Introduction: A landmark in public health
On October 13, 2025, the World Health Organization (WHO) validated the Republic of Maldives as the first country to eliminate mother-to-child transmission (EMTCT) of HIV, syphilis, and Hepatitis B virus (HBV). This triple elimination marks a historic achievement: transmission from mothers to newborns for all three infections has fallen to levels no longer considered a public health problem. While several countries had eliminated one or two infections, the Maldives’ combined success sets a powerful global benchmark and offers practical lessons for India as it pursues ambitious goals in maternal and child health.
The ethos behind vertical transmission elimination
Vertical transmission, or parent-to-child transmission, is not merely a clinical event—it is a reflection of social equity and justice. A newborn’s health should not be shaped by where a mother lives, her economic status, or access to care. Eliminating vertical transmission signals a health system that protects the most vulnerable and closes gaps that lead to preventable infections. The Maldives’ triple EMTCT achievement embodies this ethical imperative and provides a framework that India can adapt to its own diverse landscape.
Understanding the trio: HIV, syphilis, and HBV
Despite sharing a transmission pathway, each infection requires tailored interventions. HIV can be dramatically curbed with timely antiretroviral therapy (ART) for expectant mothers, reducing infant infection risk to well below 2%. Syphilis eliminated from mother to child hinges on universal screening and prompt penicillin treatment to prevent miscarriage and congenital infection. HBV transmission at birth can be prevented with Hepatitis B vaccines and Hepatitis B immunoglobulin administered within 12–24 hours of birth, dramatically lowering chronic infection risk. The cross-cutting insight is that integrated services—screening, treatment, vaccines, and data-driven monitoring—produce the best outcomes for mothers and babies alike.
How the Maldives achieved validation: a blueprint for scale
The WHO validation process rests on rigorous data, site assessments, and sustained performance. It involves a National Validation Committee, a Regional Validation Committee, and the Global Validation Advisory Committee, culminating in certification by the WHO Director-General. Key elements include:
- Extensive data verification and monitoring of testing, treatment, and vaccination coverage.
- Regular laboratory quality audits and field site assessments.
- Follow-up assessments every three years for HIV and syphilis and every five years for HBV to ensure continued elimination.
For India, the lesson is not replication of a centralized model but adoption of its core principles: strong governance, robust data systems, engaged communities, and unwavering commitment to equity.
Lessons India can translate into action
- Targeted, phased roll-out: Begin with high-burden regions (for India, consider island-like or smaller administrative units first, such as union territories or districts with higher prevalence) and scale gradually.
- Integrated service delivery: Combine HIV, syphilis, and HBV screening with routine maternal and child health services to streamline care and reduce missed opportunities.
- Data-driven accountability: Build transparent dashboards that track testing, treatment uptake, and vaccination coverage to identify gaps in real time.
- Ethical communications: Use inclusive language that avoids stigmatizing mothers and recognizes shared responsibility, aligning with India’s emphasis on gender sensitivity.
Language and framing: why “parent-to-child” matters
The terminology matters. Some global frameworks use “mother-to-child transmission,” but India has adopted “parent-to-child transmission” to reflect accountability across genders and address social vulnerabilities that heighten risk. This inclusive framing reduces stigma, encourages men’s involvement, and helps communities see prevention as a shared public health duty rather than a blame game.
Global moral imperative and India’s path forward
Triple EMTCT is technically feasible with integrated programs, disciplined data use, and sustained political will. The Maldives shows what can happen when health systems commit to equity, multisectoral collaboration, and patient-centered care. For India, the path is practical and principled: tighten screening and treatment in key birth settings, empower local health workers, and maintain transparent reporting to keep momentum alive. By translating Maldives’ discipline into India’s context, the nation can advance toward a future where every child begins life free from these preventable infections.
Conclusion: A shared vision for healthier futures
The elimination of parent-to-child transmission is both a medical milestone and a moral triumph. It embodies a health system that protects the most vulnerable, respects patient dignity, and leverages data to drive life-changing outcomes. India, facing a substantial burden in syphilis, HIV, and HBV among pregnant women, can draw actionable lessons from the Maldives’ achievement—while adapting them to its own scale, diversity, and social realities.
