This year, the World Health Organisation (WHO) has declared China free from malaria. Just 80 years ago, China faced an estimated 30 million cases of malaria and 300,000 related deaths per year, says Professor Zhou Xiaonong, Director at China’s National Institute of Parasitic Diseases (NIPD).

The country has since managed to stop all local transmissions for four years, and put in place a functional surveillance and response system to prevent a resurgence of the disease. How did they tackle this enormous problem?

GovInsider spoke to Zhou and Dr Sarthak Das, CEO of the Asia Pacific Leaders Malaria Alliance, to understand how China rose to the challenge.

Smart surveillance

Tracing and understanding the spread of a disease is the first step to stopping it, as the world now knows with Covid-19. China used AI to make sense of real-time data of malaria’s spread.

Authorities used satellite imaging data to predict possible mosquito breeding grounds, a BMC study found. Officials can be alerted to possible malaria hotspots with weather data – improving manpower resource allocation.

Other countries have implemented similar tools. Israeli’s Zzap Malaria is a map-based mobile app that uses AI to identify hotspots for malaria, and can even analyse weather patterns to help authorities identify possible surges in malaria cases. It has been successfully deployed to help hard-hit regions in sub-Saharan Africa.

Over ten years ago, China implemented a “1-3-7” surveillance strategy that was a “game-changer for monitoring malaria cases”, Dr Sarthak says. This strategy stipulated strict timelines that had to be followed in the reporting of malaria cases.

Possible cases are reported within a day and diagnosed by the third day. Authorities will conduct testing of the community to ensure no further spread by the seventh day. This strategy has already been adapted for several other nearby countries – including Cambodia, Indonesia and Thailand.

Collaboration across sectors in China was key in fighting back against malaria, Zhou says. In 2010, 13 different ministries including health, education and tourism came together to combat malaria.

For instance, schools teach students about malaria in their curriculum – this is especially important in higher-risk areas like Yunnan Province, wrote the WHO. The province borders Myanmar, Laos and Vietnam – three malaria-endemic countries.

All in this together

A public health crisis is everyone’s fight. NIPD helped to establish a network of labs that conducted specialised malaria testing, while also ensuring the accuracy and quality of results. This was an important indicator that the WHO used to evaluate if malaria had been eliminated, wrote a Malaria Journal study.

A drug resistance monitoring network was also set up. This helped officials monitor the effectiveness of treatment drugs and detect mosquito species that are resistant to them. Three out of five malarial-transmitting species are currently resistant to antimalarial treatment, the WHO found.

China’s commitment to reduce poverty played a significant role in reducing malaria numbers as well, wrote the WHO. Over 745 million people were lifted out of poverty in 30 years, reported BBC, which meant that more citizens had access to proper housing and health facilities. The government also provides free basic health coverage – which grants citizens affordable diagnosis and treatment for malaria.

International collaboration

“Malaria is a disease of poverty and inequity, which disproportionately affects vulnerable populations living in remote areas,” Dr Sarthak says.

China has worked together with authorities of bordering areas to train rural healthcare workers in the detection and treatment of malaria. This has helped to significantly reduce the number of cases in these hard-hit areas, says Zhou. They are currently looking to partner with four more countries, he adds.

Dr Sarthak agrees that international collaboration is key to helping the region overcome the disease. “We must now focus on our high burden countries and those countries nearing or still working towards malaria elimination,” he says.

International platforms such as the Asia Pacific Leaders Malaria Alliance (APLMA) and the Asia Pacific Malaria Elimination Network help support cross-border collaboration between leaders to eliminate malaria in the region by 2030. They help to adapt malaria solutions for countries with respect to the geographical context.

For instance, APLMA worked with the government of the Solomon islands to develop a surveillance and response system adapted from China. The best practices for malaria elimination should be shared across borders, says Dr Sarthak.

As the Covid-19 pandemic continues to ravage the poorest parts of the world, countries with resources already spread thin will have to work hard at curbing the spread of other diseases. Perhaps China’s approach offers some lessons.