Asia Pacific makes steady progress against malaria during the pandemic, yet gaps remain in some high burden countries

Most significant burden reported in Papua New Guinea, with high cases and stalled progress

The World Health Organisation’s annual World Malaria Report 2021, published reveals that steady progress was made in 2020 across the Asia Pacific region in the fight against malaria. The Asia Pacific Leaders Malaria Alliance (APLMA) and Asia Pacific Malaria Elimination Network (APMEN) welcome overall progress in the region despite the challenges posed by COVID-19 but urge continued commitment and collaboration from countries to end malaria by 2030.

Almost two years into the COVID-19 pandemic, health systems throughout the world have been tested in unprecedented ways. According to the report, worldwide malaria cases (241 million) and deaths (627,000) increased in 2020, resulting in approximately 14 million more cases in 2020 compared to 2019, and 69,000 more deaths. Most of the increase in case numbers in 2020 occurred in the African continent. Two-thirds of these additional deaths (47,000) were linked to disruptions in malaria services during the pandemic, primarily in sub-Saharan Africa.

While the worst was feared, despite COVID-19 disruptions many countries worldwide and in Asia Pacific swiftly adapted to ensure malaria services continued. The region continues to make steady progress, but challenges remain.

Progress and remaining challenges in Asia Pacific

The Greater Mekong subregion (GMS) which comprises Cambodia, China (Yunnan Province), Lao People’s Democratic Republic, Myanmar, Thailand and Viet Nam continued to see significant progress with a 27% decline in cases in 2020 compared to 2019 i . The WHO reported that the GMS has experienced a 93% decrease in the number of P.falciparum malaria cases between 2000 and 2020, and a 78% decrease in all malaria cases including P.vivax during the same time frame.

According to WHO estimates, India reduced its number of malaria cases between 2019 to 2020 and among the 11 countries that are part of the WHO’s High Burden to High Impact initiative, only India registered progress against malaria.

In other significant milestones, China received WHO malaria-free certification this year and Sri Lanka remains certified as malaria-free. Countries on the verge of elimination were also not deterred by COVID-19. Malaysia has had no human cases of malaria for three consecutive years, while Cambodia, the Lao People’s Democratic Republic, Malaysia, the Republic of Korea, Timor Leste, Nepal, Vanuatu and Viet Nam all reported zero indigenous malaria deaths in 2020.

“The findings from this year’s World Malaria Report demonstrate the significant and positive strides the Asia Pacific region has made in reducing cases and averting deaths from malaria, which is testament to cross-border collaboration, strong leadership and international cooperation with partners such as the WHO, Global Fund and RBM,” said Dr Sarthak Das, Chief Executive Officer, Asia Pacific Leaders Malaria Alliance (APLMA)

Despite these strides, there is still a significant burden in other countries that cannot be ignored. Papua New Guinea (PNG), the Philippines, the Solomon Islands, and Vanuatu have all seen increases in malaria cases over the past five years, according to WHO estimates.

“We absolutely cannot deny the devastation that malaria continues to cause in high burden countries, including PNG. While India and Indonesia are making steady progress, the remaining challenges cannot be ignored – no one is safe until we are all safe. Working towards the elimination of malaria requires not only continued regional and global solutions but also tailored sub-national solutions, as well as continued financing in areas such as the GMS, despite the significant investments already made. We also cannot be complacent in near elimination countries such as Bhutan and Timor Leste, which underscores the importance of cross-border collaboration, or fragile states such as Afghanistan and Myanmar. As we focus on our 2030 malaria elimination goal, let’s find creative ways to synergize both malaria and pandemic related interventions, such as programs to improve surveillance, data, and public health management particularly where systems and the communities they serve are most vulnerable,” Dr Das added.

“While the gains made elsewhere in the world are impressive, it cannot be ignored that in PNG we are facing a different situation, with malaria causing immense suffering for our people. Since 2014, we have continued to bear the most significant burden of malaria cases and deaths in Asia Pacific – and this situation is an absolute crisis,” said Leo Sora Makita, Program Manager Malaria and Vector Borne Diseases, Department of Health, PNG.

“The alarming resurgence and increase over the years have been more recently compounded by the pandemic. Despite the challenges we continue to face, we are committed to reducing the burden of malaria. We have done it before and can do it again. We urge all stakeholders to unite, focus on financing and collaboration to stay focused on the elimination of malaria even through the pandemic, in order to reduce the continued high burden of malaria in PNG,” Leo added.

Commenting on the significant progress in the GMS, Amita Chebbi, Senior Director of APLMA and APMEN said,  “We congratulate all partners in the continued fight against malaria in the GMS. The great successes seen in Cambodia, Viet Nam and Thailand in particular, are a reflection of the fundamentals of strengthening health systems, focusing on access to hard-to-reach communities and maintaining funding to help ensure surveillance and case management. This is just the start of ensuring the GMS and our neighbours in Asia Pacific remain on the essential path to malaria elimination.”

With continued resilience, commitment and collaboration, we can maintain momentum against malaria to ensure lives are saved and progress is not lost – and importantly, stay on track for malaria elimination by 2030 in Asia Pacific and beyond.

The impact of COVID-19 on malaria in the region will be further explored in a soon-to-be published report, Malaria Elimination Amidst COVID-19: A Test of Resilience in Asia Pacific, which will be launched at the virtual Leaders Dialogue for Malaria Elimination, organised by APLMA and APMEN, in partnership with the Royal Government of Bhutan on 13 December 2021. Of note, the report will offer country-specific snapshots of the tremendous commitment and agility behind this continued progress in the region in spite of the pandemic’s disruptions.