Although health services were affected by three years of Covid-19, cases of malaria continued to dip in India despite the pandemic. There was an estimated 30 per cent decline in cases and 34 per cent decline in deaths in 2022 compared to the previous year, according to the World Malaria Report released on Thursday. The Indian decline is significant because it is in contrast to global trends, which showed that around five million additional cases were recorded in 2022 compared to the 249 million cases in 2021. While the number of malaria cases had plateaued globally over the last decade or so, this year’s report shows that it started increasing during the pandemic. The number of malaria cases had dropped from 243 million to 233 million globally between 2000 and 2019. However, there was an increase of 11 million cases during the first year of the pandemic. The numbers remained the same in 2021 and increased again in 2022. The number of malaria deaths globally also remained higher than the pre-pandemic levels. Altogether 608,000 deaths were reported in 2022 compared to 576,000 cases in 2019. However, India accounted for 1.4 per cent of the global malaria cases and just 0.9 per cent of deaths. How India brought down numbers with a three-pronged strategy? Experts say it is because of the country’s focus on providing primary healthcare to the remotest areas, data-backed surveillance and better handling of extreme weather events such as cyclones. “The malaria burden has declined over the years due to preventive and case management strategies, availability of effective vector control tools as well as point of care diagnostics and prompt treatment at community level,” said Dr Neena Valecha, former director of National Institute of Malaria Research, who also served as the advisor on malaria to the WHO-Southeast Asia region previously. Dr Kaushik Sarkar, director of Institute for Health Modeling and Climate Solutions and former country director for Malaria No More India, said: “There has been investment in long-lasting insecticidal mosquito nets, point of care tests, anti-malarial drugs to prevent, quickly detect and treat the disease. Planned urbanisation and overall economic development also reduce incidence of malaria by reducing breeding grounds for most mosquitoes and helping communities fight the spread of the disease.” Besides extreme weather event states like Odisha are now well-prepared to handle cyclones, thereby reducing incidence of malaria associated with rainfall and flooding. Has climate change had a role in the spread of malaria? The malaria parasite and mosquito are both extremely sensitive to temperature, humidity and rainfall, leaving experts worried about their spread. According to Dr Sarkar, “Climate change is likely to lead to an increase in temperatures, with newer areas especially in the Himalayan belt becoming suitable for breeding. High risk zones will also emerge in states that face erratic and unusually heavy rainfall and floods.” Planning for the disease should, therefore, take into account such extreme weather events. Almost half of the five million additional malaria cases reported globally in 2022 — 2.1 million — were from Pakistan that witnessed extreme flooding, standing water becoming an ideal breeding ground for mosquitoes. “The floods also destroyed infrastructure and isolated millions, hindering medical access and increasing disease risk.” Why is there still a need for improved surveillance? There cannot be complacency with fewer cases being reported from the country and efforts must be intensified to treat scattered disease clusters. “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,” said Dr Sarkar. He added that it was important to have real-time digital data of these cases to help local administrations better plan the interventions. What are the challenges for India? Drug resistance, insecticide resistance and gene deletions in parasites make diagnosis difficult, according to Dr Valecha. 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. A 14-day course of therapy has to be taken but many do not complete the treatment and stop taking the drug once they feel better.
