Why is it in the News?

• The recently released World Malaria Report shows that the number of cases and deaths due to the mosquito-borne infection India have continued to decline.

About the World Malaria Report 2023:

Every year, the World Health Organization (WHO) releases a report on malaria worldwide. This report gives us the latest information about how malaria is being controlled and reduced globally.

Global Malaria Trends:

• The number of malaria cases had dropped from 243 million to 233 million globally between 2000 and 2019.
• However, the number of malaria deaths also remained higher than the pre-pandemic levels.
  • There were 608,000 deaths reported in 2022 as compared to 576,000 cases in 2019.

Climate Change Challenge:

• This time, the report talks about how climate change and malaria are connected. Changes in temperature, humidity, and rainfall can affect the mosquitoes that carry malaria.

Other Challenges:

• Besides climate change, things like conflicts, humanitarian crises, and problems with drugs and insecticides also make it hard to control malaria.

Positive Takeaway:

• The report shares some positive news, too. It talks about the first malaria vaccine, RTS, S/AS01, being used in three African countries.
• And now, in October 2023, WHO recommended another safe and effective malaria vaccine, R21/Matrix-M.
• Having two vaccines should help more people get protection, especially in Africa.
• Some countries with low malaria cases are also making progress towards getting rid of malaria. In 2022, 34 countries had less than 1000 cases, compared to only 13 countries in 2000.

What does the Report Say About India?

• According to the World Malaria Report, India accounted for 66% of malaria cases in the World Health Organization’s South-East Asia region in 2022.
• India and Indonesia accounted for about 94% of all malaria deaths in the region last year, the World Health Organization said.
• The report said that nearly 46% of all cases in the region were caused by Plasmodium vivax, a protozoal parasite and a human pathogen.
• According to World Malaria Report 2023, the number of cases and deaths due to the mosquito-borne infection India have continued to decline.
  • With an estimated 33.8 lakh cases and 5,511 deaths, India saw a decline of 30% in malaria incidence and 34 per cent in mortality in 2022, compared to the previous year.
• India’s downward trend was reflected in the larger WHO South East Asian region that remained on track to achieving the 2030 target of reducing cases and deaths by 90%.

What is the Reason Behind India’s Success Story?

• As per experts, a focus on providing primary healthcare to the remotest areas, surveillance that is now being backed by digital data, and better handling of extreme weather events such as cyclones have been key to India’s success.
• Good preventive practices, use of effective tools to keep the mosquito population in check, use of point of care tests for quick diagnosis, and good management of the malaria cases have been key to reducing cases and deaths due to malaria over the years.
• There has been a lot of investment in insecticide mosquito nets, antimalarial drugs, and point of care tests to quickly detect the disease.
  • Urbanisation also reduces incidence of malaria by reducing breeding grounds for most mosquitoes that spread the disease.”
• States such as Odisha that regularly see extreme weather events such as cyclones are now well prepared to handle it, thereby reducing incidences of malaria associated with such events.

Climate Change and Malaria:

• The malaria parasite and mosquito are both extremely sensitive to temperature, humidity, and rainfall.
• The report says that climate change can not only directly increase geographies for malaria spread, but also indirectly affect the impact of the disease by reducing access to healthcare facilities and timely treatment.
• Climate change is likely to lead to an increase in temperatures, with newer areas especially in the Himalayan belt suitable for the spread of the disease.
  • High risk zones will also emerge in states that face very high rainfall periodically.     
  • Planning for the disease should also take into account such extreme weather events as better planning for them can reduce incidence of malaria.
• Almost half of the five million additional malaria cases reported globally in 2022, 2.1 million, were from Pakistan that witnessed an extreme flood.
  • The standing water after the floods became ideal breeding ground for mosquitoes and led to a five-fold increase in malaria cases in Pakistan.
  • The floods destroyed infrastructure and isolated millions, hindering medical access and increasing disease risk.
• With increasing frequency of such extreme weather events, the annual report for the first time focused on climate change and malaria.

Need for Improved Surveillance:

• With fewer cases being reported, there has to be intensified efforts to find and treat the scattered cases.
  • “When the burden of disease is higher, any intervention in areas reporting most of the cases results in drastic reduction in numbers.
  • However, when the numbers go down, the cases are scattered and difficult to find.
  • This is where the role of surveillance comes in
• It is important to have real-time digital data of these cases to help local administrations better plan the interventions.

Challenges Ahead:

• While India is doing well when it comes to malaria, issues such as resistance may derail it from its target of elimination by 2030.
  • The biological threats include drug resistance, insecticide resistance, gene deletions in parasites which make diagnosis difficult.
• Another challenge is vivax malaria, which accounts for over 40 per cent of malaria cases in India.
  • The vivax plasmodium is known to hide in the liver and cause recurrent infections.
  • To treat, a 14-day course of therapy has to be taken.
  • Experts say the challenge with that is many do not complete the treatment and stop taking the drug once they feel better.
• To achieve the malaria elimination target of 2030, there has to be emphasis on strengthening of surveillance as well as tailoring of malaria interventions at sub-national level which should be data driven.
• In addition updating policies and adopting new tools as per national and subnational need in line with WHO guidance is critical.

Government Initiatives to Control Malaria in India:

• From 2000 onward, India has successfully reduced malaria cases by over 50% and malaria-related deaths by more than 66%.
• In 2016, India implemented its inaugural National Framework for Malaria Elimination (2016-2030).
• The objective is to achieve a malaria-free nation by 2027, with complete elimination by 2030.
• In 2019, the Indian government significantly boosted funding for the National Vector Borne Disease Control Programme by over 25%.
• Additionally, India increased its support as a donor to the Global Fund to Fight AIDS, Tuberculosis, and Malaria.

What is Malaria and how is it Spread?

• Malaria is an illness caused by the Plasmodium parasite, primarily transmitted to humans through bites from infected mosquitoes, specifically female Anopheles mosquitoes.
• These mosquitoes are often referred to as "night-biting" mosquitoes because they typically bite between dusk and dawn.
• While there are various types of the Plasmodium parasite, only five can cause malaria in humans.
  • Plasmodium falciparum: Most common in Africa, responsible for the majority of malaria deaths globally.
  • Plasmodium vivax: Predominant in Asia and South America, causing milder symptoms and potential for relapses due to lingering in the liver.
  • Plasmodium ovale: Uncommon and typically found in West Africa, can persist in the liver for several years without symptoms.
  • Plasmodium malariae: Rare and mainly present in Africa.
  • Plasmodium knowlesi: Very rare and located in parts of Southeast Asia.

How Malaria Spreads?

• Female Anopheles mosquitoes transmit the Plasmodium parasite during their bites, primarily occurring between dusk and dawn.
• When an infected mosquito bites a person, the parasite enters the bloodstream and travels to the liver.
• After developing in the liver, the infection re-enters the bloodstream, invading red blood cells (RBCs).
• The parasites multiply within the RBCs, causing them to burst at regular intervals, releasing more parasites into the blood.
• While mosquitoes can become infected by biting an already infected person, malaria does not spread directly from person to person.