 "Maldives Triple Elimination")
The Maldives has made global public health history by becoming the first country validated by the World Health Organization (WHO) for achieving triple elimination of mother-to-child transmission (MTCT) of HIV (Human immunodeficiency viruses), syphilis and hepatitis B.
The country was first validated by WHO in 2019 for eliminating mother-to-child transmission of HIV and syphilis. With its latest validation for hepatitis B, it has now completed the full ‘triple elimination’ milestone.
“Maldives has shown that with strong political will and sustained investment in maternal and child health, elimination of mother-to-child transmission of these deadly diseases, and the suffering they bring, is possible,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. “This historic milestone provides hope and inspiration for countries everywhere working towards the same goal,” he said, congratulating the nation.
What does ‘triple-elimination’ mean?
Across the WHO South-East Asia Region, mother-to-child transmission of HIV, syphilis and Hepatitis B remains a major public health challenge. To tackle this, WHO launched the Triple Elimination Initiative – a unified strategy to end MTCT of HIV, syphilis and Hepatitis B. It integrates HIV, STI, immunisation, and maternal health services, focusing on people-centred care to ensure every woman and child receives essential support, from antenatal screening and treatment to the Hepatitis B birth-dose vaccine.
It’s important to note that ‘elimination’ does not mean zero cases forever, but that transmission has fallen to very low, sustainable levels backed by strong testing, treatment and surveillance systems.
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WHO said the Maldives’ success marks a major step towards its 2030 goal of ending such preventable infections in children. “This landmark feat is an important step towards ‘Healthy Beginnings, Hopeful Futures,’ for improving maternal and newborn health by ending preventable deaths and prioritizing long-term well-being.” said Dr Catharina Boehme, officer-in-charge, WHO South-East Asia Regional Office.
What is mother-to-child transmission?
Mother-to-child transmission (MTCT) is the transfer of an infection from a mother to her child during pregnancy, childbirth, or breastfeeding. However, with timely and comprehensive interventions, the risk can be substantially reduced.
Without timely intervention, the risk of a mother living with HIV transmitting the virus to her child during pregnancy, delivery or breastfeeding ranges from 15 to 45 per cent. For Hepatitis B, mothers with active infection face a high likelihood of passing the virus to their babies unless preventive measures are taken. In the case of syphilis, untreated infection during pregnancy can result in foetal loss, stillbirth, congenital infection, or serious infant complications.
Preventing MTCT protects newborns from lifelong infections and associated complications.
How does WHO validate elimination?
To receive WHO validation, a country must meet strict thresholds for infection rates and demonstrate:
- Sustained low transmission for at least two years
- Reliable laboratory systems and data reporting
- Near-universal antenatal screening and treatment access
- Integrated, equitable healthcare delivery
How did Maldives achieve it?
Universal antenatal screening for all pregnant women, free treatment and vaccination programmes like Hepatitis B vaccine at birth, strong data systems for tracking and followup, community-level healthcare by using midwives, outreach, and counselling, government commitment and donor partnerships, especially with WHO, Unicef, and UNAIDS
Health officials credit a comprehensive maternal and child health strategy, including:
- Universal antenatal screening for all pregnant women
- Free treatment and birth-dose vaccination for Hepatitis B
- Community-based healthcare through midwives, outreach and counselling
- Strong data tracking for mother–infant pairs
- Consistent government commitment and global partnerships with WHO, UNICEF and UNAIDS
“The Maldives’ triple elimination stands as a powerful example of how sustained investment in health systems, innovation, and community-based care can change the trajectory of public health,” said Ms Payden, WHO Representative to Maldives.
Other nations such as Sri Lanka and Thailand have previously achieved dual elimination of HIV and syphilis.
The Maldives now leads the way in WHO’s broader Triple Elimination Initiative, part of the UN Sustainable Development Goals (SDG 3) to end preventable child deaths and infections by 2030.
What can India learn from it?
India has reduced but not yet eliminated mother-to-child transmission (MTCT).
Public-health experts stress the need to integrate HIV, Hepatitis B and syphilis services within routine maternal care, backed by stronger data tracking and community counselling. Countries aiming for triple elimination should ensure the following essential services, as outlined by WHO:
- Testing for HIV, syphilis and Hepatitis B during antenatal care
- Prompt treatment for women who test positive
- Counselling for women and their partners
- Safe, well-attended deliveries
- Follow-up of exposed infants, including the Hepatitis B birth-dose vaccine
- Optimal infant feeding practices
- Lifelong care for mothers living with HIV or under treatment for Hepatitis B or syphilis
WHO also emphasises integrating MTCT prevention into broader maternal, newborn and child health programmes, a step that could help India move closer to the Maldives’ milestone. For more health updates, follow #HealthwithBS
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