Malaria continues to be one of the most intractable public health problems in the world, especially in sub-Saharan Africa, but a handful of countries have succeeded in dramatically reducing malaria incidence and mortality. While some consider malaria eradication hopelessly optimistic, we highlight the significant economic benefits that it has already brought to China. We also offer some ideas of how these lessons can help other countries. How was malaria eradication in China achieved? What have its economic impacts been? What are the lessons that other countries can learn from China’s experience?
The Malaria Landscape in China
However, China’s journey to control malaria has proven a long and costly one. Its public health campaign to stamp out the disease started from a base of high incidence. Malaria outbreaks like these, with millions of cases per year, have defined much of the 20th century in China The country first started to bring malaria under control in the mid-20th century through a combination of effective public health policies, international cooperation, and massive investment. By the early 2000s, China had largely controlled the public health emergency, reporting fewer than 1 million malaria cases annually. Over the next two decades, the share of China’s population living in areas with high malaria transmission dropped from 25 percent to just 4 percent. By early 2021, the World Health Organization (WHO) officially declared China malaria-free.
Economic Benefits of Malaria Eradication
Increased Productivity
The most tangible economic benefit can be measured through increased work productivity. Malaria, as an illness, negatively impacts individuals’ ability to work and contributes to economic losses. Perhaps unsurprisingly, people who suffer from malaria are more likely to miss work or school than those who are healthy. This general relationship between health and work means that eradication, by increasing the number of days people are in good health, also increases the number of days they go to their jobs and classrooms. This directly stimulates economic output. With fewer people falling ill from malaria, China has restored lost work productivity, which has led to a measurable increase in overall economic productivity.‴ A healthier workforce is a more productive workforce, no matter how one defines the latter.
Enhanced Educational Outcomes
Children are particularly vulnerable to malaria, probably accounting for much of the sickness-related absenteeism in young people. The absence of malaria has increased the proportion of children attending school and its benefits to learning outcomes are certain. All of these effects will have a positive and long-lasting impact on the economic outlook of China. The persistence of higher average educational levels will translate into more economic growth. This is achieved primarily through a more skilled and innovative workforce, fostering greater technological innovation and economic advances.
Reduced Healthcare Costs
The eradication of malaria has saved China significant healthcare expenses. Previously, diagnosing and treating malaria was costly for both the government and affected families. By eliminating malaria, these funds can now be redirected to other infrastructure and public health initiatives, rather than being spent on necessary healthcare.
Attraction of Foreign Investment
A country that has overcome its malaria challenge by controlling or eliminating the parasite becomes much more attractive to foreign investment. With public health risks minimized, investors are more likely to take a chance on a particular region and its nascent industries. By eradicating malaria, China has positioned itself as a stable and healthy country in the eyes of domestic and international investors, who have invested heavily in the country, boosting development and modernization.
Tourism Growth
Being free from malaria also attracts tourists. For example, malaria-free status has contributed to China’s growth in tourism as travel agencies may lack incentives to organize tours for countries with high health risks. Tourism brings entrepreneurs more revenue and employment opportunities, further facilitating economic progress. Moreover, tourism promotes cultural exchange and the potential development of infrastructure and services for local people.
Lessons for Other Nations
Integrated Approach to Public Health
While it is true that malaria had no place in this discourse, the true catalyst behind China’s epidemiological triumph rested neither in its trade regime nor its medical interventions, but in an age-old integrated approach that conjoined vector control, non-medical surveillance, and political mobilization, as well as community engagement, social networks and learning-by-doing. The countries recreating the experience of modern China for the 21st century should follow suit – and emulate the full encyclopedia of malaria eradication.
Investment in Research and Development
Increased investment in research and development (R&D) must also continue to develop new tools and approaches for control. It was an investment in the R&D of improved drugs, insecticides, and diagnostic tools that enabled China to reach the status where it no longer has endemic malaria. Other countries must be similarly committed to R and D so they can have at their disposal the latest tools and treatments for combating malaria in the search for the much talked about but not yet achieved, zero malaria, program.
Strengthening Health Systems
This is the result of decades of healthcare investment in the fight against malaria, allowing China to build robust health systems capable of delivering services across regions with significant variation. In the countries now working towards the elimination and eradication of malaria, strengthening health systems will be essential to bring the disease to an end, from rural village clinics to malaria-endemic remote border regions.
Community Engagement and Education
Promoting community involvement in malaria control gained importance in eradication programs; China’s was one of the largest campaigns of community outreach and public education, which also contributed to the low rates of transmission. Other countries should aim to engage local communities in malaria control on a substantial scale and provide more public education on prevention.
International Collaboration
Eradication demands that countries work together. China’s success relied on teaming up with other countries, as well as international bodies such as the World Health Organisation. Such partnerships—for financing, technical support, and knowledge-sharing—are crucial to success and sustainability. Other nations would likewise be well-served to be like-mind with one another, and with international organizations, to improve their malaria control efforts.
Challenges and Considerations
Though it might be a useful case study for others, the history of China’s malaria eradication efforts demonstrates that there is no easy path. After 34 years, China’s malaria-free status is so tenuous that it spends around US$100 million every five years just to keep it.
For other countries hoping to emulate China (and especially upon course correction), simply copying travel ‘plans’ don’t work: we must look for ‘travel guides’ that suit our existing starting point our reality of existing hospitals, patients, economy, resources, and society.
China’s struggle with malaria eradication is just such a case study of the economics of eradication in action; the country’s economy has soared after it succeeded in eliminating a serious disease, and there are similar reports of economic gains from other countries that tamed malaria.
Other countries could learn from China’s commitment to an integrated public health strategy, from investing in research and development, building health systems, relying on public engagement, and improving international cooperation. With their innovative answers, the needs of their country’s people, and the high stakes involved, it will be exciting to see what lessons these countries can share with the rest of the world to measurably reduce – perhaps even one day to end – malaria. There are important economic motivations that drive national politicians to make malaria control a priority.
In short, malaria eradication comes with sweeping economic implications that fall far beyond any direct health benefits of eradication. China’s experience shows that its economic growth and development can serve as a model for other countries still grappling with malaria.
