Maldives First Country to Achieve ‘Triple Elimination’ of Congenital HIV, Syphilis and Hepatitis B

The Maldives has become the first country in the world to eliminate the mother-to-child transmission (EMTCT) of HIV, syphilis and hepatitis B, according to a news release from the World Health Organization (WHO). This latest WHO validation recognizes the EMTCT of hepatitis B. The country has maintained its WHO validation for the elimination of congenital HIV and syphilis since 2019.

The WHO gives validation to countries who meet the standards of the Triple Elimination framework, a global, WHO initiative that aims to end vertical transmission by 2030.

The Maldives, the archipelagic South Asian country located in the Indian Ocean, is part of the WHO South-East Asia Region of 10 countries, including India, Thailand and the Democratic People’s Republic of Korea.

In 2022 and 2023, no babies in the Maldives were born with HIV, syphilis or hepatitis B. This elimination can be attributed to universal healthcare, supported by investment of over 10% of GDP in health, according to the news release. Benefits include free prenatal care, plus vaccine and diagnostic services for all residents, including migrants.

Specifically, more than 95% of pregnant women in the Maldives receive prenatal care, which involves almost universal testing for HIV, syphilis and hepatitis B. Additionally, more than 95% of newborns receive a birth dose of the hepatitis B vaccine and go on to receive full vaccine coverage.

Mother-to-child transmission of HIV, syphilis and hepatitis B affects millions of people worldwide. In the WHO South-East Asia Region alone, in 2024, more than 23,000 pregnant women had syphilis, resulting in more than 8,000 cases of congenital syphilis. Approximately 25,000 HIV-positive pregnant women received HIV treatment to prevent transmission, while 42 million people had hepatitis B.

Without treatment, mother-to-child transmission can be highly deadly.

HIV

Approximately 1.3 million women and girls with HIV become pregnant each year, according to the WHO. Without treatment, there is a 15 to 45% chance it will be passed to the child during pregnancy, breastfeeding, labor or delivery.

In resource-limited countries such as South Africa, approximately 53% of infants with congenital HIV will die before the age of two.

Syphilis

Syphilis is one of the most common sexually transmitted infections worldwide, responsible for approximately 6 million cases annually. During pregnancy, it can be easily treated with antibiotics, preferably before the second trimester. However, if left untreated, the outcome can be deadly. For example, in 2022, there were an estimated 700,000 congenital syphilis cases worldwide, resulting in approximately 390,000 adverse birth outcomes, including 150,000 early fetal deaths and stillbirths and 70,000 neonatal deaths.

Hepatitis B

Hepatitis B is a viral infection of the liver. Infection in infancy or childhood leads to chronic hepatitis B approximately 95% of the time, which can lead to liver cancer or death from cirrhosis. The most effective form of prevention for infants is a vaccine given shortly after birth, followed by boosters a few weeks later.

"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,” Tedros Adhanom Ghebreyesus, Ph.D., WHO Director-General, said in the news release. “This historic milestone provides hope and inspiration for countries everywhere working towards the same goal.”