Features
Campaign against Malaria : challenges ahead for Lanka
by Amarasiri de Silva
Between 2020 and 2022, the World Health Organization (WHO) granted Malaria-free status to 12 countries, recognising their successful efforts in combating the disease. The nations awarded this prestigious certification include the United Arab Emirates, Morocco, Turkmenistan, Armenia, Argentina, Kyrgyzstan, Uzbekistan, Paraguay, Algeria, China, El Salvador, and Sri Lanka. The WHO officially acknowledges these countries as Malaria-free.
However, it is essential to note that the USA is not entirely Malaria-free, as isolated cases of home-grown Malaria continue to be reported. In south Asia, most countries, except Sri Lanka, are endemic to Malaria. India represents approximately 3% of the global malaria burden, signifying the significant impact of the disease in the country. In Pakistan, around 217 million people face a moderate risk of Malaria, while approximately 63 million are exposed to high risk. Malaria remains endemic in 13 out of 64 districts in Bangladesh, highlighting the ongoing challenges in combating the disease. Approximately 14 million people in Bangladesh are at risk of Malaria. The fight against Malaria remains an ongoing global challenge, with various countries grappling with its impact and implementing measures to control its spread and reduce its burden on communities.
This article focuses on Sri Lanka’s recent achievements in Malaria control, celebrating its success in eliminating Malaria. However, it also sheds light on the challenges ahead for Sri Lanka as it strives to maintain this Malaria-free status.
The southward shifting of kingdoms in Sri Lanka is believed to have been influenced by foreign invasions and epidemics such as Malaria and kidney disease. According to the ancient chronicle, Mahavamsa, which traces the history of Sri Lanka from the 3rd century B.C., the island faced numerous foreign invasions beginning in 300 A.D. These invasions resulted in extensive damage to irrigation systems, leading to disruptions in agriculture. Abandonment of irrigation tanks and cascades, which served as breeding grounds for malaria-carrying mosquitoes, contributed to a devastating “depopulating sickness,” causing significant population declines during that era.
During the Dutch occupation in the 17th century, the southern part of the country experienced another calamity known as the “fever pestilence.” This outbreak profoundly impacted the population, leading to a considerable decrease in numbers. Scholars have postulated that Malaria might have been the disease described in these ancient records, given its prevalence during historical times.
By the 1880s, the local population had given the disease a colloquial name – “Kelae Una,” meaning “forest fever.” This name reflects the understanding that Malaria was often associated with forested areas, which served as ideal habitats for mosquito vectors.
Overall, the historical records shed light on the significant influence of epidemics like Malaria on the shifting fortunes of kingdoms in Sri Lanka. These accounts underscore the critical role that infectious diseases have played in shaping the nation’s history and population dynamics throughout the ages.
The historical accounts offer a glimpse into the significance of Malaria in shaping the island’s history and underscore the importance of understanding the past to inform present-day efforts in malaria control and prevention.
Malaria, a persistent and deadly disease, has plagued humanity for centuries, causing immense suffering and claiming the lives of more than half a million people, annually. While significant progress has been made in the fight against Malaria, the world’s mortality rates for Malaria have remained relatively stagnant since 2015. However, amidst these challenges, a ray of hope emerges as the first-ever Malaria vaccine, RTS, S, begins to be rolled out to children in African countries (RTS, S/AS01 (RTS, S) is a vaccine that acts against Plasmodium falciparum, the deadliest Malaria parasite globally and the most prevalent in Africa. RTS, S is the first Malaria vaccine recommended for use to prevent Malaria in children in areas of moderate to high Malaria transmission). It’s important to explore the potential impact of new vaccines and innovative approaches to combat Malaria in Sri Lanka, considering the current Malaria landscape and the potential threats posed by climate change.
Malaria, once a significant public health concern in Sri Lanka, reached a pivotal turning point in 2012, when it was officially declared eliminated. Subsequently, in 2016, the World Health Organization (WHO) granted Sri Lanka the much-coveted certification, affirming the nation’s successful fight against the disease. This achievement culminated in meticulous planning, collaborative efforts, and dedicated expertise in Malaria control at both central and local levels.
The journey toward Malaria elimination in Sri Lanka showcased some key epidemiological features. Notably, there has been a steady decline in the incidence of Malaria cases since 1999, marking a crucial milestone in the path to eradication. Additionally, Sri Lanka witnessed the simultaneous elimination of two primary Malaria-causing parasites, Plasmodium falciparum and Plasmodium vivax, a feat that underscored the effectiveness of the country’s elimination strategies.
The success in eliminating Malaria was rooted in a well-coordinated approach. Central authorities collaborated with dedicated personnel at all levels at the national centre and on the ground in all districts for several years. This synergy of efforts formed the firm foundation upon which Sri Lanka’s elimination endeavours were built.
The historical backdrop of Malaria in Sri Lanka was riddled with a tragic chapter in the form of a massive epidemic in 1934/35. Over 1.5 million Malaria cases were reported during that devastating outbreak, leading to a staggering death toll of 80,000. However, the country’s health authorities demonstrated resilience and commitment to combat the disease in the following decades.
The significant milestone in the battle against Malaria was reporting the last indigenous case of the disease in October 2012. Remarkably, this milestone was achieved ahead of the established targets, underscoring the effectiveness of Sri Lanka’s elimination efforts. After this achievement, Sri Lanka has maintained an admirable record of zero cases of indigenous Malaria.
Despite eliminating indigenous Malaria, Sri Lanka faced new challenges in the form of imported cases. In 2018, the country reported its first case of Malaria, originating from an external source, six years after achieving elimination status. The rise in imported cases can be attributed to increased foreign labour migration from countries like India and China and an influx of tourists from various parts of the world.
This surge in external mobility introduced a setback to the elimination efforts, creating a higher vulnerability to potential malaria resurgence. Coupled with the prevailing receptivity within the country, the risk of Malaria resurgence escalated, necessitating continued vigilance and proactive measures.
Sri Lanka’s journey toward Malaria elimination is a testament to the power of strategic planning, effective implementation, and tireless dedication. While the country successfully achieved Malaria elimination in 2012 and has sustained a Malaria-free status to date, the rise in imported cases serves as a reminder that ongoing surveillance and preparedness are imperative to safeguard against potential resurgences. By upholding its commitment to Malaria control and continued vigilance, Sri Lanka remains an inspiring model for other nations seeking to combat and eradicate this tenacious disease.
The emergence of new drug-resistant strains and the potential spread of Malaria to new regions due to climate change pose fresh challenges that warrant continued vigilance.
The introduction of RTS, S, the first Malaria vaccine, brings renewed hope to the fight against this relentless disease. Developed by GlaxoSmithKline (GSK) in partnership with PATH Malaria Vaccine Initiative, the vaccine targets the Plasmodium falciparum parasite, responsible for most Malaria-related deaths. As the vaccine is rolled out to children in Africa, its efficacy and impact will be closely monitored. Should RTS, S successfully reduce Malaria cases, it could serve as a beacon of hope for countries like Sri Lanka, which have already made significant strides but remain vulnerable to resurgence. By learning from the experiences of African countries and building on their successes, Sri Lanka could potentially integrate RTS, S into its existing Malaria control programmes to further bolster protection against the disease.
Artemisinin-based combination therapies (ACTs) have long been regarded as the most effective treatment for Malaria. However, recent reports of artemisinin resistance in certain regions cause concern. The spread of resistance compromises the effectiveness of these life-saving drugs, potentially leading to increased Malaria-related fatalities. In light of this threat, researchers are working tirelessly to find alternative treatments and preventive measures. Developing new vaccines targeting the Malaria parasite at various stages of its life cycle offers a promising approach. By attacking the parasite from multiple angles, these vaccines could potentially thwart the development of resistance and ensure sustained protection against Malaria.
Beyond vaccines, researchers are exploring other innovative avenues to combat Malaria. Monoclonal antibodies, which have successfully treated various diseases, are being studied as a potential tool to prevent and treat Malaria infections. These antibodies could provide temporary immunity and act as a complement to existing preventive measures. Moreover, the concept of gene drive technology is being explored as a means to suppress or replace mosquito populations. By modifying mosquito genes to reduce their ability to transmit Malaria, this approach could offer a sustainable and environmentally friendly method of vector control. However, it is essential to consider the ethical and ecological implications of implementing gene drive technology.
The battle against Malaria has been long and challenging, but recent advancements in vaccines and innovative approaches offer hope for a brighter future. As RTS, S begins to be distributed in African countries, its potential benefits may extend to regions like Sri Lanka. By adopting an integrated approach that includes new vaccines, alternative treatments, and cutting-edge innovations, Sri Lanka can strengthen its defenses against Malaria. Nevertheless, it is vital to remain vigilant and adaptive in the face of evolving challenges to ensure that progress in the fight against Malaria remains steadfast. Together, with global cooperation and sustained commitment, we can envision a world where Malaria no longer threatens human life.
In order to achieve successful Malaria elimination in Sri Lanka, the Malaria elimination programme must take into account the intricate interplay of social and cultural factors that influence the disease. Understanding and addressing these factors are crucial for effective control measures. One of the key aspects that demand attention is people’s behaviours and practices related to Malaria prevention. Local communities’ knowledge, attitudes, and beliefs regarding Malaria transmission and prevention play a significant role in the success of control efforts. Conducting awareness campaigns and educational programmes tailored to the specific needs of different communities can foster positive behavioural changes, such as using preventive measures and seeking timely treatment.
Furthermore, attention to sleeping patterns is imperative in Malaria control. The Anopheles mosquito, responsible for transmitting Malaria, is predominantly active during the nighttime. Therefore, promoting the use of insecticide-treated bed nets and ensuring their widespread distribution can serve as a potent intervention. The exemplary case of the Kataragama-Buttala area in the 1990s, led by Professor Kamini Mendis, stands as a powerful testament to the success of bed net implementation in curbing Malaria transmission rates. This particular initiative highlighted the remarkable effectiveness of such interventions in combatting the spread of the disease.
Additionally, the Malaria elimination programme should engage with local communities to identify and address any unique challenges they may face in adopting preventive measures. Factors such as housing conditions, access to healthcare, and economic constraints can impact the feasibility of implementing control strategies. Tailoring interventions to suit the specific social and economic contexts of different regions can enhance the programme’s effectiveness and sustainability.
In conclusion, achieving Malaria elimination in Sri Lanka requires a comprehensive approach that takes into account the social and cultural dynamics of the disease. By understanding and addressing people’s behaviours, promoting preventive practices, and implementing successful interventions, like bed nets, the country can make significant strides towards its goal of a Malaria-free future.
In the event of a resurgence of Malaria, whether we should implement the RTS, S vaccine requires careful contemplation. In 2021, the World Health Organization (WHO) recommended the broader use of the RTS, S vaccine in the fight against Malaria. Subsequently, the Gavi Board approved funding to facilitate the roll-out of the Malaria vaccine in sub-Saharan Africa. This groundbreaking development marks the first-ever recommendation and support for a Malaria vaccine and represents a remarkable achievement as the world’s first vaccine targeting a parasite.
As discussed in the WHO document on Malaria free Sri Lanka, the new challenge lies in enhancing our astuteness, adaptability, and ability to strategize on the go. We must proactively identify and address potential threats from frequent travel. Our goal is to prevent the re-emergence of Malaria while remaining prepared for any unforeseen circumstances. Being proactive and forward-thinking is essential. Who can predict that amidst the lush greenery of an endemic area near human settlements, the Anopheles mosquito may lurk, waiting for an opportunity? All may seem peaceful, but this tranquility can be disrupted when an unsuspecting febrile traveller returns from overseas, relying on only mere paracetamol to combat their illness.
Features
‘Lord Edgware Dies’
It has been some time since I read an Agatha Christie, the plot of which I cannot remember. So, I was delighted to find on the shelves of a friend Lord Edgware Dies, which I had a vague memory of, but no certainty about who had done it.
When I read it, I found that my memory of who was probably the killer was correct, but I could not be certain and the red herrings Christie threw in were so diverting that until almost the very end I wondered if I had been wrong.
The plot is very simple. Jane Wilkinson, who is married to Lord Edgware, tells him that she is desperate for a divorce since she is in love with a very proper Anglo-Catholic peer, Lord Melton, but Edgware refuses to divorce her. She asks Poirot to talk to him, which he does, and is surprised to find that Edgware has told Jane he is prepared to give her a divorce. This was, after he had categorically refused, through a letter, which Jane said she had not received.
That night Edgware is murdered, after Jane had been to see him, or so the butler said, and also Edgware’s secretary. But Jane had been that evening at a grand dinner many miles away, where a dozen fellow guests could swear to her presence.
There was a solution however to the mystery of two Jane Wilkinsons, namely a skilful impersonator called Carlotta Adams who, in the opening chapter had impersonated Jane Wilkinson, who had also been at the performance. But when Poirot goes to see her, he finds that she had been found dead on the morning after Edgware had been killed, of an overdose. And in her bag was a gold case, with a strange inscription, that contained the drug, along with a pair of pince-nez.
Her maid said she had written a letter to her sister in America and posted it the previous night. Poirot asks Inspector Japp to get the letter, and a transcript is received from America, and in it the name of Edgware’s nephew Ronald Marsh is mentioned; he had taken Carlotta to dinner after her performance, with which the book opens, and had then set her a challenge. Japp arrests Marsh, but Poirot is not happy and asks for the original of the letter, which the sister sends him. That shows that a page is missing, and the tear is obvious, though that raises the question as to why it had not simply been cut.
Matters are further complicated by the fact that Marsh had gone in a taxi to the Edgware house, along with Edgware’s daughter Geraldine, in the interval of an opera which had previously seemed to provide them with cast iron alibis. Geraldine had gone in to fetch her pearls so that Marsh could raise money he needed, and thus had an opportunity to kill Edgware, as did Marsh, for the driver said he had got out of the taxi while waiting and gone into the house.
Marsh explained why he had gone to the house on the night of the murder as having followed Bryan Martin, an American actor, who had been in love with Jane, whom he saw go into the house with a key. But there was no one visible when he entered, and Geraldine almost immediately came down and they left together. And Martin too has become an object of suspicion to Poirot, for he had been to see him before the murders were discovered with a story of being followed by a man with a gold tooth – a story Poirot immediately realized was false when he was asked how old the man was, and was told he was young, for young people did not have gold teeth.
A heap of French money Edgware had got for a trip to Paris was missing, but since Marsh had no need for it after his cousin’s offer of help, Poirot deduces that it must have been taken by the butler, who has disappeared. Christie has stressed that he is astonishingly handsome, unusual in a butler, and Poirot notes a resemblance to Martin, so he thinks the mysterious man going into the house must have been him.
Incidentally, later Poirot assumes that Edgware’s change of mind was because he was involved in some scandal, and I believe Christie intends us to see the cause of this in his handsome butler, though this is not specified.
Meanwhile, Poirot has asked Japp to find out the provenance of the case found in Carlotta’s handbag, and it turns out to have been made in Paris, specially commissioned, and collected by a woman with pince-nez.
But then another murder occurs—that of another guest at the grand dinner, which provided Jane with her alibi. The victim is an actor who had been bemused when Jane, at a lunch, thought the Judgment of Paris referred to the city. He told Hastings he wanted to see Poirot, but was killed before he could get to the appointment. Poirot had rushed there when told about his request, but it was too late.
Meanwhile, Poirot has tried out the pince-nez on Edgware’s secretary, but she could not see through these. It was only a chance remark heard outside the theatre that led him to try them out on Wilkinson’s maid Ellis, a spare pair that had been appropriated for the night of the murders.
Poirot then lays things out, having summoned Martin and told him that he probably suppressed Edgware’s letter, as he had been dropped by then and he did not want Jane to marry another. But after teasing Martin, Poirot says that Jane was in fact the murderer, and she got Carlotta to impersonate her at the dinner while she went to the house and killed her husband. After meeting Carlotta later and checking with her through a call that she had
not been rumbled, Jane had gone ahead with the murder – she put veronal into her drink and the case with veronal into the handbag. She forgot to take out the pince-nez she had used earlier to imitate an American. Carlotta had registered as the American in a hotel and Jane had gone to see her, and there they exchanged identities. After seen the letter, she made use of it by tearing off the page that referred to her, and the S of She, so that the person who had challenged Carlotta to impersonate her seemed to be a man.
There is a coda in which Jane, condemned to death, writes to Hastings, still full of pride at her ingenuity hoping she will be remembered.
Features
Desilt reservoirs, learn from our ancient irrigation systems
by Prof. O. A. Ileperuma
Silting of reservoirs is a major problem today affecting our hydropower production and irrigation systems. The main Mahaweli reservoirs are silted to a considerable extent reducing the water holding capacity of them. Due to poor soil management practices, floodwaters deposit large amounts of silt in these reservoirs. When the Polgolla reservoir was fully drained about two years back, one could see mountains of silt in the lower reaches of the reservoir. A rough estimate is that 50% of the total capacity of these reservoirs has been lost to siltation. This is a serious issue which affects not only power and agriculture but also flood control.
Our ancient irrigation systems ensured that desilting of reservoirs took place under royal decree where all users of the reservoirs were ordered to carry out desilting of reservoirs during the dry season. The clay thus collected was used in making bricks for the construction of great stupas which dot the landscape of our ancient kingdoms. This ensured that the reservoirs had their full capacity filled with water for the next cultivating season. Our ancient kings were clever enough not to construct reservoirs by blocking main rivers such as the Mahaweli. A classic example is the Minipe left canal where they tapped only the surface water of Mahaweli. Even the bigger tanks such as Nuwara Wewa and Parakrama Samudraya were fed with minor rivulets. There were also other ingenious features in the cascade irrigation systems built by the ancient kings, such as mud sluice canals and forest reservations between the reservoirs in the cascade system. These reservations helped trap silt and remove excess nutrients, which could otherwise contribute to increasing salinity as water flowed from one reservoir to another.
- Parakrama Samudraya
- Kalawewa
- Kotmale
A classic engineering marvel is the former Yoda Ela, which carries water from Kalawewa to Nuwara Wewa and Tissa Wewa. It is 87 km long although the straight distance between these points is only about 40 km. The gradient of this canal is about 10 cm per km or 6 inches per mile. Yodha Ela functions as a moving reservoir and feeds about 4,600 hectares of paddy lands. It is a winding canal with about 120 smaller reservoirs on its way. It was constructed during the reign of King Dhatusena around 459 AD and later expanded by King Parakramabahu by connecting more reservoirs to the network. Unfortunately, during the Mahaweli project our modern-day engineers constructed a concrete canal replacing the winding path of this Yoda Ela also called Jaya Ganga. This effectively removed the ability of the old Yoda Ela to remove silt and nutrients. The bank of this Ela has wet zone trees such as jak and areca nut growing well. They take up the nutrients from the flowing stream making the water suitable for irrigation later.
Ancient Mesopotamian civilisations depended on dams constructed along the two main rivers, Euphrates and Tigris. After continuous irrigation of their fields over several thousand years, salinity of the irrigated lands increased making them unsuitable for agriculture. People died due to famine and this clearly illustrates the danger of blocking main rivers for agriculture. There is scientific evidence that the salinity of paddy soils in the Mahaweli C area is increasing.
We saw the devastation caused by Cyclone Ditwah. The sluice gates of the Kotmale Reservoir were opened, and Kandy and Peradeniya were flooded. If the reservoir had had greater storage capacity, couldn’t the opening of the gates have been delayed? This may not be an argument that modern-day engineers would readily accept, and I am not an irrigation expert. These ideas may well be naïve. But most of us tend to think of reservoirs mainly in terms of hydropower generation and irrigation, while their role in flood control receives much less attention. The question therefore deserves serious consideration. Could restoring lost reservoir capacity through desilting help improve our ability to manage extreme rainfall and reduce flood risks?
Desilting our reservoirs should be considered a national priority.
Features
Losing out to Ethiopia
Export diversification – Missing the wood for the trees – Part III
by Gomi Senadhira
In Sri Lanka, the word “Ethiopia” is often used as disparaging slang to describe individuals or areas experiencing extreme poverty, starvation, or severe economic hardship. This linguistic habit originated in the 1980s with the Western media coverage of the devastating Ethiopian famine of 1983-85. That media coverage shocked the world but also left an outdated and offensive global stereotype that the country is permanently starving. Much has changed since then. By now, with an annual growth rate of around 9%, it is the fastest-growing economy in sub-Saharan Africa. Ethiopia has also emerged as a highly competitive exporter and is challenging not only its competitors in the region but also countries like Sri Lanka. This article is on how Sri Lanka has lost ground to Ethiopia (and a few other countries) in the GCC markets for agricultural and floricultural products.
Sri Lanka – A Pioneer in the Agriculture and Floricultural Market in the GCC
As discussed in Part II of this article, by the mid-1980s Sri Lanka had established a strong foothold in the GCC’s fruit, vegetable, and floricultural market. Geographical proximity and well-established shipping and air links gave Sri Lanka a strong comparative advantage over Southeast Asian and African nations. Thailand, Vietnam, and Kenya were not even in the market. At that time, Ethiopia was experiencing (as BBC news reports described) “a biblical famine”.
The market was not very large, but it was lucrative and growing. Trade Minister Lalith Athulathmudali as well as the Chairman of the Export Development Board, Victor Santiapillai, who visited Kuwait (and the GCC countries), recognised the market potential for these products and encouraged us to continue with our work. The minister was particularly keen to further develop links between the market for these products, exporters, and his Export Production Villages (EPVs). So, it was becoming a successful case not only for export diversification but also for transferring gains from exports directly to rural households.
From Trailblazer to Tailender
As a result, even by the beginning of this century Sri Lanka had a larger market share than most of its competitors from Asia or Africa. But since then, our competitiveness has weakened significantly. The tables below provide a comparative snapshot of Sri Lanka’s performance vis-à-vis Thailand, Vietnam, Kenya and Ethiopia in the GCC market for vegetables, fruits and floricultural products. As illustrated therein, in 2001 Sri Lanka was ahead of Thailand, Kenya and Ethiopia in this small but rapidly growing market. Since then, we have fallen behind Thailand, Kenya and many other countries in that lucrative market. If this trend continues, Sri Lanka will fall behind Ethiopia within the next few years. (See Table 1)
In the GCC market for vegetables (covered in HS chapter 07), Sri Lanka was ahead of most other competitors in 2001. As illustrated in Table 1 , Sri Lanka had failed to develop this market, while Thailand, Kenya, and even Ethiopia had very efficiently increased their market shares. The GCC is a market to which Sri Lanka can supply some vegetables, like cabbages, by sea. It appears Sri Lanka had also failed to exploit this mode of supply.
We can see a similar trend in the market for fruits. Vietnam, Kenya, and Thailand have emerged as major players, while exports from Sri Lanka have staggered on slowly. In this segment, Vietnam has emerged as a leading player during the last twenty years and the GCC imports from Viet Nam have shot up from US$44 thousand in 2001 to US$346 million by 2024. In part one of these articles, I discussed the remarkable increase of jackfruit exports from Vietnam “…just $3 million in 2015 to an impressive $236.8 million in 2023” while most of our jackfruit production rots under the trees. This explains how countries develop their markets, geographically and product-wise. (See Table 2)
Sri Lanka’s performance has been weakest in the market for floricultural products (HS Chapter 06), which groups live trees, cut flowers, and ornamental foliage. When we first entered the market in the 1980s, the market was dominated by the Netherlands, and Kenya and Ethiopia were not even in the market. At that time, we identified the Gulf states as a market where Sri Lanka could have a dominant presence due to geographical proximity. Even in 2001, Sri Lanka was ahead of Kenya, Ethiopia, and Thailand. But by now, Kenya has emerged as the dominant supplier. Ethiopia is also expanding its market share and is the third-largest exporter. (See Table 3)
Missing the Wood for the Trees
In the mid-1980s, Sri Lanka first established its foothold in the GCC market. Since then, Thailand, Vietnam, Kenya, and even Ethiopia have moved well ahead of us and have become leading players. Why did we lag behind in our export diversification efforts in general and, more particularly, in the GCC market?
The reasons are very clear. After the initial attempts in the 1980s and early 1990s, Sri Lanka has not been proactively involved in identifying, developing, and promoting new products and markets, or protecting and further developing new markets already established. The focus has simply been on traditional exports: tea, coconut, cinnamon, and garments, while other products were almost ignored. In essence, we have been and continue to focus intensely on a narrow group of products and markets, and we have lost sight of the bigger picture.
(The writer can be reached at senadhiragomi@gmail.com)
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