Southeast Asia's fight against malaria has entered the "last mile": what role does China's experience play
2024-08-18
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It is hard to imagine that the biggest threat to humans in nature is not venomous snakes or ferocious beasts, but mosquitoes that we encounter in daily life.
Every year, more humans die from mosquito bites than any other creature. According to statistics from the World Health Organization (WHO), about 725,000 people die from diseases caused by mosquito bites each year, and malaria alone caused 608,000 deaths in 2022.
August 20th is the annual "World Mosquito Day". Although it is named "Mosquito", it is not established to commemorate mosquitoes, but to raise public awareness of malaria and other mosquito-borne diseases.
China achieved the elimination of malaria in 2021, and most of the Southeast Asian countries connected to China by mountains and rivers, except Myanmar, have also entered the "last mile" in the fight against malaria, and the epidemic areas have shrunk to individual remote areas.
Researcher Gao Qi, member of the WHO Malaria Policy Advisory Committee and head of the National Malaria Elimination Technical Expert Group, previously told the First Financial reporter that in Vietnam, Laos and Cambodia, among Southeast Asian countries, the annual number of cases of malignant malaria has dropped to less than 100, and there is "great hope" of achieving malaria elimination by 2030.
Joint prevention and control of malaria at the border
Malaria is one of the oldest infectious diseases in the world, caused by a parasite called Plasmodium and transmitted through the bites of infected mosquitoes. Malaria symptoms include fever, headache, vomiting, etc., and in severe cases can cause death.
Due to its special geographical and climatic factors, Yunnan was once one of the provinces in China with the most serious malaria epidemic. The disease has a long history in Yunnan. As early as the Three Kingdoms period, Zhuge Liang led his troops to the south and left a record of "soldiers infected with malaria, offering sacrifices to the Lu River to eliminate the disease", which is also the earliest written record of malaria in Yunnan.
Menghai County, Xishuangbanna Dai Autonomous Prefecture, Yunnan Province, is located in the southwest of Yunnan Province, bordering Myanmar in the west and south. It was once a highly malaria-prone area in Yunnan. In 1956, when malaria broke out locally, Yunnan set up the Provincial Malaria Prevention and Treatment Center in Menghai. According to data from 1957, at least 50 people out of every 100 in Menghai County were infected with malaria.
With the unremitting efforts of malaria prevention workers, malaria was basically eliminated in Menghai County by 1962. In Xishuangbanna Prefecture, the last locally infected malaria case was reported in April 2013. In June 2020, Yunnan Province passed the national malaria elimination final evaluation. Yunnan, once known as the "malaria-ridden area", has achieved the goal of eliminating malaria.
Yunnan is one of the provinces with the longest borders in the country, with 25 border counties in eight prefectures (cities) bordering Myanmar, Laos and Vietnam, all of which have yet to achieve malaria eradication.
In 2005, with the support of the National Health Commission and the Yunnan Provincial Health Commission, the Yunnan Provincial Institute of Parasitic Diseases began to undertake and implement the national "China-Myanmar Border Area Malaria Joint Prevention and Control Project". In 2010, the project was expanded to Laos and Vietnam and dengue fever was added, and it developed into the "Greater Mekong Subregion Part of the Border Area Malaria and Dengue Fever Joint Prevention and Control Project". Since then, the project has been expanded to all countries in the Greater Mekong Subregion.
Myanmar has the highest malaria incidence in the Greater Mekong Subregion. According to the World Malaria Report 2023 released by the WHO, Myanmar has a total population of 53.4 million, of which nearly 32 million are at risk of malaria. According to Myanmar statistics, the total number of malaria cases in 2022 was close to 160,000. Between 2019 and 2022, due to political and social instability in Myanmar, local malaria cases increased nearly sevenfold.
Menghai County borders Mongla in Shan State, Myanmar. Although Myanmar's overall malaria epidemic is serious, there are significant regional differences. Chen Ran, deputy director of the Menghai County Center for Disease Control and Prevention, told China Business News that Menghai County and Mengla have carried out joint prevention and control of epidemics such as malaria. Since 2017, there have been few reports of malaria cases in Mengla, and malaria is no longer a major threat to the local area.
Chen Ran said that Menghai County would exchange data and information on malaria and other epidemics with Mengla every quarter. In terms of hardware, Mengla would be provided with thermal fog machines, mosquito repellents, personal protective equipment, and malarial parasite antigen detection reagents.
Based on the joint prevention and control of malaria, the Menghai County Center for Disease Control and Prevention sends staff to Mengla every year to provide technical assistance for malaria and other infectious diseases. In addition, Chen Ran told reporters that if Mengla encounters a case that is difficult to diagnose, they will contact them as soon as possible to assist in research and resolution.
In the process of eliminating malaria, China has formulated a strategy of "tracing clues, clearing and eliminating sources" and explored and summarized the "1-3-7" strategy for malaria reporting, investigation and disposal. Specifically, it means reporting cases within 1 day, completing case review and epidemiological investigation within 3 days, and conducting epidemic site investigation and disposal within 7 days.
Chen Ran said that when encountering malaria cases in Mengla, Menghai County Disease Control would assist Mengla in conducting "1-3-7" investigations and disposal. She told reporters that although the education level of local medical workers is not high and it may be difficult for them to master theoretical knowledge, once they are taught on site, "the specific operations can be learned quickly, and the execution strength in the later stage is also good."
Chen Ran finally said proudly that she and her colleagues had trained most of the staff engaged in disease control in Mengla. Now the departments and institutions of the disease control in Mengla also referred to the Chinese organizational model when setting up. "If they do a good job, our pressure will be reduced."
In addition to the joint prevention and control mechanism for malaria at the border, the Yunnan Office of the Health Poverty Alleviation Action (HPA) is active in border areas such as Mengla, distributing long-lasting insecticide-treated mosquito nets, providing antimalarial drug treatment, and training local health workers in malaria diagnosis and treatment. These measures have helped reduce the spread and incidence of malaria.
According to the website of the Chinese Center for Disease Control and Prevention, on June 13, the 8th China-Myanmar Malaria Elimination and Infectious Disease Cooperation Seminar was held in Naypyidaw, the capital of Myanmar. Aye Tun, Deputy Minister of Health of Myanmar, said at the meeting that although Myanmar has made remarkable achievements in malaria prevention and control, it still faces challenges in remote and underserved areas. Cooperation with China has played a key role in addressing these unique challenges.
The “last mile” of encirclement and suppression
Among Southeast Asian countries, the Mekong River Basin countries are more seriously troubled by malaria. In 2015, the six countries in the Greater Mekong Subregion issued the "WHO Greater Mekong Subregion Malaria Elimination Strategy", aiming to eliminate malaria in the entire subregion by 2030.
In Vietnam, during the 1991 malaria pandemic, 1 million cases were reported nationwide, including 4,646 deaths. By 2023, 46 of Vietnam's 63 provincial administrative regions have achieved the goal of eliminating malaria. In the provinces that have not yet eliminated malaria, the epidemic areas are mainly concentrated in villages, and the number is decreasing every year. Vietnam expressed confidence in achieving the goal of eliminating malaria by 2030.
The number of malaria cases in Laos has dropped significantly from about 462,000 in 1997 to 2,305 in 2022. Rattanaxay Phetsouvanh, director of the Department of Communicable Disease Control of the Lao Ministry of Health, previously said that malaria currently only affects a small part of the population in Laos, and only 10% of health institutions in the country have reported malaria cases, but areas affected by malaria are often remote and difficult to reach.
On World Malaria Day on April 25 this year, Cambodian Prime Minister Hun Manet said that Cambodia will strive to become a malaria-free country by 2025. He said that Cambodia has made new breakthroughs in malaria prevention and control, with only 1,384 cases of malaria in 2023 and no deaths since 2018. Like Laos, Hun Manet said that providing timely diagnosis and treatment services to remote areas has become Cambodia's goal.
The Clinton Health Initiative (CHAI) has been carrying out malaria eradication work in Southeast Asia for more than 10 years. Hu Yang, the organization's malaria project manager in Asia, told the First Financial reporter that there are now few cases of malaria in cities in Vietnam, Laos and Cambodia. The high-risk group for malaria is adult men who often go to work in the forest. They are generally the backbone of the family's income. Once they become ill, it means that the whole family will have no income.
In the process of eliminating malaria in the region, the "Chinese experience" has been widely used after combining with local actual conditions. Hu Yang told reporters that in Laos, malaria-endemic areas are currently divided into malaria elimination areas and malaria control areas. In the malaria elimination areas, the local "1-3-7" strategy is applied; while in Cambodia, the local "1-3-7" strategy is appropriately modified to "1-7", that is, case reporting and investigation within 1 day, and disposal of epidemic points within 7 days.
In addition, three or four Chinese manufacturers have already produced insecticide-treated mosquito nets that have passed WHO pre-certification and are purchased by the Global Fund to Fight AIDS, Tuberculosis and Malaria for distribution in Southeast Asian countries. Insecticide-treated mosquito nets are an economical and effective tool for malaria prevention. When mosquitoes come into contact with insecticide-treated mosquito nets, they will be poisoned or lose their ability to bite.
Hu Yang told the First Financial Daily reporter that Southeast Asian countries are very eager to learn from China's experience in eliminating malaria, especially how to prevent the resurgence and re-introduction of malaria when approaching the elimination stage. This will help improve local malaria elimination capabilities. As the number of malaria cases in Southeast Asia decreases, the assistance provided by the international community is also gradually decreasing, and the sustainability of malaria elimination is becoming increasingly important.
(This article comes from China Business Network)
