Catalyzing the Elimination of Malaria and Lymphatic Filariasis from the Caribbean

Calling the International Community to Action
In September 2008, The Carter Center, in partnership with the Dominican Republic and Haiti, launched a historic 18-month initiative to help the two countries and their other partners accelerate the elimination of two devastating mosquito-borne infections — malaria and lymphatic filariasis — from Hispaniola. The only island in the Caribbean that still has malaria, Hispaniola also contains more than 90 percent of all lymphatic filariasis remaining in the Americas. Both diseases are more prevalent in Haiti than in the Dominican Republic.

All  Photos: Carter Center (Click to enlarge)

The Dajabón or Massacre River is a natural border between the Dominican Republic and Haiti and is the focus of an 18-month Carter Center initiative to accelerate the elimination of malaria and lymphatic filariasis from the island of Hispaniola. With assistance from The Carter Center, the nations' health officials will target malaria in two border towns joined by a bridge over the Dajabón or Massacre River: Dajabón, Dominican Republic (pop. 27,000), and Ouanaminthe, Haiti (pop. 92,000). The towns constitute the most important commercial exchange area on the Haiti-Dominican border. Lymphatic filariasis and malaria was targeted through a smaller project in a third town in Haiti, Trou-du-Nord (pop. 40,000).

The initiative stems from a 2006 recommendation of the Carter Center's International Task Force for Disease Eradication (ITFDE) — a group of 12 global experts on infectious disease — that it is "technically feasible, medically desirable, and would be economically beneficial," to eliminate these two parasitic diseases from Hispaniola. Since then, the binational project has broken new ground in collaborations between these two countries for the betterment of public health on the entire island. (Read the 2008 Carter Center Press Release: Carter Center Launches Effort to Spur Elimination of Malaria and Lymphatic Filariasis in Haiti and the Dominican Republic.)

Malaria and lymphatic filariasis are costly economic burdens, as both diseases are caused by — and create — additional poverty. An outbreak of malaria on the island in 2004 cost the Dominican Republic an estimated US $200 million in lost revenue from tourism. Since then, two transient outbreaks of malaria in the Bahamas and another in Jamaica have been imported from Hispaniola, which also is the source of several cases of malaria imported to the U.S. each year. View flier "How To Use a Mosquito Net" (Spanish/PDF) >

Building Hope Across Borders

With assistance from The Carter Center, the nations' health officials targeted malaria in two border towns joined by a bridge over the Dajabón, or Massacre, River: Dajabón, Dominican Republic (pop. 27,000), and Ouanaminthe, Haiti (pop. 92,000). The towns constitute the most important commercial exchange area on the Haiti-Dominican border. Lymphatic filariasis and malaria were targeted through a smaller effort in a third town in Haiti, Trou-du-Nord (pop. 40,000).

The Carter Center initiative purchased insecticide-treated bed nets, microscopes, computers, motorbikes, and other materials; funded additional health staff in the three targeted communities; and provided technical assistance. Funding was channeled via the National Center for Control of Tropical Diseases, an agency of the Dominican Republic's Ministry of Public Health and Social Assistance, and the Centers for Development and Health, a Haitian nongovernmental organization working directly with the Haitian Ministry of Public Health and Population.

Through these efforts, the technical objectives of the binational project have been met:  the countries have developed a standard protocol and procedures, including free diagnosis and treatment of malaria; primaquine has been added as a tool for treatment of malaria; and surveillance and use of microscopy to confirm diagnosis of malaria has been intensified.

With support from The Carter Center, the Dominican Republic and Haiti have prepared binational plans to complete elimination of both the diseases from the island.

In October 2009, former U.S. President Jimmy Carter led a Carter Center delegation to the Dominican Republic and Haiti to underscore — and stimulate international support for — the binational plan to complete elimination of both diseases from Hispaniola.  The delegation also included former First Lady Rosalynn Carter, Carter Center President and CEO Dr. John Hardman, Vice President of Health Programs Dr. Donald Hopkins, and Malaria Control Program Director Dr. Frank Richards.

Elimination efforts continue in 2012 with Carter Center support of a series of four binational meetings on the issue with participants from: The Carter Center, the technical teams of the National Center for Tropical Disease Control, the Dominican Republic's Ministry of Health, the National Malaria Control Program of the Haitian Ministry of Health, the Panamerican Health Organization, and the U.S. Centers for Disease Control and Prevention.

Read the press release: The Dominican Republic and Haiti Continue Plans to Eliminate Malaria and Lymphatic Filariasis on the Island by 2020 >

Read the Global Health Magazine Expert Article: The Allure of Eradication (PDF) >

Read the New York Times Feature: Haiti and Dominican Republic Urged to Fight Mosquito Illnesses Together >

Read  the Voice of America article: The Carter Center Works to Eradicate Malaria in Haiti, Dominican Republic >

Malaria, a major cause of death for young children and pregnant women, causes incapacitating fevers and flu-like symptoms. It occurs nationwide in Haiti, and in the Dominican Republic, malaria is concentrated in 14 of 155 municipios (counties). It can be eliminated from Hispaniola because: the parasite is still sensitive to chloroquine (a safe and inexpensive antimalarial drug); the local mosquito vector (Anopheles albimanus) is relatively inefficient in transmitting the infection; the lethal predominant parasite (Plasmodium falciparum) has no dormant phases; the two ministries of health and their partners are supporting indoor residual spraying and distribution of long-lasting insecticidal nets; and all other Caribbean islands already have eliminated the infection.

Lymphatic filariasis, especially in Haiti, is tightly intertwined with poverty, which is both a contributing cause and a result of the disease. Although not fatal, lymphatic filariasis is a debilitating disease that causes severe swelling in the limbs and genitals, which often devastates victims socially, emotionally, economically and physically. A nationwide survey in 2001 found that lymphatic filariasis affected more than five percent of the population in most of Haiti's communes (counties). In the Dominican Republic, lymphatic filariasis is far less of a problem, and the national program expects to stop lymphatic filariasis transmission in 2010. Lymphatic filariasis can be eliminated on the island because the parasite (Wuchereria bancrofti) transmitted by a mosquito has no animal reservoir, and the infection can be treated safely and inexpensively with diethylcarbamazine (DEC) and albendazole, donated by GlaxoSmithKline.