China goes malaria-free with multi-pronged health strategy

It hasn’t reported any case in four consecutive years

July 03, 2021 10:05 pm | Updated 10:05 pm IST

Malaria Test text with blood sample. Top view isolated on black background. Healthcare/Medical concept

Malaria Test text with blood sample. Top view isolated on black background. Healthcare/Medical concept

The World Health Organization (WHO) declaring that China was “malaria-free” followed a seven decade-long, multi-pronged health strategy that was able to entirely eliminate indigenous cases for four straight years, health experts said.

The “malaria-free” certification from the WHO this week followed a visit in May from an independent panel to verify China’s malaria-free status, which requires four consecutive years of reporting no local cases.

The number of malaria cases worldwide in 2019 was around 229 million, according to the World Malaria Report in 2020, with 409,000 lives lost to the mosquito-borne disease. The 2020 report said the majority of cases were reported in Africa, while India and Southeast Asia recorded a significant drop. Cases in India fell from approximately 20 million to 6 million, according to the 2020 report.

The WHO said China is the first country in the Western Pacific region to be declared malaria-free in more than 30 years, following Australia in 1981, Singapore in 1982 and Brunei in 1987. Takeshi Kasai, Regional Director of the WHO Western Pacific Regional Office, attributed its success to “strong political commitment and strengthening national health systems” allowing it to “eliminate a disease that once was a major public health problem”.

The effort began in the early 1950s, a time when China was reporting millions of cases annually, starting with a multi-pronged approach of providing anti-malarial medicines while targeting mosquito breeding grounds and using insecticide spraying.

A national effort called ‘the 523 Project’ was launched in 1967 involving more than 500 scientists from 60 institutes, the WHO noted, leading to the discovery of artemisinin in the 1970s, which is “the core compound of artemisinin-based combination therapies, the most effective antimalarial drugs available today”.

In the 1980s, China began using insecticide-treated nets widely, distributing 2.4 million nets by 1988. Cases began to drop, down to 117,000 in 1990. The number would fall to 5,000 annually by the end of the following decade. With assistance from the Global Fund to Fight AIDS, Tuberculosis and Malaria starting in 2003, China “stepped up training, staffing, laboratory equipment, medicines and mosquito control, an effort that led to a further reduction in cases,” the WHO said.

‘1-3-7 strategy’

It credited China’s public health system offering free of charge diagnosis and treatment of malaria in bringing down cases to zero, as well as a “1-3-7 strategy” referring to a one-day deadline to report a malaria diagnosis, confirming a case and determining the spread by the third day, and measures taken to stop the spread by the seventh day, along with continued surveillance in high-risk areas.

At the same time, concern over imported cases remains, particularly from Laos, Myanmar and Vietnam, which share a border with the southwestern Yunnan province. The “malaria-free” certification was welcomed by public health experts in China and was welcome news for its health authorities, amid an intense global debate over how they handled the COVID-19 pandemic and scrutiny facing its disease control agencies.

China has been widely criticised for the delays in initial reporting of an unknown pneumonia outbreak in Wuhan that was suppressed by local authorities in late December 2019 and early January 2020, including by silencing doctors, later leading to the sacking of city and provincial officials. Subsequently, a sweeping nationwide lockdown ordered by the central authorities, along with a massive testing and tracing strategy, allowed China to control the outbreak by the summer of 2020 and avoid a second wave unlike most countries, with continuing travel restrictions as well as test-and-trace strategies successfully squashing subsequent local outbreaks linked to imported cases.

The COVID-19 response showed the duality of the Chinese system, according to Dali Yang, professor of Chinese politics at the University of Chicago, who told The Hindu earlier the system can see “shirking” at the local level and a tendency to cover-up problems when they emerge, combined with a top-down approach that is “capable of decisive action when things get big”.

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