Clock ticking for India to eliminate malaria by 2030

With 1.1 million cases and 600 deaths in 2014, India has become the malaria capital of Asia, says Richard Feachem, pointing to the “not so good news” on tackling this mosquito-borne disease.

A grim reality, especially when compared to neighbouring Sri Lanka. The island nation was declared malaria free by the World Health Organisation in September.

No other country in the region has such a high incidence, says Feachem, Director of the University of California, San Francisco (UCSF) Global Health Group. India is the most populous malaria-endemic country, accounting for 75 per cent of all cases in the region. The UCSF's Malaria Elimination Initiative convenes an annual meeting of international experts called the Malaria Elimination Group. Feachem chaired the latest meeting in Chennai this week.

And an outcome of this meeting, Feachem hopes, will be the regional pressure from neighbouring countries (Sri Lanka, Bhutan, Nepal and Bangladesh), pushing India to speed up the pace of implementation of its initiatives to tackle the disease. A situation similar to polio, where India is disease-free, but faces cross-border risk from Pakistan that still records cases of polio.

About 91 per cent of India’s population is at risk of malaria infection, says Feachem, comparing it to Bangladesh at 11 per cent and Nepal at 48 per cent. Complicating matters is the under-reporting — where the actual number of malaria cases in the country is not known, as patients are treated inadequately at private clinics and do not get reported into the government system, he observes.

Experts caution that the numbers could even be 10 times higher, he says. (Inadequate treatment causes the added problem of drug resistance, where the malaria-causing parasite in the human body stops responding to the medicine.)

“You can’t beat the enemy without knowing the size of the enemy,” says Feachem, contrasting this scenario with the “spectacular” success story of Sri Lanka. And this was achieved through a public health network, accurate data, excellent malariologists, and a targeted and flexible treatment that was nimble to responding to new evidence, he adds.

Like India, Sri Lanka is green, tropical and gets large amounts of rainfall. And what makes Sri Lanka’s achievement that much more spectacular is that the achievement came during the civil war, he observes.

An achievement that India needs to be paying careful attention to, he says, adding that countries in the region could benefit by coordinating on malaria control strategies, including sharing data.

But there is some good news too. In February, India came out with a national framework to eliminate malaria by 2030. Since 2000, India has nearly halved malaria cases — down from 2 million to 1.1 million in 2014, points out Feachem.

In fact, Punjab and Tamil Nadu are two low-burden States that are leading the way in malaria control, he says.

Punjab could well be the first State to be declared malaria-free by the Union Health Ministry, having reported 596 cases in 2015, down from 1,036 in 2014. Tamil Nadu achieved a 60 per cent decrease in the number of cases since 2011. In 2014, the State reported 8,729 cases and zero deaths.

As States compete to tackle malaria, Feachem agrees that India faces the unique challenge of unplanned urban development and its contribution to increased incidence of malaria and other mosquito or vector-borne diseases like dengue and chikungunya. In fact, malaria, seen largely among economically weaker sections, could benefit from the political and government attention given to tackle dengue and chikungunya, which occur in urban landscapes, he observes.

It’s not just India, but even globally efforts are on to set the clock on ending malaria. And the research efforts in this direction are yielding not just a vaccine, but even genetically modified sterile mosquitoes. That, though, opens up an entirely new debate on creating a new monster in trying to drive out an older one.

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