Carving a path from Maldives to India
On October 13, 2025, the World Health Organization confirmed that the Republic of Maldives became the first country to eliminate mother-to-child transmission (EMTCT) of HIV, syphilis, and Hepatitis B. While Maldives’ population is small and geographically discreet, the core principles behind its achievement offer actionable lessons for India’s vast and diverse public-health landscape. The goal is ambitious: prevent vertical, or parent-to-child, transmission of three infections that together shape maternal and child health outcomes in major ways.
Vertical transmission as an ethical and public-health barometer
Vertical transmission is not just a medical concern; it signals equity gaps in health access and protection. An infant born with a preventable infection carries a legacy of social and systemic gaps—access to testing, timely treatment, and financial and social protection. Eliminating vertical transmission, therefore, is a fairness issue—an indicator that health systems are safeguarding every child, regardless of geography, caste, or income.
Three diseases, one integrated objective
HIV, syphilis, and HBV share a common transmission corridor at birth, yet each demands targeted actions: HIV transmission can be dramatically reduced with timely antiretroviral therapy; syphilis is preventable with early screening and penicillin treatment; HBV transmission at birth can be capped through timely hepatitis B vaccination and immunoglobulin. When combined in an integrated program, the triple-elimination approach strengthens the health system’s reach and resilience, addressing stigma and ensuring that mothers and infants receive comprehensive care.
How the WHO validation process works—and why governance matters
Maldives’ victory rests on a rigorous, multi-tier validation process. A National Validation Committee gathers data and assesses coverage; a Regional Validation Committee audits laboratory quality and program implementation; and a Global Validation Advisory Committee makes recommendations to the WHO Director-General for formal certification. Even after validation, repeated reassessment every three to five years ensures the gains are sustained. India, with its vast scale, can adapt by building robust data ecosystems, transparent auditing, and community-based verification that does not rely on a single center of authority.
Lessons for India: scale with precision
WHO estimates from South-East Asia highlight ongoing challenges: tens of thousands of pregnant women affected by syphilis, thousands needing HIV treatment, and millions living with HBV. India can draw practical, scalable lessons from Maldives:
- Targeted pilot zones—start with smaller geographies (coastal states, island territories, or high-burden districts) to refine screening, linkage to care, and vaccination logistics before expanding nationally.
- Integrated service delivery—combine antenatal care with HIV, syphilis screening, and HBV vaccination in a single continuum, ensuring mother and child stay connected to care.
- Data-driven targets—set explicit epidemiological and health-system performance targets, with transparent reporting and community accountability.
- Ethical language and stigma reduction—adopt inclusive terminology such as parent-to-child transmission, acknowledging that responsibility and protection extend beyond mothers to partners and families.
Language, dignity, and stigma: a practical framework
India’s adoption of inclusive framing demonstrates how public health messaging can reduce stigma and increase uptake of testing and treatment. Respectful language, paired with clear, non-punitive communication, helps families seek care without fear of blame. This approach is essential when addressing sensitive issues around infection, gender, and violence, and it enhances trust in health systems.
A global moral imperative and a practical path for India
Eliminating parent-to-child transmission is both a medical necessity and an ethical commitment. Maldives shows that triple elimination is technically achievable when programs are integrated, validated, and data-driven. India can translate these principles into scalable, locally adapted strategies—protecting infants, upholding maternal dignity, and advancing health equity across the nation.
