 1920s when the country prohibited the cultivation of rice and agricultural crops near homes. Egypt designated malaria a “notifiable disease” in 1930 and, soon after, opened its first malaria control and research station. The first comprehensive malaria survey in Lower Egypt in 1936 indicated that prevalence of the disease varied from less than 1% in Giza to around 40% in the provinces of Qaliubiya, Beheira, and Dakahlia.
During World War II, Egypt experienced an unprecedented surge in malaria cases among both civilians and military personnel as a result of a disruption of public health services, shortages in the supply of malaria treatments and larvicides, population displacement, and the invasion of Anopheles arabiensis, an efficient mosquito vector of malaria. The country mounted a successful response through the establishment of 16 treatment divisions and the recruitment of over 4000 health workers to implement vector control measures.
5. What about post- World War II efforts to control malaria?
Malaria control success during the 1950s and 1960s was mainly driven by continued vector surveillance, larval control (applying chemicals to standing water bodies where mosquitoes breed), environmental management and rapidly increasing economic development in previously rural and agricultural areas. This period also saw the introduction of campaigns using the insecticide DDT (dichloro-diphenyl-trichloroethane).
The construction of the Aswan Dam, completed in 1969, created a new malaria risk for Egypt in the area close to the Sudan border. An extensive system of irrigation canals and reservoirs fed by the dam increased the potential for stagnant water in agricultural fields and nearby communities. Building on the successful experience of the elimination of Anopheles arabiensis, the Government of Egypt launched a project in 1970 in collaboration with Sudan that mitigated the malaria threat near the Aswan Dam. The project involved, among other measures, rigorous vector control and public health surveillance to rapidly detect and respond to any signs of malaria outbreaks.
6. How did Egypt succeed in stamping out the last cases of malaria?
By 2001, malaria was firmly under control and the Ministry of Health and Population set its sights on elimination through a strong, time-limited attack on any remaining locally transmitted malaria cases.
Egypt experienced a small outbreak of indigenous malaria cases in the Aswan Governorate in 2014 which was successfully managed through early case identification, prompt treatment, vector control and public education.
Over the last decade, Egypt has made significant progress in expanding access to health services for the population. Notably, 95% of Egyptians live within 5 kilometers of a primary health care facility. Malaria diagnosis and treatment are provided free of charge to the entire population, including undocumented migrants from Sudan.
Malaria control in Egypt has been successfully integrated with the management of other vector-borne diseases. In 2016, Egypt formed a High Committee for Integrated Vector Management, with representatives from Ministry of Agriculture, Ministry of Environment, and Ministry of Water Resources & Irrigation. The Committee reinforces an integrated approach to tackle vector-borne diseases, with secured funding through synergy and coordination across ministries.
7. What measures has Egypt taken to prevent the re-establishment of malaria transmission?
The Government of Egypt is committed to preventing the re-establishment of malaria transmission. To maintain a robust surveillance and response system, the country has invested in ensuring continued capacity for malaria diagnosis, treatment, entomological surveillance and vector control.
Egypt’s long-term cross-border partnership with neighbouring countries, including Sudan, has played a key role in preventing the re-establishment of local malaria transmission, paving the way for the country to be officially certified as malaria-free.
In response to the armed conflict in Sudan that displaced thousands of civilians to Egypt starting in April 2023, the Egyptian Ministry of Health implemented an action plan to provide life-saving and supportive care, manage gender-based violence, and respond to malaria, leishmaniasis, and filariasis.
Egypt provides free access to essential health services for migrants, regardless of their legal status. Essential supplies, including malaria rapid diagnostic tests and antimalarial medications, have been delivered to designated hospitals, particularly in the point of entry in Aswan.