WHO report says India reduces malaria caseload, deaths by 69% each: Why combination drugs and insecticidal mosquito nets worked

India has finally managed to control malaria, reduce mortality and has gotten out of the High-Burden-High-Impact (HBHI) group of endemic countries, according to the World Malaria Report released on Wednesday.

India reduced its malaria caseload by 69 per cent from 6.4 million in 2017 to 2 million in 2023. Similarly, the estimated malaria deaths registered a 69 per cent decrease from 11,100 to 3500 during the same period. Every year, the report serves as a vital tool to evaluate global progress and gaps in the fight against malaria. It provides a snapshot of efforts to control and eliminate the disease in 83 countries.

“India has made progress in reducing the malaria burden because of its multi-sectoral approach and political commitment to bring down the burden,” said Dr Daniel Madandi, Director of Global Malaria Programme. “It’s never as fast as we would like, and there are some worrying plateaus but the trends are still encouraging. Apart from India, countries like Liberia and Rwanda have seen huge drops in cases,” added Dr Arnaud Le Menach, lead author of this year’s report and head of the Strategic Information for Response unit within the WHO Global Malaria Programme.

According to Dr Rajni Kant Srivastava, Indian Council of Medical Research (ICMR), Chair for Disease Elimination, this was possible due to the Artemisinin-based combination therapy (ACT) and long-lasting insecticidal nets (LLIN). The advantage of the combination therapy is that the artemisinin first kills the majority of malaria parasites by attacking a certain protein, and the partner drug clears the small number of parasites that remains.

When mosquitoes try to bite someone sleeping under a LLIN, they are not only blocked by the net, but also killed by the insecticide coating. According to the CDC, if more than half of a community uses an insecticide-treated net, the number of mosquitoes in the area and their lifespan will be reduced.

Effective monitoring and evaluation helped in case management. “The use of these tools in forested and tribal areas in Jharkhand, Odisha, Chhattisgarh and North-East has made an impact,” said the former founder-director, ICMR-Regional Medical Research Centre, Gorakhpur. According to the report, targeted interventions resulted in improved access to diagnostics, treatments and drugs. New generation insecticide-treated nets, which provide better protection against malaria than the standard pyrethroid-only nets, are being deployed more widely.

This year’s report presents some encouraging data and trends in global malaria control. Between 2000 and 2023, 2.2 billion cases and 12.7 million deaths were averted worldwide. Also, more countries are introducing the recently approved malaria vaccines.

Till date, the WHO has certified 44 countries and one territory as malaria-free – including, most recently, Egypt.

Certification of malaria elimination requires the elimination of the four main human parasite species: P. falciparum, P. vivax, P. Ovale and P. malariae. Certification is awarded when a country or territory can prove beyond a reasonable doubt that the mosquito-borne transmission chain has been interrupted nationwide, resulting in zero indigenous malaria cases for at least three consecutive years. Africa continues to be the hardest hit.

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