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[MANILA] The Asia Pacific region has made significant gains against malaria, according to reports by the WHO and the Asia Pacific Leaders Malaria Alliance (APLMA).
The World Malaria Report 2020 published by WHO says its South-East Asia region is the only one on track to reach the milestone indicated in the Global Technical Strategy for Malaria, which targeted reduction of malaria cases and fatality rate by at least 40 per cent in 2020.
“Mosquitoes do not require visas for entry”
Sarthak Das, Asia Pacific Leaders Malaria Alliance
WHO’s South-East Asia regional office (SEARO) covers Bangladesh, Bhutan, India, Indonesia, Maldives, Myanmar, Nepal, North Korea, Sri Lanka, Thailand and Timor-Leste, with headquarters in New Delhi.
In 2000—2019, SEARO countries saw a 69 per cent reduction in the number of malaria cases from 23 million to 6.3 million. Meanwhile, it reduced the total number of deaths due to the disease from 35,000 to 9,000. Sri Lanka was certified malaria-free in 2015, while Timor-Leste reported no indigenous malaria cases in 2018 and 2019.
India played a key role in the drop in numbers. “Most of the reduction in SEARO came from improvements in India which has been working very hard to eliminate its malaria problem,” says Kim Lindblade, team leader of WHO’s Global Malaria Programme’s elimination unit.
WHO’s Africa Region continues to shoulder the heaviest burden of the disease. Globally in 2019, the region accounted for 94 per cent of both malaria cases (215 million cases) and malaria deaths (384,000 deaths). The region actually made major gains in reducing its malaria burden in the 2000–2019 with total malaria deaths down by 44 per cent from 680,000 to 384,000.
Although case incidence reduced substantially over the last two decades, it saw a small increase in the total number of malaria cases — from approximately 204 million in 2000 to 215 million in 2019, attributed to rapid population increase. The population in sub-Saharan Africa increased from 665 million in 2000 to 1.1 billion in 2019. Six countries accounted for approximately half of all malaria deaths globally in 2019, with Nigeria accounting for 23 per cent of fatalities.
Meanwhile, WHO’s Western Pacific region (WPRO), while not seeing dramatic drops like SEARO, also managed to see a 43 per cent drop in the total malaria cases, from 3 million to 1.7 million. Total malaria deaths, meanwhile, fell by 52 per cent, from 6,600 to 3,200.
“The decline in WPRO is not as marked but also due to countries ensuring universal access to effective malaria interventions and case management,” says Lindblade.
Approximately 80 per cent of the malaria cases in WPRO are from Papua New Guinea. The number of cases, however, dropped in 2019 after the Pacific country expanded its use of rapid diagnostic tests and improved its reporting of confirmed cases, according to WHO.
The Greater Mekong subregion (GMS) has emerged as a key player in addressing antimalarial drug resistance. The Global Fund’s Regional Artemisinin-resistance Initiative was launched in 2013 and expanded in 2018 to support the countries in the GMS through increased malaria service coverage, particularly for the remote populations, as well as support in strengthening surveillance systems and case management.
“The countries of the Greater Mekong have made extraordinary efforts to eliminate malaria before drug resistance spreads throughout the region, and they are now close to eliminating Plasmodium falciparum [malaria parasite], and should achieve elimination throughout the GMS by 2030,” says Lindblade.
The malaria elimination roadmap report released by the APLMA said that collective action has delivered results as key strategies have already been developed and are being implemented to eliminate malaria, which the report said was once neglected.
“The Asia Pacific region eliminating malaria by 2030 is no longer an aspirational statement, but a highly-achievable reality. The progress and achievements year after year indicate how close the region is towards that bold goal,” public health NGO Malaria Consortium said in a statement to SciDev.Net.
However, the non-profit noted the importance of sustaining these gains. “As long as there is even just one nation left with malaria, we have seen from previous eradication attempts how quickly malaria can rebound and resurge to massive levels again,” it said in the statement.
According to the consortium, the Asia Pacific region is home to the top three high-burden countries: India, Indonesia and Papua New Guinea. India, while recording a significant drop in the number of malaria cases in the past years, is still one of the countries with a high number of indigenous cases. It is the only country outside Africa included in the top 11 countries that account for 70 per cent of the global malaria burden.
Financing remains an issue. “Many countries in the region are still heavily reliant on international funding to run their malaria programmes, and with the possibility of an impending global economic recession as we exit the pandemic, a lot is at stake when it comes to prioritising constrained resources,” said the statement issued by Malaria Consortium.
Access also remains a challenge. “In Asia Pacific, the path to elimination of malaria is largely a last mile challenge. Rural, remote, and vulnerable communities are where the highest areas of endemicity [are located],” Sarthak Das, APLMA CEO, tells SciDev.Net. “We need to ensure that a robust health system that provides quality assured diagnostics and drugs is built on a platform with good surveillance and strong program management.”
Das says that cooperation within and across governments is critical in the fight against malaria. “Whether we are discussing malaria, other vector-borne diseases or infectious diseases such as HIV, TB or SARS-COV2, these are pathogens that do not respect political boundaries.”
“Mosquitoes do not require visas for entry,” says Das. “To succeed in our collective endeavour we must work both multi-sectorally within governments and across governments to ensure strong cross-border collaboration.”
This piece was produced by SciDev.Net’s Asia & Pacific desk.
*Sarthak Das’s statements were amended on 10 December 2020.