China has been certified malaria-free by WHO after a 70-year campaign, which as per the health body is an impressive achievement for a country that reported 30 million cases of the disease annually in the 1940s.
The certification is given by WHO when a country can show that the chain of indigenous malaria transmission by Anopheles mosquitoes has been disrupted nationwide for at least three years, based on thorough, trustworthy data.
A country must also demonstrate the capacity to prevent the re-establishment of transmission, as per WHO.
In more than three decades, China became the first country in the WHO Western Pacific Region to receive a malaria-free accreditation.
Australia (1981), Singapore (1982), and Brunei Darussalam are among the other countries in the region to have attained this status (1987).
“Today we congratulate the people of China on ridding the country of malaria,” said Dr. Tedros Adhanom Ghebreyesus, WHO Director-General.
“Their success was hard-earned and came only after decades of targeted and sustained action. With this announcement, China joins the growing number of countries that are showing the world that a malaria-free future is a viable goal.”
WHO has certified 40 nations and territories as malaria-free, the most recent being El Salvador (2021), Algeria (2019), Argentina (2019), Paraguay (2018), and Uzbekistan (2018). (2018).
Dr. Takeshi Kasai, Regional Director of the WHO Western Pacific Regional Office congratulated China for eliminating malaria.
China’s unwavering commitment to achieving this significant milestone demonstrates how strong political commitment and the building of national health systems may result in the eradication of a disease that was once a serious public health issue, Kasai said.
With China’s achievement, we are one step closer to realizing our vision of a malaria-free Western Pacific.
China’s march to Malaria extinction
Beginning in the 1950s, Chinese health officials tried to detect and halt the spread of malaria by giving both preventive antimalarial drugs and therapy for those who had already been infected.
In some locations, the country also made a concerted effort to limit mosquito breeding sites by increasing the use of chemical spraying in households.
The Chinese government initiated the “523 Project” in 1967, a nationwide research initiative aimed at developing new malaria remedies.
Artemisinin, the fundamental ingredient of artemisinin-based combination therapies (ACTs), the most potent antimalarial medications available today, was discovered in the 1970s thanks to a collaborative effort involving more than 500 scientists from 60 universities.
China’s ability to think outside the box has served the country well in its own response to malaria over many decades, and has also had a huge worldwide rippling effect, says Dr Pedro Alonso, Director of the WHO Global Malaria Programme.
The government and its people were continually looking for fresh and ingenious ways to speed up the extermination process.
China was one of the first countries in the world to widely evaluating the use of insecticide-treated nets (ITNs) for malaria prevention in the 1980s, long before the World Health Organization (WHO) endorsed nets for malaria control.
More than 2.4 million nets have been distributed across the country by 1988. In the locations where they were deployed, the usage of such nets resulted in significant reductions in malaria incidence.
The number of malaria cases in China had dropped to 117 000 by the end of 1990, while mortality had dropped by 95%.
Beginning in 2003, China increased training, staffing, laboratory equipment, medicines, and mosquito control with support from the Global Fund to Fight AIDS, Tuberculosis, and Malaria, resulting in a further reduction in cases; within ten years, the number of cases had fallen to around 5000 annually.
China requested for an official WHO certification of malaria elimination in 2020, after reporting four years of zero indigenous cases.
In May 2021, members of the independent Malaria Elimination Certification Panel traveled to China to verify the country’s malaria-free status as well as its malaria prevention program.
Chana’s recipe to success
China delivers a free basic public health service package to its citizens.
Everyone in China, regardless of legal or socioeconomic position, has access to affordable malaria diagnosis and treatment as part of this package.
Successful multi-sector collaboration was also essential. In 2010, 13 Chinese ministries joined forces to eradicate malaria across the country, including those responsible for health, education, finance, research and development, public security, the army, police, trade, industry, information technology, media, and tourism.
In recent years, the country has reduced its malaria caseload even more by sticking to the “1-3-7” strategy’s timeframes.
The “1” represents a one-day deadline for health facilities to report a malaria diagnosis; by the end of day 3, health authorities must confirm a case and estimate the danger of spread; and, within seven days, suitable actions must be done to prevent the disease from spreading further.
Malaria imported from other countries is still a major concern, especially in southern Yunnan Province, which borders three malaria-endemic nations: Lao People’s Democratic Republic, Myanmar, and Vietnam.
Chinese nationals returning from Sub-Saharan Africa and other malaria-endemic locations have an additional challenge: imported cases.
Throughout the COVID-19 pandemic, China has organized virtual meetings for the exchange of information on malaria case investigations, among other issues, and has maintained online training for health providers.