São Tomé and Príncipe has made significant progress in the fight against malaria. In the past five years, the country has recorded only two malaria-related deaths. During the first quarter of 2025, there were 1,293 reported cases of malaria but no fatalities. The Autonomous Region of Príncipe, the smaller of the two main islands, reported only three cases of malaria by March 2025, a decrease from nine cases during the same period the previous year.
Building on this success, the National Malaria Elimination Programme (PNEP), with support from the World Health Organisation (WHO), is actively working to raise community awareness and maintain momentum in the effort to eliminate malaria.
António de Oliveira is a community health worker from Praia das Burras, situated on the northern coast of Príncipe Island. He began his career in this role at the age of 19 and, at 56, serves as the primary health contact for his community as well as three neighbouring ones. Working from a modest community post, he conducts initial malaria screenings and treats mild cases while referring more severe cases to the regional hospital. In January 2025, he identified a malaria case in his community. "Whenever someone has a fever, body aches, or feels unwell, I always perform a rapid diagnostic test to rule out malaria. In one instance, when a person who had been experiencing fever at home for several days tested positive, I immediately called an ambulance to take them to the hospital," Oliveira explains.
Bem Vindo, a nurse in the Autonomous Region of Príncipe, outlines the protocol after a positive diagnosis: "As a community health worker, we visit the patient's home to identify mosquito breeding sites and areas of stagnant water. We also provide preventive medication to family members, conduct tests, and spray the house if needed." Oliveira is dedicated to raising awareness in his community about maintaining proper household and environmental hygiene, emphasising the importance of draining stagnant water and using mosquito nets. “Every morning, I check to ensure that the areas are clean and discuss preventive measures with residents. Only through everyone's active participation can we eliminate this disease,” he states.
Dr Wilson Soares, the Acting Regional Delegate in the Autonomous Region of Príncipe, reported that from 2018 to 2020, the region recorded no indigenous cases of malaria. This success positioned the island as a key player in the malaria elimination strategy aimed for 2025. Jairson Rosário, 28, a resident of Praia das Burras, recalls, "I can't remember the last time I had malaria. It was a long time ago, but we always sleep under mosquito nets at home. Better safe than sorry." While the enhanced malaria control measures have shown positive outcomes, contributing to São Tomé and Príncipe's inclusion in the WHO's E2025 initiative for potential elimination by 2025, a recent rise in malaria cases has hindered progress. The region has seen an average of 15 to 30 cases each year, with 34 cases reported in 2024.
"People have lost their immunity to the disease, and without preventive measures like house spraying, the use of treated mosquito nets, and improved environmental hygiene and sanitation, the disease is becoming more prevalent," explains Dr. Didiena Vilhete, coordinator of PNEP.
“We are making significant efforts to halt the spread of the disease. While we may not meet our initial target for 2025, we are committed to enhancing our response to prevent new cases on Principe Island, aiming to eliminate malaria by 2027,” states Dr. Soares. "We have access to medicines, insecticides, a reactive treatment strategy, and the necessary human resources to address cases. Additionally, we are focused on increasing awareness and communication among local policymakers, communities, and health professionals. This is our path to defeating malaria in the Autonomous Region of Príncipe," he adds.
With support from the WHO, the country has developed a new plan for 2023–2027 aimed at eliminating indigenous malaria cases in Caué and five other districts in São Tomé, as well as in the Autonomous Region of Príncipe, by 2027. Jessica Veiga Soares, head of public health and disease control at WHO in São Tomé and Príncipe, states, “Achieving this goal requires strengthening disease surveillance, implementing a robust monitoring and evaluation strategy, ensuring high-quality laboratory diagnostics, providing appropriate treatment for all malaria cases, and executing integrated vector control interventions. Additionally, it is crucial to engage the entire community through social mobilization, communication, and training.”
In keeping with its commitment to eradication, the National Malaria Control Programme has been renamed the National Malaria Elimination Programme. This new initiative features revised strategies that emphasise targeted and reactive interventions, along with epidemiological milestones at the national level, beginning in the Autonomous Region of Príncipe and the Caué district before expanding to other areas. "In this effort, WHO reaffirms its dedication to assisting the country in implementing evidence-based strategies to expedite malaria elimination and realize the goal of a malaria-free future," states Veiga Soares.
