Press Release: Amid Madagascar’s Plague Outbreak, NGO PIVOT is Responding with Ongoing Strengthening of the Public Health System

Boston — October 20, 2017

Madagascar is experiencing an unusually catastrophic outbreak of plague this year, with 1,153 cases reported and 94 lives claimed since August. Although Madagascar sees an average of 400 cases of plague annually, this year’s outbreak is distinct in that it started earlier than usual and has spread to major cities where the disease does not typically occur. Most problematic is that the majority of confirmed cases thus far are of pneumonic plague – the most deadly form of the disease, with airborne transmission from person to person. Usual occurrences of plague in Madagascar are primarily bubonic, a less fatal form transmitted to humans by infected fleas. Though pneumonic plague is treatable with antibiotics if diagnosed early,  it is nearly always fatal when left untreated. Given the state of the public health system, Madagascar is especially susceptible to outbreaks year after year.

The global health nonprofit PIVOT is responding to the plague outbreak with a continued focus on strengthening Madagascar’s public health system so that the country is better prepared to respond to recurring crises such as these. Working in southeastern Madagascar, PIVOT partners with the Ministry of Health (MoH) and rural communities to improve access to quality healthcare and transform the Ifanadiana District, serving a population of 200,000 people, into a sustainable and scalable health system model for the rest of the country.

Suspected cases of plague have been identified in Ifanadiana District, with PIVOT and MoH clinicians responding directly through isolation and treatment for patients and their families. Together, PIVOT and MoH personnel are working to curb the spread of the outbreak by training and equipping the district’s facilities and clinicians, and maximizing the awareness of the disease through community sensitization efforts. PIVOT’s teams are currently working to procure needed protective equipment, diagnostic tests, and other essential supplies in the face of a national shortage. The organization is also lending support to the Ministry’s national response, sending one of its ambulances to the nation’s capital, Antananarivo, where the country is experiencing the highest occurrence of suspected cases.

“The emergence of plague in Madagascar is sadly not new,” says PIVOT Co-CEO Matthew Bonds, a disease ecologist and economist at Harvard Medical School. “This particularly devastating outbreak has occurred due to a confluence of factors at the intersection of poverty, weakened health systems, and demographic and environmental change.”

PIVOT Country Director Dr. Mohammed Ali Ouenzar adds that the ongoing crisis “points to the essential role of strengthened health systems to serve vulnerable populations, prevent unnecessary deaths from plague and other diseases, and support emergency responses when necessary. PIVOT stands in solidarity with the Ministry of Health, our partners, and all of Madagascar.”

PIVOT has a network of professionals available to speak about Madagascar’s health system and the eco-epidemiology of plague. To schedule an interview, please contact Amy Donahue at or (203) 482-5222.