National commitment aided elimination of disease

Sarthak Das

Doctor Sarthak Das, CEO of the Asia Pacific Leaders Malaria Alliance, said China's sustained national commitment to malaria control, tailored interventions and its science-based and robust response mechanism underpinned the elimination of malaria in the country in seven decades.

Annual malaria cases in China dropped from 30 million cases in the 1940s to zero in 2017, which Das said is "the most momentous accomplishment" in the global battle against the historic scourge.

"The ultimate success, as the Chinese example shows us, depends on systems," he said, adding that it isn't a system that only requires monitoring. "It's a system that also involves reporting, analyzing data in real time and identifying where hot spots are. It also is a system that can communicate to a provincial capital, a capital city, about where resources should be shifted."

Das, who holds a doctorate in public health, said the overarching premise in wiping out malaria is a national commitment to stand up to the challenge of curbing malaria at multiple levels of leadership and across different arms of government.

One cornerstone in China is that in 2010, 13 ministerial-level government departments, including health and science authorities and financial and public regulators, decided to join forces to end malaria nationwide.

"Looking at examples of elimination efforts across the world, if you don't have that constellation and alignment, you won't achieve the goal," he said.

Since China began intensifying malaria control efforts in the 1950s, the burden of malaria had been gradually reduced, prompting authorities to roll out more targeted and tailored interventions, Das said.

"Some maybe dealing with high-risk populations, some maybe dealing with border-related issues," he said. "Those solutions are not the same."

Strong support for scientific research also played a significant role, which culminated in a project starting in 1967 that gathered 500 scientists from 60 institutions to find treatments, Das said. The project eventually led to the discovery of artemisinin in the 1970s, the core compound for the most effective and widely used anti-malaria drugs so far.

In addition, Das said, China was one of the first countries to extensively test the use of insecticide-treated nets, an effective preventive tool to reduce the incidence rate.

"Another critical thing is the prioritization of making malaria notable to see," he said. "And that takes us to the 1-3-7 strategy."

The strategy, created by Chinese disease control workers, requires local health facilities to report a case in one day, investigate the case in three days and implement response measures in seven days.

China's experiences have shown that even in the most vulnerable regions, the strategy can be effectively implemented with enough political will.

One of the most difficult areas for malaria elimination in China was the southwestern province of Yunnan. Its lush mountains and plantations offer fertile breeding grounds for mosquitoes that can harbor and transmit malarial parasites.

There was a real emphasis on sustained monitoring in Yunnan, which was tied to the very clear methodology of 1-3-7, he said, and that enabled people to take swift and decisive action.

It's a major lesson for all countries fighting the disease in remote and rural areas, Das said.