April 26, 2023
NEW DELHI – Malaria continues to be a major life-threatening disease caused by five species of Plasmodium malaria parasites transmitted through the bite of an infected female Anopheline mosquito.
The World Health Organization’s (WHO) 2022 World Malaria Report reported an estimated 247 million cases of malaria and an estimated number of 619,000 deaths due to malaria worldwide in 2021, of which African countries carry a disproportionately high burden of cases (95 percent) and deaths (96 percent).
The WHO’s South-East Asia region has reported an 8.4 percent increase (2021 data). The WHO’s Western Pacific region reversed its upward trend from 2020, seeing a 14 percent drop in malaria cases down to near 2019 levels. The WHO’s Mediterranean region reduced malaria by 38 percent between 2000 and 2015, before increasing by 44 percent between 2015 and 2021.
On April 24, the Indian Ministry of Health and Family Welfare and the Asia Pacific Leaders Malaria Alliance hosted the Asia Pacific Leaders’ Conclave on Malaria Elimination to review the progress of malaria elimination and renew the commitment to eliminate malaria from the region by 2030.
The global map of malaria has gradually shrunk over the past few decades. From 1955-2023, 41 countries and one territory eliminated malaria using available tools. In the same period, malaria in another 61 countries disappeared without specific intervention or never existed. In the Asia Pacific region, of the 48 countries, 20 still have endemic malaria, and aggressive and targeted interventions in these countries can end malaria.
Public health professionals, Ministries of Health of endemic countries, and many global institutions (such as the Global Fund, World Health Organization, Bill and Melinda Gates Foundation, United States President’s Malaria Initiative, Roll Back Malaria Partnership to End Malaria, Asia Pacific Leaders Malaria Alliance, African Leaders Malaria Alliance, South Africa Development Community Malaria Elimination Eight Initiative, Global Institute for Disease Elimination, End Malaria Council, Medicine for Malaria Ventures, Innovative Vector Control Consortium and the US Centers for Disease Control and Prevention) have engaged in an unprecedented collaborative manner to end malaria.
Imagine an Asia Pacific region, where no one dies of malaria, no one gets sick due to malaria, children do not miss school and their education is uninterrupted, women have safer malaria-free pregnancies, and heathy babies are born, people do not miss work and provide for their families in an uninterrupted manner, and nations don’t have to spend on malaria control and treatment programs perpetually.
The recent success of malaria elimination in Sri Lanka, Maldives, and China provides us the optimism that malaria can be eliminated from other Asia Pacific nations.
However, there are concerns to share as well. Challenges such as civil conflicts, political instability, natural disasters, weak health systems, and the inability to absorb external aid are some of the pressing threats to the malaria elimination efforts in Myanmar, Pakistan, Afghanistan, Papua New Guinea, and the Solomon Islands.
From India, there are experiences to share from a comprehensive malaria elimination demonstration project in Madhya Pradesh. This project has provided valuable information that can be used for sub-national, national, and regional elimination programs.
The key learnings of the Mandla project are: 1) oversight at management, technical, operational, and financial levels for checks on the quality of human resources and supply chain systems; 2) independent review by public health experts; 3) analysis of data in real time; 4) regular briefing at national and sub-national levels; and 5) sharing data through peer-reviewed publications.
I argue that a malaria-free India and most nations in Asia Pacific region is feasible by 2030. There is one top-line request for the leaders of the Asia Pacific nations.
The expansion of an advocacy campaign on “A Malaria Free Nation Starts with Me” from Africa to Asia Pacific would provide a much-needed boost. It would be desirable for this campaign to be initiated by the prime ministers, led by the health ministers, the chief/provincial ministers, national secretaries and from the principal health secretaries of the state to the district collectors and chief medical and health officers at the district level.
For the malaria elimination goal to be realized in a timely manner, a malaria-free Asia Pacific region must be everyone’s goal and seen through the lens of a “Decade of Collaboration” with an all-hands-on-deck approach.
A malaria-free Asia Pacific is feasible by 2030, because safe, effective, and affordable diagnostics tests, drugs and tools of vector control are available and made in the region.
Unless the entire region is free of malaria, it would be difficult to sustain malaria elimination from those that have achieved it. This challenge can be overcome by a meaningful cross-border collaboration, by invoking “nation as a whole” and “region as a whole” approach.
Therefore, now is the time to seize the moment for an all-hands approach to end malaria forever in all Asia Pacific countries through collective leadership and the investment of resources by national governments and by targeted and sustained external support by donor agencies.
The writer is a senior advisor for global health and innovation at Sun Pharma, the director of the Malaria Elimination Demonstration Project and a former board member of the Asia Pacific Leaders Malaria Alliance