What should India learn from China's “Malaria Free Nation”?
Global Elimination Scenario
Since 1970, 27 countries have regulated malaria elimination. Many other small & big; developed & especially developing nations have taken steps, including a wide range of medium to long term schemes to eliminate malaria.
In 2021, Feb 25, El-Salvador, a small nation, has been declared free from Malaria. Taking a path to the same route, China, on June 29, 2021, has been declared Malaria free nation by WHO (World Health Org.)
As an international organization, which works in close collaboration with the respective nations and monitors the elimination process and Govt data before certification of malaria elimination as “Malaria Free Status.”
A Country is granted the certification if it has demonstrated rigorous, credible evidence that the chain of local transmission of all human malaria parasites has been interrupted nationwide for at least 3 consecutive years. And that fully functional surveillance and response system have been designed by the nation concern to prevent the re-establishment of indigenous transmission.
Countries intending to get the malaria-free status certification by WHO need to follow the elimination process, which may be self-designed by the nation or coordinated with WHO or any other voluntary organizations. The nations can apply the malaria elimination certification process by submitting an official request to the WHO Director-General, which is dealt with the due organizational process by WHO.
Recently, China being the largest population holder of degrees globally, achieved the process and got 2 stage certification from WHO. The certification process was started by WHO in Nov 2020 after finding that china has recorded 4 consecutive years of zero indigenous malaria cases; finally, after all, observations on June 29, 2021, Malaria Free Status certification was given. It’s really astonishing to know that when the whole world was battling against the COVID19 pandemic, China found a way to remove malaria from its land.
Chinese Strategy of 1-3-7 system
China followed a strong system to win the battle against malaria in close coordination with WHO. They named the strategy a 1-3-7 system. 1-day malaria diagnosis, 3 days for case investigation by the end of 7 days for public health response. A case investigation strategy of 3 days was used to identify the cause and sources (indigenous or imported by people coming from outside) so that due measures to be taken. By the 7th day, the response would be to prevent further spreading.
Surveillance system
Chinese Molecular Malaria Surveillance for Drug Resistance and Genome-based approaches were preferred; this would distinguish between indigenous and imported malaria cases. In imported malaria patients, all borders were thoroughly screened to prevent undesired malaria cases in the country.
Context of India
India has a great history of malaria and its control process. The highest incident of malaria occurred in the 1950s, with an estimated 75 million cases with 0.8 percent death per year.
In 1953, National Malaria Control Program was launched. In 1958, the National Malaria Eradication program came into place, making it possible to bring down malaria cases to 100,000 with no reported death by the year 1961. The success of such programs by Govt was on the path of elimination of malaria from India, but due to some uncertainties’ goals & set targets couldn’t be achieved.
From the year 1961 up to the Year 1976, the malaria cases started to resurge approx. 6.4 million cases. Within the gap of 15 years, the huge turnaround in malaria cases symbolized the failure of machinery and administration to eliminate malaria.
As per a report of 2009, the cases of malaria have decreased to 1.6 million with approx. 1100 deaths. The latest report of 2019 shows that India is on a path to achieve malaria-free status as only 80 deaths soon and less than 0.4 million cases were registered.
As per the WHO report of 2019 for the Southeast Asia Region, India accounted for 88 percent of cases and 86 percent of all malaria death in the region. The report also states that India is the only country outside Africa among the world’s 11th high burden to high impact countries, which shows that other nations of S.E Asia regions, which mostly includes the neighborhood of India, have shallow malaria cases compared to India.
India is already a signatory to National Framework for Malaria Elimination (NFME) 2016-2030, aiming to be malaria-free by 2030.
Lessons from China
India is the second-most populous nation and overcrowded with traffic need to take a lesson from China. China Collaborated with HARVARD University & Massachusetts Institute of Technology, the USA, for molecular malaria Surveillance and finding best practices to study, identify and eliminate malaria, and better study the genome.
Last Words
In the year 2020-21, when the whole is fighting with Covid19, pandemic, malaria has been given a backstage. In comparison with 2019, India has a 32 % decline in total blood smear collection for malaria surveillance in 2020. India is very close to malaria elimination and needs to achieve the set target of malaria-free by 2030. It’s not so far that India would gain the status of “Malaria Free Nation” from WHO like “India is Polio Free” declared by WHO on 27th March 2014.
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