“Driven to End Malaria”: Ten years of success for Sri Lanka

This World Malaria Day, observed on 25 April, carries a distinct weight for Sri Lanka. Under the theme "Driven to End Malaria: Now We Can. Now We Must," Sri Lanka marks a decade since receiving its WHO malaria-free certification in 2016. It has been fourteen years since the last reported indigenous transmission in 2012 in the country. This national milestone is a significant public health achievement, yet it serves as a reminder that elimination is a status that must be actively defended every day.

“On World Malaria Day 2026, let us renew our collective commitment to sustaining malaria elimination by embracing innovation, strengthening cross-sector collaboration, supporting frontline health workers, and actively engaging the communities we serve.” - Dr Rajesh Sambhajirao Pandav, WHO Representative to Sri Lanka.

In March 2026, WHO Representative to Sri Lanka visited the Anti Malaria Campaign to celebrate 10 years of malaria-free certification and 14 years without indigenous cases, reaffirming a shared commitment to preventing re-introduction and strengthening resilient health systems for the future.

While Sri Lanka has successfully interrupted local transmission, the global malaria burden is actually rising. In 2024, global cases in around 80 countries reached an estimated 282 million - an increase of 19 million from the previous year. Although the South-East Asia Region has made major gains, the disease remains endemic in several neighboring countries such as India and Myanmar. As international travel continues to increase, the threat of "imported" malaria is a constant reality as imported cases can easily lead to the re-establishment of transmission, particularly if competent vectors remain present.

In Sri Lanka, the establishment of the Anti-Malaria Campaign (AMC) in 1911 and subsequent expansion of control measures laid the foundation for long-term malaria control. Early anti-malaria campaign activities, particularly in heavily impacted regions like Sri Lanka (then Ceylon) and in post-WWI efforts, focused on environmental management, larval control, and quinine distribution, as this era predated the use of modern insecticides like dichlorodiphenyltrichloroethane (DDT).

The country suffered two major malaria outbreaks in 1934 and 1935, affecting approximately 1.5 million people and resulting in nearly 80,000 deaths. A large-scale response focused on widespread quinine distribution to treat infections and reduce the parasite reservoir, alongside vector control measures such as larviciding, oiling water reservoirs, and using Paris green to target mosquito breeding. Environmental management, entomological surveillance, and the deployment of mobile medical units further strengthened efforts to eliminate breeding sites and deliver care to affected remote communities. Specifically, the introduction of DDT in 1946 and the launch of a national malaria elimination programme in 1958 marked critical turning points in reducing transmission.

Extracts of photos from National Archives and the Imperial War Museum on the state of malaria in Sri Lanka in the 1930s and 1960s.

History has shown that success can be temporary if surveillance slips. Despite nearing elimination in the early 1960s, Sri Lanka experienced a resurgence of malaria between 1967 and 1969, highlighting the challenges associated with sustaining gains and the risks of complacency. In response, the AMC programme adapted its strategies, including decentralizing operations in 1989 to strengthen local-level implementation and responsiveness. It took decades of these efforts by the AMC to finally stop indigenous transmission, after which Sri Lanka was formally recognized by WHO as malaria free in 2016.

Maintaining this malaria-free status, however, also remains a complex and ongoing challenge. Ten years since certification, the country continues to face risks such as the importation of malaria cases, the presence of competent mosquito vectors, and declining clinical familiarity with the disease. With mosquito vectors capable of spreading the parasite still present across Sri Lanka, the Prevention of Re-establishment (PoR) phase is critical.

Cattle-baited trap used for malaria vector surveillance, attracting host-seeking mosquitoes using livestock as bait for species collection and monitoring.

According to WHO Malaria Report 2024, key challenges include the impacts of climate change and humanitarian crises, emerging biological threats such as diagnostic-evading parasite mutations and resistance, persistent inequities in access to care, and stalled progress in high-burden countries, all of which are hindering efforts to meet the 2030 malaria targets. Sri Lanka has implemented comprehensive measures to address these risks, including strengthened surveillance systems, both passive and active case detection, entomological monitoring, and close follow-up of imported cases. Preventive measures, including the provision of prophylaxis for travellers to endemic areas, further support efforts to minimize the risk of reintroduction.

Combatting present-day concerns has required more than just medical interventions; it has required a strategic partnership led by the Ministry of Health and the AMC, with support from partners including UN and other multilateral and bilateral development agencies, academic institutions, and international donors. Through technical guidance, capacity-building initiatives, and financial support, WHO has contributed to strengthening surveillance, enhancing laboratory quality assurance, and ensuring the availability of essential malaria medicines in the country.

Importantly, in 2024, WHO supported an ‘Integrated review of vector-borne diseases’ to further strengthen these defenses. The recommendations focus on strengthening surveillance and case detection, enhancing healthcare capacity for vector control, promoting data-driven decision-making, and improving coordination, community engagement, and cross-border collaboration.

Moving forward, sustaining Sri Lanka’s malaria-free status will require continued investment and a multi-sectoral approach involving tourism, defense, and labor to monitor high-risk travel. The WHO Global Technical Strategy for Malaria, adopted in 2015 and updated in 2021, provides a comprehensive framework to guide countries in their malaria control and elimination efforts. It sets ambitious targets to reduce malaria incidence and mortality rates by 2030, with defined milestones to track progress and ensure accountability.

Globally, with science advancing faster than ever, ending malaria in our lifetime is no longer just a vision - it is an achievable reality supported by advancing science and pioneering technologies. As more countries look towards 2030 elimination targets, WHO Sri Lanka remains committed to supporting the country in strengthening malaria surveillance, preparedness, and response, ensuring continued progress towards sustaining malaria elimination and protecting all communities at risk. Sri Lanka’s journey serves as both evidence and a reminder that the fight against malaria does not end with elimination - it must be sustained to protect the gains achieved.