Q&A on the E-2020 initiative and malaria elimination

3 July 2019

What is the E-2020 initiative?

In May 2015, the World Health Assembly endorsed a new Global Technical Strategy for Malaria 2016-2030, setting ambitious goals aimed at dramatically lowering the global malaria burden over this 15-year period, with milestones along the way to track progress. A key milestone for 2020 is the elimination of malaria in at least 10 countries that had the disease in 2015. To meet this target, countries must report zero indigenous cases in 2020.

According to a WHO analysis published in 2016, 21 countries have the potential to eliminate malaria by 2020. They were selected based on an analysis that looked at the likelihood of elimination across 3 key criteria:

  • trends in malaria case incidence between 2000 and 2014;
  • declared malaria objectives of affected countries; and
  • informed opinions of WHO experts in the field.

Together, these 21 malaria-eliminating countries are part of a concerted effort known as the E-2020 initiative, supported by WHO and other partners, to eliminate malaria in an ambitious but technically feasible time frame.

If the global response to malaria is at a crossroads, why are we seeing some countries accelerate towards elimination?

Globally, progress in the malaria response has stalled: the declining trend in malaria cases and deaths has levelled off and even reversed in some regions. However, as highlighted in the World malaria report 2018, 46 countries reported less than 10 000 malaria cases in 2017, compared to just 37 countries in 2010.

This bright spot in the response shows that elimination of the disease is possible and that global efforts to control and prevent malaria have resulted in substantial declines in malaria cases and deaths. Now, it is important to focus on continuing to support both groups of countries: those with a high burden of malaria and those accelerating towards elimination.

Argentina and Uzbekistan have eliminated malaria: why are they not featured in the E-2020 report?

The E-2020 report is focused on progress among 21 malaria-eliminating countries that were identified by WHO in 2016 as having the potential to eliminate the disease by 2020. At the time of the initiative’s development, Argentina and Uzbekistan were already too advanced in the elimination process to be included in the E-2020 group.

Both countries have reported zero indigenous cases of malaria since 2011. Uzbekistan was officially certified malaria-free by WHO in December 2018 and Argentina attained this status in May 2019.

Once a country achieves malaria elimination, does this mean there is no longer any need to focus on the disease?

The malaria elimination journey does not end with certification. Preventing re-establishment of malaria requires keeping robust technical capabilities and skilled know-how in place.

In practical terms, this means maintaining up-to-date malaria surveillance systems and ensuring health workers at all levels, in both public and private sectors, are continuously trained on how to detect malaria and the procedures for diagnosis, notification, treatment and patient follow up – critical components to prevent the disease from coming back.

For countries with a high burden of malaria, is elimination of the disease a possibility?

Yes. While elimination is undoubtedly a longer-term goal, it is the ultimate objective that all malaria-endemic countries should aim for. To support countries on the path towards elimination, the WHO Global Technical Strategy outlines the critical requirements needed to achieve and maintain elimination at every level of malaria transmission intensity in every endemic country, focusing on the need for:

  • country ownership,
  • tailored responses,
  • strengthened surveillance,
  • equity in access to health services, and
  • innovation in malaria control tools.