Introduction: A landmark achievement with global relevance
On October 13, 2025, the World Health Organization (WHO) celebrated a historic milestone: the Republic of Maldives became the first country to eliminate mother-to-child transmission (EMTCT) of HIV, syphilis, and Hepatitis B virus (HBV). This validation, endorsed by the WHO Director-General after rigorous review, marks the first time a nation has reduced the vertical transmission of all three infections to levels no longer considered a public health problem. While several countries have achieved single or dual eliminations, the Maldives’ triple triumph showcases what is possible with integrated, data-driven health systems and a steadfast commitment to equity.
Vertical transmission and social justice
Vertical transmission—pregnancy, delivery, or breastfeeding-related infection transfer—poses a profound ethical challenge. Preventing it is not only a medical obligation but a moral imperative that reflects social justice. Eliminating transmission reflects fairness across gender, geography, and class and requires strong antenatal care, universal screening, timely treatment, and public protection for mothers and their babies.
Three infections, one strategic goal
HIV, syphilis, and HBV share a common objective: prevent infection in newborns. HIV can be dramatically curtailed with timely antiretroviral therapy, reducing infant infection risk to well below 2%. Syphilis is preventable through early screening and penicillin treatment to avert miscarriage, stillbirth, or congenital infection. HBV transmission at birth can be prevented by immediate birth-dose vaccination and hepatitis B immunoglobulin. The Maldives achieved triple elimination by integrating these interventions into a single, coordinated maternal-child health platform while maintaining rigorous performance monitoring.
The WHO validation process: a framework for lasting success
The validation process is multi-layered. A national validation committee compiles data on testing, treatment, and vaccination coverage. The regional validation committee conducts site assessments and laboratory quality audits. The Global Validation Advisory Committee reviews findings and makes a formal recommendation to the WHO Director-General. Even after validation, ongoing verification every three years for HIV and syphilis and every five years for HBV ensures the durability of elimination. The Maldives’ case provides a replicable blueprint: set strict targets, ensure data integrity, and maintain continuous program integration.
Lessons for India: how to translate scale and discipline
India faces substantial public health burdens: thousands of pregnant women with syphilis and HIV, and millions living with HBV across the region. The WHO Southeast Asia estimates highlight ongoing needs and the risk of congenital infections. India does not need to copy Maldives’ centralized system to resemble its success; rather, it should adapt the core principles:
- Targeted, geography-led implementation: Focus first on sub-populations and regions with the highest burden, such as select island-like territories or districts with higher rates of HIV, syphilis, and HBV.
- Integrated service delivery: Combine HIV, syphilis screening, HBV vaccination, and maternal care into a single contact point at ANC visits to reduce missed opportunities.
- Data-driven accountability: Establish robust monitoring to track screening, treatment, vaccination coverage, and vertical transmission outcomes at the district level.
- Ethical, non-stigmatizing communication: Embrace inclusive terminology that emphasizes parent-to-child transmission where appropriate, recognizing that infection management involves multiple caregivers and partners.
- Scaled, staged milestones: Pursue elimination step by step—districts first, then states, then a national objective—while maintaining adaptable strategies for diverse contexts.
Language, dignity, and global ethics
India’s linguistic and cultural context matters in public health messaging. The shift toward inclusive terminology—acknowledging that responsibility for transmission rests with families and communities as a whole—not only reduces stigma but also enhances engagement with testing and care. The Maldives example, coupled with India’s emphasis on respectful, community-centered health communication, can help align clinical goals with social justice.
Global and moral imperative
Triple elimination signals that ambitious public health goals can become realities through integrated programming, rigorous verification, and sustained political will. For India and other high-burden settings, the Maldives case offers a pragmatic blueprint: pursue evidence-based strategies, prioritize vulnerable populations, and maintain transparent accountability. Every infection prevented changes a life course and upholds the dignity of mothers, children, and their families.
