“The people and governments of Azerbaijan and Tajikistan have worked long and hard to eliminate malaria,” said WHO Director-General Dr Tedros Adhanom Ghebreyesus. “Their accomplishment is further proof that, with the right resources and political commitment, eliminating malaria is possible. I hope that other countries can learn from their experience.”

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.

“Azerbaijan’s and Tajikistan’s achievement was possible thanks to sustained investment and the dedication of the health workforce, together with targeted prevention, early detection and treatment of all malaria cases. The WHO European Region is now two steps closer to becoming the first region in the world to be fully malaria-free,” said Dr Hans Henri P. Kluge, WHO Regional Director for Europe.

Azerbaijan detected its last case of locally transmitted Plasmodium vivax (P.vivax) malaria in 2012 and Tajikistan in 2014. With today’s announcement, a total of 41 countries and 1 territory have been certified as malaria-free by WHO, including 21 countries in the European Region.

Investing in universal health coverage and malaria control

Malaria control efforts in Azerbaijan and Tajikistan were strengthened through a range of investments and public health policies that enabled the governments, over time, to eliminate the disease and maintain malaria-free status.

For more than six decades, both governments have guaranteed universal primary health care. They have vigorously supported targeted malaria interventions – including, for example, prevention measures such as spraying the inside walls of homes with insecticides, promoting early detection and treatment of all cases, and maintaining the skills and capacities of all health workers engaged in malaria elimination.

Both Azerbaijan and Tajikistan utilize national electronic malaria surveillance systems that provide nearly real-time detection of cases and allow for rapid investigations to determine if an infection is local or imported. Additional interventions include biological methods of larvae control, such as mosquito-eating fish, and water management measures to reduce malaria vectors.

Since the 1920s, a sizeable portion of Tajikistan’s economy and, to a lesser extent Azerbaijan’s, has depended on agricultural production, particularly valuable cotton and rice exports.

The agricultural irrigation systems in both countries have historically also posed a malaria risk to workers. Both countries have established systems to protect agricultural workers by providing free access to malaria diagnosis and treatment in the public health care system.

Malaria control staff have the capacity to immediately test, diagnose and treat infected workers with appropriate antimalarial drugs, and to monitor and assess environmental, entomological and epidemiological risk factors. Additional programme activities include regularly assessing the judicious use of insecticides for vector control, implementing water management systems, and educating the public on malaria prevention.