Recently, El Salvador and China were declared malaria-free by the WHO.

What is Malaria?

• Malaria is a disease caused by a parasite called plasmodium vivax, p. filarium.
• The parasite is spread to humans through the bites of infected mosquitoes.
• People who have malaria usually feel very sick with a high fever and shaking chills.
• While the disease is uncommon in temperate climates, malaria is still common in tropical and subtropical countries.

How many countries have successfully eliminated malaria?

• Since 1900, 127 countries have registered malaria elimination. This is definitely not an easy task.
• It needs proper planning and a strategic action plan based on the local situations.
• All these countries followed the existing tools and strategies to achieve the malaria elimination goal.
• The main focus was on surveillance.

How did China eliminate malaria?

• China followed some specific strategies, namely strong surveillance following the ‘1-3-7’system: malaria diagnosis within 1 day, 3 days for case investigation and by day 7 for public health responses.
• Molecular Malaria Surveillance for drug resistance and genome-based approaches to distinguish between indigenous and imported cases was conducted.
• All borders to the neighboring countries were thoroughly screened to prevent the entry of unwanted malaria into the country.

What is the current scenario of malaria in India?

• As per the Global Malaria Report 2020 by the World Health Organization (WHO) India shared 2% of the total global malaria cases in 2019.
• India has a great history of malaria control.
• The highest incidence of malaria occurred in the 1950s, with an estimated 75 million cases with 0.8 million deaths per year.
• The launch of National Malaria Control Programme in 1953 and the National Malaria Eradication Programme in 1958 made it possible to bring down malaria cases to 100,000 with no reported deaths by 1961.
• This is a great achievement been made so far.

Unexpected resurgence

• But from a nearing stage of elimination, malaria resurged to approximately 6.4 million cases in 1976.
• Since then, confirmed cases have decreased to 1.6 million cases, approximately 1100 deaths in 2009 to less than 0.4 million cases and below 80 deaths in 2019.
• India accounted for 88% of malaria cases and 86% of all malaria deaths in the WHO South-East Asia Region in 2019.
• It is the only country outside Africa among the world’s 11 `high burden to high impact’ countries.

Road ahead for India

Collaboration:

• India is a signatory to National Framework for Malaria Elimination (NFME) 2016-2030 aiming for malaria elimination by 2030.
• This framework has been outlined with a vision to eliminate the disease from the country which would contribute to improved health with quality of life and poverty alleviation.
• China collaborated with Harvard University and the Massachusetts Institute of Technology, USA for Molecular Malaria Surveillance.
• In India, there are very dedicated expert scientists who can take up such assignments.

Diagnosis:

• India stands at a very crucial stage. The present challenge is the detection of asymptomatic cases in most endemic areas.
• Molecular Malaria Surveillance must be used to find out the drug-resistant variants and genetic-relatedness studies to find out the imported or indigenous cases.
• The surveillance must be strengthened and using smart digital surveillance devices would be an important step. Real-time and organic surveillance is needed even in remote areas.

Monitoring:

• The results of each malaria case can be registered in a central dashboard at the National Vector Borne Disease Control Programme, as it is done for COVID-19 cases by Indian Council of Medical Research.
• All intervention activities must strictly be monitored.
• Vector biology, site of an actual vector mosquito bite, host shifting behaviour, feeding time, feeding behaviour and insecticide resistance studies need to be carried out to support the elimination efforts.

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