China has been awarded a malaria-free certification from WHO, following a 70-year effort. China’s achievement comes as a notable feat for a country that reported 30 million cases of the disease annually in the 1940s.
China is the first country in the WHO Western Pacific Region to be awarded a malaria-free certification in more than 3 decades. Other countries in the region that have achieved this status include Australia (1981), Singapore (1982) and Brunei Darussalam (1987).
“Today we congratulate the people of China on ridding the country of malaria,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. “Their success was hard-earned and came only after decades of targeted and sustained action. With this announcement, China joins the growing number of countries that are showing the world that a malaria-free future is a viable goal.”
Globally, 40 countries and territories have been granted a malaria-free certification from WHO – including, most recently, El Salvador (2021), Algeria (2019), Argentina (2019), Paraguay (2018) and Uzbekistan (2018).
In the 1980s, China was one of the first countries in the world to extensively test the use of insecticide-treated nets (ITNs) for the prevention of malaria, well before nets were recommended by WHO for malaria control. By 1988, more than 2.4 million nets had been distributed nationwide. The use of such nets led to substantial reductions in malaria incidence in the areas where they were deployed.
By the end of 1990, the number of malaria cases in China had plummeted to 117,000, and deaths were reduced by 95%. With support from the Global Fund to Fight AIDS, tuberculosis and malaria, beginning in 2003, China stepped up training, staffing, laboratory equipment, medicines and mosquito control, an effort that led to a further reduction in cases; within 10 years, the number of cases had fallen to about 5,000 annually.
Risk of imported cases
In 2020, after reporting 4 consecutive years of zero indigenous cases, China applied for an official WHO certification of malaria elimination. Members of the independent Malaria Elimination Certification Panel travelled to China in May 2021 to verify the country’s malaria-free status as well as its programme to prevent the re-establishment of the disease.
The risk of imported cases of malaria remains a key concern, particularly in southern Yunnan Province, which borders 3 malaria-endemic countries: Lao People’s Democratic Republic, Myanmar and Viet Nam. China also faces the challenge of imported cases among Chinese nationals returning from sub-Saharan Africa and other malaria-endemic regions.
To prevent the re-establishment of the disease, the country has stepped up its malaria surveillance in at-risk zones and has engaged actively in regional malaria control initiatives. Throughout the COVID-19 pandemic, China has maintained training for health providers through an online platform and held virtual meetings for the exchange of information on malaria case investigations, among other topics.