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Picture Courtesy: The Hindu

Context:

India is on track to eliminate malaria by 2030, but achieving this requires sustained efforts across surveillance, treatment, prevention and addressing challenges like migration, urban malaria and drug resistance.

Current status of Malaria in India

• From 2015 to 2023, India achieved a steep decline in malaria burden. Reported cases dropped from nearly 7 lakh to about 2.27 lakh, while deaths decreased from 384 to roughly 83, reflecting an overall reduction of around 80% in both incidence and mortality.
• In 2024, India was officially removed from the World Health Organization’s High Burden to High Impact (HBHI) list, an important recognition of the country’s sustained progress in controlling the disease.
• Malaria transmission is now largely restricted to limited high-risk pockets, particularly in certain northeastern States such as Mizoram and Tripura, along with a few remote and hard-to-access regions. Most other parts of the country report very low levels of transmission.
• India has set a clear national target of achieving zero indigenous malaria cases by 2027, with the broader aim of complete malaria elimination by 2030, in line with the WHO Global Technical Strategy.

Source: PIB

What is Malaria and how does it spread?

Malaria is a serious infectious disease caused by Plasmodium parasites. People become infected when they are bitten by an infected female Anopheles mosquito, which transmits the parasite into the bloodstream. The disease is most common in warm, tropical climates.

Malaria does not usually spread directly from one person to another, but transmission can rarely occur through blood transfusions, shared needles, or from mother to child during pregnancy. If prompt treatment is not given — especially in infections caused by Plasmodium falciparum — the illness can quickly become severe and may turn fatal within a short time.

Symptoms:

Early signs of malaria often resemble flu-like illness. The most frequent symptoms are:

• Fever
• Headache
• Chills and shivering

These symptoms typically appear about 10 to 15 days after an infective mosquito bite. In people who have had malaria before, symptoms may be milder, which can delay diagnosis.

In more serious cases, malaria can progress to severe disease, leading to:

• Extreme weakness or fatigue
• Confusion or altered consciousness
• Repeated convulsions
• Difficulty breathing
• Dark or blood-tinged urine
• Yellowing of the skin or eyes (jaundice)
• Unusual bleeding

Certain forms of malaria are particularly dangerous and can be life-threatening if not treated quickly.

Prevention:

Prevention mainly focuses on protecting against mosquito bites and, when necessary, using preventive medication.

• People travelling to malaria-affected regions should consult a doctor in advance about preventive antimalarial medicines (chemoprophylaxis).
• Sleeping under insecticide-treated mosquito nets is one of the most effective protective measures.
• Applying mosquito repellents containing DEET, IR3535, or Icaridin after sunset can reduce exposure.
• Using mosquito coils, vaporizers, and window screens helps keep indoor spaces mosquito-free.
• Wearing long-sleeved clothing and full-length garments in the evening also lowers the risk of bites.

Key challenges in malaria elimination:

Persistent high-transmission pockets: Even though India reduced malaria cases by about 80.5% between 2015 and 2023, transmission remains concentrated in certain tribal, forested and hard-to-reach districts, making consistent intervention difficult.

Migration: Movement of people from high-burden areas continues to pose a threat of reintroducing malaria to places that have achieved low transmission, undermining elimination gains.

Urban Malaria spread: The spread of invasive vectors like Anopheles stephensi in urban settings has increased malaria risk in cities, where dense populations and infrastructure challenges complicate control.

Species complexity and relapse: Plasmodium vivax, which makes up a large share of India’s malaria cases, can lie dormant and cause relapses, hindering complete interruption of transmission.

Surveillance and reporting gaps: Timely and complete case reporting remains uneven, especially from private health providers and peripheral areas, limiting accurate tracking of residual transmission.

Resistance to insecticides and drugs: Emerging resistance among mosquito vectors to insecticides and among parasites to antimalarial drugs threatens the effectiveness of current prevention and treatment strategies.

Government initiatives on Malaria elimination:

Way Forward:

• Strengthen surveillance to detect every case: India must further improve real-time, case-based surveillance to ensure every malaria infection is detected, reported, and investigated, especially as the country moves toward zero indigenous cases by 2027.

• Ensure complete treatment and radical cure: Strict adherence to full treatment regimens, including the 14-day primaquine course for Plasmodium vivax, is essential to prevent relapses that can silently sustain transmission.
• Focus on high-risk and hard-to-reach areas: Targeted interventions are needed in tribal, forested, border, and northeastern districts (such as parts of Mizoram and Tripura) where malaria transmission remains relatively high.

• Prevent re-establishment in malaria-free areas: Districts that have achieved zero indigenous cases must maintain vigilant surveillance and rapid response systems to stop imported cases from restarting local transmission.

• Tackle urban malaria proactively: With the spread of urban vectors like Anopheles stephensi, cities need better water management, construction-site monitoring, and community participation to reduce breeding sites.

Conclusion:
India has made remarkable progress in reducing malaria and is moving steadily toward elimination, but the final phase demands vigilant surveillance, targeted action in high-risk areas, and sustained political and community commitment. Preventing re-establishment of transmission will be just as important as eliminating the remaining cases to achieve a malaria-free India by 2030.

Source: The Hindu