Zanzibar’s last mile fight: Can the Islands eliminate malaria for good?

ZANZIBAR: FOR decades, malaria was a constant threat across Zanzibar’s islands, filling hospitals, disrupting livelihoods and claiming lives, especially among children and pregnant women.

Today, the story is dramatically different. From a staggering prevalence of nearly 40 per cent in the late 1990s, Zanzibar has reduced malaria to just 0.04 per cent.

It is a public health success story often cited across Africa.

Yet, as health experts caution, the final stretch, eliminating malaria completely, may prove the hardest.

“We are now in the most critical phase,” says Dr Slim Salim, Director of Preventive Services.

“Malaria is no longer widespread, but that does not mean it is gone.”

This paradox defines Zanzibar’s current battle: fewer cases, but greater risk of resurgence.

With infections now extremely low, health authorities are focusing on what experts call the “last mile,” identifying and eliminating the remaining pockets of transmission.

Data shows that malaria is no longer evenly distributed. Instead, it is concentrated in specific hotspots such as Urban West and North A districts.

In fact, more than half of all reported cases come from Urban West alone.

Young adults aged 15 to 45, particularly men working in outdoor jobs like fishing, construction, and transport, are now the most affected group.

Their exposure to mosquitoes during evening and night hours increases their risk. This shift has forced a rethink of traditional malaria strategies.

New tools for a new phase

Zanzibar is now embracing innovation to tackle the disease more precisely.

One of the most notable strategies is the planned deployment of drones to spray larvicides in stagnant water, targeting mosquito breeding grounds that are often difficult to reach.

At the same time, the government has established the Zanzibar END Malaria Council, a high-level platform designed to mobilise domestic funding and sustain the fight beyond donor support.

Community-based interventions are also being expanded. Health workers are increasingly deployed at grassroots level to test, treat and track malaria cases in real time.

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“We cannot rely on old methods alone,” says Dr Shija Joseph Shija of the Zanzibar Malaria Elimination Programme (ZAMEP).

“The strategies must evolve with the changing nature of the disease.”

Zanzibar’s progress has been supported by strong partnerships with international organisations.

A key initiative currently underway is the Malaria Elimination in Zanzibar (MEZA) project.

Funded by the Bill & Melinda Gates Foundation with $4.5 million, the project runs from 2024 to 2027 and focuses on strengthening surveillance, improving data use and building local leadership.

Implemented in collaboration with Population Services International and the Swiss Tropical and Public Health Institute, MEZA aims to close the remaining gaps in malaria control.

One of its priorities is preventing imported cases, an increasingly important issue as Zanzibar remains a major tourist destination and trade hub.

Ironically, success itself has created a new challenge: complacency.

A hidden danger: Complacency

With fewer visible cases, many people no longer perceive malaria as a serious threat. Health officials warn this mindset could reverse years of progress.

“Even one untreated case can lead to an outbreak,” Dr Salim explains.

“That is why vigilance is essential.” The lack of symp – toms in some infections further complicates detection, allowing the disease to spread silently within communities.

Experts agree that eliminating malaria will depend not only on government action but also on community behaviour.

Simple measures, using mosquito nets, clearing stagnant water, seeking early treatment, remain critical.

Yet adherence has weakened in some areas. Public awareness campaigns are now targeting behavioural change, particularly among high-risk groups such as youth and outdoor workers.

The message is clear: malaria elimination is everyone’s responsibility.

Despite the challenges, there are strong reasons for optimism. Malaria-related deaths have dropped significantly, from 29 in 2023 to just nine in 2025, with no deaths reported in early 2026.

This steady decline reflects improvements in diagnosis, treatment, and prevention.

Moreover, Zanzibar’s goal of eliminating malaria, especially in Pemba, where cases are already minimal, appears increasingly within reach.

The road ahead As Zanzibar marks World Malaria Day (April 25) under the theme: “Driven to End Malaria: Now We Can. Now We Must,” the message from health leaders is both urgent and hopeful.

The theme Developed by the World Health Organisation (WHO) and the RBM Partnership to End Malaria, this theme highlights that, with new vaccines, tools, and treatments, eliminating malaria is possible within our lifetime if action is taken immediately. Eliminating malaria is no longer an impossible dream.

But it demands sustained commitment, innovation, and collective responsibility.

“Accountability is key,” Dr Salim emphasises.

“Government, health workers, and communities must all play their part.”

If successful, Zanzibar could become one of the few places in Africa to eliminate malaria, offering a powerful model for others to follow.

But until the last case is gone, the fight continues.