The WHO Southeast Asia region has made dramatic progress in malaria prevention and control. As the recently released World Malaria Report documents, since 2010, Southeast Asia has led the world in reducing the number of people falling ill and dying from malaria, slashing the caseload by 50% and associated mortality by 60%.
In addition, two countries in the region -- Maldives and Sri Lanka -- have been certified malaria-free. In 2016, four countries recorded fewer than 10,000 cases, while Bhutan and Timor-Leste reported zero deaths since 2013 and 2015 respectively.
These are substantial achievements, particularly in a world where the battle against malaria remains as challenging as ever. That eight of the region’s nine malaria endemic countries are on course to reduce malaria cases by 40% by 2020 (with three countries -- Bhutan, Nepal, and Timor-Leste -- identified as having the potential to achieve elimination) is proof that with the right policies and robust political will, malaria’s deadly burden can be lifted.
To make that happen region-wide by 2030, high-burden countries such as India, Indonesia, and Myanmar must continue their forward trajectory. While each has made substantial gains in driving down malaria incidence and mortality, their further success will have a decisive impact on the region’s fortunes given that together they account for around 98% of its burden.
More importantly, they will have a decisive impact on vulnerable populations now suffering the disease, raising up their health and well-being and promoting social and economic advancement.
To achieve these outcomes, a number of tools outlined in WHO’s Technical Strategy for Malaria 2016-2030 are of critical function.
Key among them is deepening community engagement and action at the grassroots. As the World Malaria Report highlights, countries across the Southeast Asia region have benefitted immensely from working directly with affected communities.
Whether by disseminating insecticidal nets or carrying out rapid diagnostic testing, grassroots volunteer networks have the ability to catalyze real change where effectively engaged. India’s Accredited Social Health Activist program is a good example of how this can be done, and how countries can reach the unreached and underserved while establishing greater community buy-in.
The embrace of innovation and new technologies is likewise crucial. That means strengthening and expanding support for basic, clinical, and implementation research able to enhance understanding of both malaria parasites and the mosquitoes that spread them.
Given that malaria’s burden transcends national borders, and can be reintroduced where it has already been eliminated, region-wide cross-border collaboration is essential
It also means investing in new technologies and forms of service delivery that can hasten progress in specific contexts.
Though region-wide uptake of Artemisinin-based Combination Therapy (ACT), for example, has had dramatic impact, countries in the Greater Mekong sub-region, where resistance has inhibited ACT’s efficacy, must now seek-out and obtain newer, more powerful tools before untreatable parasite strains emerge.
Stronger surveillance and information systems also hold great potential. By building on and fortifying existing surveillance, national malaria programs will be in a better position to allocate or redirect resources to affected areas, especially in the event of an outbreak.
Stronger surveillance will also help gauge the effectiveness of interventions, allowing authorities to modify their approach where appropriate. As part of this push, better information on the abundance and behaviour of mosquitoes is needed to support mosquito control measures, including the spraying of insecticides, the use of insecticidal nets, and behavioural change communications.
Importantly, given that malaria’s burden transcends national borders, and can be reintroduced where it has already been eliminated, region-wide cross-border collaboration is essential. To this end, WHO’s data-sharing platform in the Greater Mekong sub-region is a great example of how countries can pool information to pursue common goals and empower national malaria programs.
A similar model should be considered for the entire region, allowing authorities in each country to access robust and up-to-date data that can help guide their efforts. To make this happen, political obstacles must be overcome in all countries, and transparency pursued as a matter of principle.
Recent momentum in each of these areas is encouraging. In November, a ministerial roundtable was held in New Delhi where, among other things, member countries focused on operationalizing the Southeast Asia Region’s 2017-2030 malaria elimination action plan.
To follow that up, in early December the region’s health ministers convened once again, this time in Myanmar’s capital, Naypyidaw, to share experiences and learn from one another in an effort to accelerate progress at the local, national, and regional levels.
This momentum is exactly what is needed for the Southeast Asia region to stay on course and achieve its 2020 and 2030 targets. For the region’s three high-burden member countries, as well as those that have eliminated or are on the cusp of eliminating the disease, the need to retain focus and deepen the implementation of key tools and strategies cannot be overemphasized.
Across the region, we can accelerate progress and help secure the health and well-being of vulnerable populations. Malaria: We can, and must, eliminate it.
Dr Poonam Khetrapal Singh is WHO Southeast Asia Regional Director.