India was one of the two high burden countries that achieved a 28 per cent reduction in malaria cases in 2018, according to the World Health Organisation’s (WHO) World Malaria Report 2019 released on December 5.

Malaria cases dropped by 28 per cent in 2018 compared to 2017, while there was 24 per cent decline in cases between 2016 and 2017.

Despite being the highest burden country of the South-East Asia Region, India reduced its reported cases by half as compared with 2017. Bangladesh and Thailand also reported substantial decline in reported cases, WHO said.

Two high-burden-to-high-impact countries that achieved a significant reduction in malaria cases in 2018, as compared with the previous year, were India (2.6 million fewer cases) and Uganda (1.5 million fewer cases), the report said.

How did India improve?

According to the report, an estimated 6,737,000 malaria cases and 9,620 deaths due to it were reported in India in 2018. The figure was 9,348,000 cases and 16,310 deaths in 2017.

According to the report, India’s progress means the country no longer has the world’s fourth highest malaria burden, though it still is the only non-African country among the top 11 countries with the most malaria globally.

In India, only seven out of 36 states accounted for 90 per cent of the estimated cases in 2018. In these seven states, there were large reductions in malaria cases in 2018 compared with 2010, from a total of 14.3 million cases to 5.7 million cases.

Setting an example for other countries to follow, the report also lauds India for being the only one of the 11 countries to increase its domestic funding between 2017 and 2018 to fight malaria.

“India must be applauded for its sustained effort against malaria. By aligning all the stakeholders - government, private sector and citizens - India has increased awareness and combatted the adverse socio-economic impact of malaria, which disproportionately affects the most vulnerable including pregnant women and children under five,” said Malaria No More India country director Sanjeev Gaikwad.

“While we have come a long way, sustained focus and increased funding are crucial to boost India’s fight against malaria and ensure that India continues to lead the world and becomes malaria-free by 2030,” Gaikwad said.

The way forward

On the one hand, the analysis shows that if malaria case incidence and mortality rate remained the same as those in 2000, globally there would be 320 million cases and nearly 1 million malaria deaths in 2018. Instead, there were an estimated 228 million malaria cases and 405,000 malaria deaths in 2018.

These represent about 30 per cent fewer cases and 60 per cent fewer deaths in 2018 than would have been the case had levels of malaria incidence and malaria death remained similar to those in 2000.

While the gains to date are impressive, the global malaria challenge remains enormous, and the rate of progress is slowing. For example, on the current trajectory, globally, the 2020 Global Technical Strategy for Malaria 2016-30 (GTS) milestones for morbidity will not be achieved, and unless there is accelerated change, the 2025 and 2030 milestones will not be achieved.

A global malaria case incidence of 45 per 1,000 population at risk in 2018 would have been required to get the world on target for the 2020 milestones, but current estimated incidence is 57 cases per 1,000 population at risk.

If the current trend in incidence is maintained, estimated malaria case incidence (per 1,000 population at risk) would be 54 in 2020, 48 in 2025 and 42 in 2030, instead of the 35, 14 and six required to achieve the GTS milestones.

Progress towards the GTS elimination goals is on track. At least 10 countries that are part of the WHO E-2020 initiative are on track to reach the 2020 elimination milestone of the global malaria strategy.

In 2015, all of these countries were malaria endemic; now they have either achieved zero malaria cases or are nearing the finish line. Across the six countries of the Greater Mekong subregion - Cambodia, China (Yunnan province), Laos, Myanmar, Thailand and Vietnam - there was a 76 per cent reduction in malaria cases and a 95 per cent reduction in deaths in the period 2010-18.

In 2018, Cambodia reported zero malaria-related deaths for the first time in history and China reported its second consecutive year of zero indigenous malaria cases.

In 2018, total funding for malaria control and elimination reached an estimated $2.7 billion, falling far short of the $5 billion funding target of the GTS. Moreover, the funding gap widened between 2017 and 2018, from $1.3 billion to $2.3 billion.

Over the period 2010-18, nearly 70 per cent of total malaria funding in 2018 was provided by international sources. Governments of malaria endemic countries contributed about 30 per cent of total funding.

As WHO South-East Asia Region continues to register a steep decline in malaria incidence, the WHO reiterated accelerated efforts by member countries to achieve zero malaria by 2030.

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