Plague is endemic in Madagascar. On average 400 cases of bubonic plague are reported yearly, and the disease is most prevalent in the rural areas, especially the central highlands. Plague season runs from September to April.
A deadly plague epidemic affected both the country’s endemic and non-endemic areas—including the capital Antananarivo and port city, Toamasina in 2017-2018. A total of 2676 cases of both pneumonic and bubonic plague in 57 out of 114 districts was reported, including 225 deaths. After the epidemic, Madagascar’s ministry of health organized an After Action Review (AAR) using standardized WHO methodology to improve preparedness and response.
The AAR took place in July 2018 in preparation for the next plague season. By identifying challenges and incorporating best practices, it prompted calls for 23 priority actions. Implementation started immediately with the support of Resolve to Save Lives through WHO and other partners.
From 19 August 2018 to 21 April 2019, the new plague season occurred in Madagascar. Only 257 isolated cases of plague were reported including 50 deaths from 28 districts.
A post AAR follow-up mission was organized in May 2019 by WHO to document progress made. Out of the 23 priority actions identified during the AAR, 18 were implemented. The health ministry and partners acknowledged the importance of early action and its contribution to reducing the burden of plague in Madagascar. Nine of the priority actions aligned with recommendations from a Joint External Evaluation (JEE) conducted in July 2017.
Post-AAR activities supported by WHO include: coordination of plague response by the development of the national contingency plan for epidemics and pandemics; the strengthening of regional plague coordination committees (Groupe Intersectoriel d’Appui à la Lutte contre la Peste : GIALP); development/implementation of data management procedures for both national and district levels; standard operating procedures for case management and infection, prevention and control; control at points of entry; and the reinforcement of capacity with more than 156 community health workers for vector control and reservoir management.