At the 9th East Asia Summit (EAS) in 2014, the Prime Minister of India, along with 17 other Asia Pacific Heads of Government, committed to the goal of an Asia Pacific free of malaria by 2030. Nearly a decade later tremendous progress has been made both in India and the region as a whole. Sri Lanka and China have eliminated malaria while many countries, such as Bhutan, Bangladesh, and Nepal, are nearing elimination. India has been no exception; between 2015-2021, the country has seen an 86 per cent decline in malaria cases and a 76 per cent drop in deaths from malaria.
According to the World Health Organization (WHO), in 2021, there were an estimated 247 million malaria cases and an estimated 619,000 deaths attributed to malaria. Africa carries a disproportionately high share of the global malaria burden, with 95 per cent of malaria cases and 96 per cent of malaria deaths, where children under five accounted for about 80 per cent of all malaria deaths. Out of the global 247 million malaria cases in 2021, Asia Pacific nations contributed to 1.79 million cases, with P. vivax in many countries as the dominant species.
Malaria in Asia Pacific countries presents its own complexities and challenges in terms of biological, clinical, epidemiologic and social dimensions. In the region, in 2021, Papua New Guinea (PNG) contributed to 36 per cent burden, followed by Pakistan (22 per cent), Indonesia (17 per cent), India (9 per cent), Afghanistan (5 per cent), Solomon Islands (5 per cent), and Myanmar (4 per cent). The highest Annual Parasite Incidence (API) belongs to the Solomon Islands (119), followed by PNG (65.5) and the remaining countries had an API of less than two. For comparison the average API of India is 0.11 (2021 data).
The burden of malaria in India is concentrated in hard-to-reach and forested areas of Maharashtra, Chhattisgarh, Jharkhand, West Bengal, Odisha, Meghalaya, Mizoram, Tripura, where environmental conditions coupled with suboptimal infrastructure and development make it challenging for communities to access health services.
There are an estimated 25 high-burden districts in India (2021), which should be the target for intense and targeted malaria elimination effort, so that these ‘heartlands of malaria’ are made malaria free as soon as possible. These districts are designated as Category 2 (medium) and 3 (highest) based on the intensity of malaria transmission. There is an informed consensus that elimination of malaria from these high-burden districts presents a pathway for elimination of malaria from the country.
To complete the task of elimination, a project has emerged that has generated considerable evidence of what is possible. The Malaria Elimination Demonstration Project in Mandla, Madhya Pradesh, situated in a malaria endemic high-transmission tribal district, showed elimination was possible in under four years. The Mandla project provided a rich detailed model and strategies, which we define as the “Science of Malaria Elimination”, that could be used for sub-national, national, and regional elimination programmes in the Asia Pacific region.
The key learnings of the Mandla project were significant for oversight at management, technical, operational, and financial levels, periodic independent reviews by public health experts, sharing data and results on a regular basis, and regular formal briefing for technical and policy leadership at national and sub-national levels. We now have a better understanding of the “Science of Malaria Elimination” through the lessons learned from the Mandla Malaria Elimination Demonstration Project. These lessons can be used by making context-specific changes for effective and time-bound implementation of other sub-national, national, and regional elimination programmes.
A Malaria-Free Asia Pacific is feasible by 2030.
This optimism comes from the fact that we have safe, effective, and affordable diagnostic tests, drugs and tools of vector control that are made in the region. The countries that have eliminated malaria have used these existing vector control and case management tools.
It is the “Science of Malaria Elimination” that will allow us to identify all cases for prompt treatment, including low density infections and asymptomatic cases, ensure all cases are treated promptly and tracked post treatment, and detect and treat imported malaria so that outbreaks are prevented. The other aspects that have shown relevance include administering continuous training and capacity building programmes, so that front line workers are always on top of their game,and deploying management controls and routine external reviews.
Three keys will accelerate our progress to meet the goal: 1) A focused approach that has built-in management, operational, technical, and financial controls 2) Active collaboration on management of cross-border malaria at domestic and international levels to prevent reintroduction and 3) Political commitment at multiple levels of leadership from the Chief Ministers and Governors to Heads of Government.
The fight against malaria can be won. There is the science to prove it.
Disclaimer
Views expressed above are the author’s own.
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