ON Oct 20, 2024, Egypt received a certificate from the World Health Organisation (WHO) declaring it malaria-free. A disease that once plagued the pharaohs is now history. Health experts noted that this milestone marked the end of malaria as a threat to Egypt. Achieving malaria-free status requires three consecutive years without a single case of local transmission, and Egypt met this rigorous criterion. Maintaining this success, however, remains a priority.

For countries like Pakistan, where cases of malaria and other mosquito-borne diseases are on the rise, Egypt’s success offers valuable lessons. Why has Egypt been able to achieve this victory, while nations like Pakistan continue to struggle? What lessons can be learned from Egypt’s approach to eliminating malaria, and why is it crucial for Pakistan to take similar steps? Understanding Egypt’s journey can help policymakers and health professionals in Pakistan identify what may be hindering progress and the potential consequences of not acting swiftly.

Egypt’s victory against malaria represents the culmination of decades of concerted efforts spanning nearly a century. This achievement relied on a multifaceted and multidimensional approach encompassing public awareness, vector control, disease management, and environmental improvement.

Key initiatives included large-scale drainage projects aimed at removing stagnant water from the Nile delta, agricultural fields, and irrigation canals. Stagnant water serves as a breeding ground for Anopheles mosquitoes, the primary vectors of malaria. Additionally, irrigation systems were modified to ensure continuous water flow, significantly reducing breeding sites.

To minimise environmental harm and prevent mosquito resistance, Egypt implemented the rotation of safer insecticides. This ensured that mosquitoes did not develop immunity to control measures. Biological control methods also played a crucial role: mosquito-eating fish were introduced into irrigation canals and other water bodies, while specific vegetation was planted to attract natural mosquito predators, fostering an environment where mosquito populations could be naturally suppressed.

Year after year, Pakistan sees the tragic loss of lives across all age groups due to vector-borne diseases.

Robust surveillance networks were established to monitor areas with historical malaria transmission. Health workers collected data, tracked potential outbreaks, and ensured prompt action. Public health campaigns educated rural communities on the importance of eliminating mosquito breeding sites near homes, using bed nets, and seeking early treatment for symptoms. Commu­nity participation was another cornerstone of the strategy. Residents were trained to identify mosquito breeding grounds and encouraged to report stagnant water. This active involvement turned local populations into key partners in the malaria elimination exercise.

Given the risk posed by travellers from malaria-endemic regions such as sub-Saharan Africa, strict screening protocols were implemented. Imported cases were promptly treated to prevent re-establishment of local transmission.

In Pakistan, the battle against vector-borne diseases like chikungunya, dengue haemorrhagic fever, and malaria has escalated into a national health crisis. Despite support from international organisations like the WHO and numerous government and NGO campaigns, these infections continue to exact a heavy toll. All segments are affected — from rural communities to urban populations — underscoring these diseases’ pervasive nature. Year after year, Pakistan sees the tragic loss of lives across all age groups due to these diseases.

An extremely concerning factor is the limited availability of vaccines for most vector-borne diseases, leaving prevention efforts heavily reliant on vector control. While promising vaccines for diseases like malaria are under development globally, they remain inaccessible to many in Pakistan, highlighting the urgent need for proactive measures to nip the spread of diseases in the bud.

Given today’s interconnectedness, the concept of ‘no one is safe until everyone is safe’ rings especially true for Pakistan. As part of the global community, it is imperative for the country to adopt practical and evidence-based measures, inspired by success stories like Egypt. A foundational step in this direction is to address mosquito-breeding sites, a common factor in the spread of most vector-borne diseases in the country. Stagnant water, heaps of garbage, and unattended litter provide ideal conditions for mosquitoes to thrive. Taking control of these breeding grounds can mitigate the spread of disease.

Educational initiatives must also be prioritised. Raising awareness at schools, colleges, universities, and in rural communities is crucial for long-term success. Media outlets, with their extensive reach, can play a transformative role by broadcasting public health messages and promoting preventative practices. Media can play a pivotal role by educating the public through schools, universities, and rural outreach programmes, ensuring that no area is overlooked by the health authorities.

Community involvement is equally critical. Encouraging citizens to report mosquito-breeding sites and fostering a culture of environmental responsibility can amplify the impact of government and NGO efforts. Additionally, livestock and domestic animals, which often serve as hosts for fleas and ticks that transmit diseases, require focused attention. Collaborative efforts among the health authorities, NGOs, and agricultural agencies can help manage and control these vector populations.

The generation and maintenance of comprehensive biostatistical data on vector-borne diseases is essential too. By regularly updating and analysing this data, policymakers and health professionals can identify trends, assess the effectiveness of interventions, and adapt strategies to emerging challenges. Such data-driven approaches are critical for sustaining progress and ensuring that efforts are targeted where they are needed most.

Egypt’s systematic efforts demonstrate that combating malaria is not just about resources but also strategic implementation and community involvement. These are lessons Pakistan can readily adapt to its unique challenges. Despite having the potential to implement similar strategies, Pakistan has struggled with inconsistent efforts in malaria control, hindered by gaps in the public health infrastructure, limited community participation, and lack of sustained political will.

By learning from the success of other countries in their fight against various diseases and adopting integrated strategies and a multidimensional approach, Pakistan can work towards controlling and even eradicating these diseases. Taking inspiration from Egypt’s comprehensive approach could help it move towards a future where malaria and other mosquito-borne diseases are no longer a threat to its people.

The writer is a medical doctor.

Published in Dawn, December 30th, 2024