By Dr Arvind Mathur, WHO Representative to Timor-Leste
In Timor-Leste, the most common diseases transmitted to people by vectors (insects such as mosquitos, ticks, and sandflies) include malaria, dengue, and lymphatic filariasis (LF). Out of these, malaria and LF have been targeted for elimination globally. The country has evidenced significant reduction in malaria cases. However, sudden increase of cases in 2020 has raised alarm and called for retrospection, undertaking the gap analysis on control of vector borne diseases as Timor Leste gears itself for reaching the ‘Last Mile’ of Malaria Elimination in Timor-Leste.
The untiring efforts of thousands of health workers, volunteers, and people themselves have resulted in dramatic changes in the malaria landscape in Timor-Leste in the past 15 years. The remarkable efforts showed in steadily declining malaria burden until the last indigenous case was reported in June 2017. There have been no malaria deaths in the country since 2015. However, globally this preventable and treatable disease continues to have a devastating impact on health and livelihood of people and in 2020 an estimated 241 million new cases of malaria and 627,000 deaths were reported in 85 countries.
The malaria control, and thereafter the elimination effort in Timor Leste has been intense and sustained, with a focus on providing universal access to malaria diagnosis, treatment, and prevention such as with Long lasting Insecticide nets (LLINs) and Indoor Residual Sprays (IRS) whilst improving surveillance and response. Attention to detail such as to the quality control of malaria diagnosis and training of dedicated malaria staff with high quality technical guidance from World Health Organization (WHO) Timor-Leste are some of the hallmarks of the country’s programme. With limited domestic resource for malaria control, the funding from the Global Fund provided much need impetus to the elimination effort. The success is more admirable given that the Timor Leste shares a highly porous border with Indonesia’s West Timor which is endemic for malaria. The extensive movements of population across the international borders between Timor Leste and Indonesia increases its vulnerability for Malaria transmission and potential outbreaks.
The recently concluded Vector Control Need Analysis (VCNA) by WHO Timor-Leste, revealed that Malaria has been restricted mainly around the international border areas. The reporting of notifying 14 Malaria cases during 2020 indicating few indigenous and imported cases during COVID-19 pandemic is clearly an alarm and call for strengthening vector control in border areas and have greater cross border cooperation and collaboration. The focused efforts led to successful containment and stamping out the small outbreak that illustrates the Ministry of Health (MoH) commitment and ability to detect and mount an effective response. However, this alert and alarm is more significant as Timor Leste with zero cases for last three consecutive years was gearing to prepare for WHO certification of Malaria Elimination which now seems to be pushed back. But it’s critically important that the preventive measures are sustained, follow-up of the cases is continued, and the entomological surveillance is carried out as part of the routine program and comprehensive vector control measures continue in the border area.
Malaria Control and Elimination efforts in Timor Leste offers many lessons. One of the key learning is that fragmented approach and working in silos will neither control vectors nor vector borne diseases. Therefore, an integrated vector control strategy is the need of the hour with inter-departmental (environmental health, surveillance, disease control) coordinated effort supported with multi-sectoral actions such as that of and from Ministries of Public Works, Education, and Defense etc. This would mean regular monitoring and vigilance on vector abundance, its bionics across the country, entomological surveillance, vector control measures including eliminating breeding sites of mosquitos everywhere with people’s own individual preventive actions. Such an approach would not only help in reaching the last mile for Malaria Elimination but also significantly contribute to controlling other vector borne diseases such as Dengue.
No single tool that’s available today will solve the problem of malaria. In line with the theme of World Malaria Day – Harnessing innovation to reduce the malaria disease burden and save lives”; Timor Leste is working to adopt technological advances such GIS mapping for breeding sites, initiating the shift to electronic surveillance through integration into DHIS2 with integrated vector control efforts as cited above. The importance of high level political and financial commitment to prevent re-establishment of Malaria can’t be overemphasized.
We are at a critical point in the fight against Malaria in Timor Leste with end in sight. The way forward to reach the last mile for Malaria Elimination, therefore would include sustained political commitment, stronger cross border collaboration, integrated vector borne control strategy led by integrated vector borne disease control unit in MoH for mounting more effective and sustained coordinated response, multi-sectoral actions, harnessing the technological innovation to eliminate Malaria and ensuring people and community’s continuing engagement for these efforts. As a trusted and long-standing partner of Ministry of Health and people of Timor Leste, WHO Timor-Leste is committed to extend evidence based practical and actionable technical assistance and look to work collaboratively with partners, government, and people of Timor Leste to achieve Malaria Elimination in very near future.
TATOLI
