New Delhi: India, a malaria endemic country, has achieved a huge milestone by bringing down the cases and deaths related to the parasitic disease, and is no longer part of the group of nations classified as high burden high incidence (HBHI) for the disease, says the latest World Malaria Report released Wednesday by the World Health Organization.
However, half of all the estimated malaria cases in the South East Asia region occur in India.
The report on malaria—a potentially life-threatening disease caused by parasites transmitted through the bite of infected female Anopheles mosquitoes—has revealed that India reported 2 million cases and 3,500 deaths in 2023. This showed that there was a decrease of 69 percent since 2017 when the number of malaria cases and deaths were 6.4 million and 11,100, respectively.
The report also revealed that the significant achievement implied India left the HBHI group—a classification used to describe countries with considerable burden of the disease.
“India exited the HBHI group officially in 2024 due to significant progress in reducing the malaria incidence and mortality observed in its high endemic states,” it said.
Apart from lauding progress made against malaria in the region, Saima Wazed, regional director WHO South-East Asia Region, had a word of caution against complacency.
“We must not forget that the risk of malaria not only persists but could increase due to factors such as climate change. We must continue to do all we can to accelerate our progress against malaria,” Wazed said in a statement.
Globally, the disease remains a serious global health threat, particularly in Africa. In 2023, there were an estimated 263 million cases and 5,97,000 malaria deaths in 83 countries.
This represented about 11 million more cases in 2023 compared to 2022, and nearly the same number of deaths. Approximately 95 percent of the deaths occurred in the WHO African Region, the United Nations health body said, where many at risk still lack access to the services they need to prevent, detect and treat the disease.
Burkina Faso, Cameroon, Democratic Republic of the Congo, Ghana, Mali, Mozambique, Niger, Nigeria, Sudan, United Republic of Tanzania and Uganda are the 11 African countries that account for two-thirds of the global malaria burden.
Malaria, believed to have been existent since prehistoric times, is characterised by fever, fatigue, vomiting and headaches. In severe cases, it can cause jaundice, seizures, coma or even death.
There are five Plasmodium parasite species that cause malaria in humans. Two of these species—Plasmodium falciparum and Plasmodium vivax—pose the greatest threat. P. falciparum is the deadliest malarial parasite and the most prevalent in Africa. Malaria caused by it can progress to severe illness and death within 24 hours.
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So far so good, but challenges ahead
India—where the highest burden of malaria is reported from Odisha, Chhattisgarh, Jharkhand, Meghalaya and Madhya Pradesh—has set a target of eliminating the disease by 2030, in line with the WHO’s Global Technical Strategy (GTS 2016-2030) that aims to reduce malaria case incidence and deaths by at least 90 percent by that year.
In India, P. vivax used to be the main malarial parasite but scientific evidence now shows that since 2019, P. falciparum has been the dominant parasite, accounting for 63.3 percent of cases in 2020. The number of cases caused by P. falciparum decreased to 62.8 percent and 57.4 percent in 2021 and 2022, respectively.
Artemisinin-based combination therapy (ACT) and long-lasting insecticidal nets (LLIN) have been instrumental in controlling the malaria epidemic in the country, officials in the Union health ministry told ThePrint.
The advantage of the combination therapy, a senior official explained, is that artemisinin first kills the majority of malarial parasites by attacking a certain protein, and the partner drug clears the small number of parasites that remain.
And even as effective treatment is critical in the global fight against for malaria, the emergence of partial resistance to artemisinin—defined as delayed clearance after treatment with a drug containing an artemisinin—and resistance to ACT partner drugs are significant threats to efforts aimed at reducing the global burden of malaria, experts explained.
“There is now evidence of drug resistance to ACT in some parts of India and it is possible that we may need to rethink our strategy to eliminate the disease depending on how this trend unfolds,” a scientist associated with the Indian Council of Medical Research (ICMR) told ThePrint.
Another challenge is preventing the disease in pregnant women in endemic areas.
Malaria infection during pregnancy poses substantial risks to pregnant women, the foetus and the newborn child. Malaria in a pregnant woman can be severe and even lead to death. Placental sequestration of the parasite can lead to maternal anaemia. It also puts the mother at increased risk of death before and after childbirth and is a significant contributor to stillbirth and preterm birth.
Placental infection, on the other hand, can result in poor foetal growth and low birthweight which, in turn, can lead to decline in child growth and poor cognitive outcomes and hence, is a major risk factor for perinatal, neonatal and infant mortality.
Treatment and prevention options
Two malaria vaccines—RTS,S and R21—are now recommended for use in malaria endemic areas by the WHO, with priority given to areas of moderate-to-high transmission.
R21, a vaccine developed by Oxford University and produced by Pune-based biotechnology and biopharmaceutical company Serum Institute of India (SII), had received the WHO’s recommendation for vaccination against malaria in kids under five years last year.
RTS,S or AS01 (brand name Mosquirix) developed by British pharmaceutical major GlaxoSmithsKline (GSK), on the other hand, received a WHO recommendation in 2021.
The Indian government, however, is not planning to introduce the malaria vaccine as part of its Universal Immunisation Programme (UIP) anytime soon, sources in the health ministry told ThePrint.
(Edited by Radifah Kabir)
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