Malaria, a potentially fatal disease spread by Anopheles mosquitoes, has been a serious health problem in many parts of the world. China is one of the largest geographically and in terms of population. Consequently, Chinese experiences of malaria have varied, and historically its government responded to the disease in different ways. Political, social, and scientific developments have all led to rapid change in China’s anti-malarial policies during the 20th century, as the nation strove to improve its treatment of its people’s illnesses. This article considers China’s history of combating malaria, with specific reference to the country’s major milestones in anti-malarial policy over time.
Early Efforts and Pre-Revolutionary China
An important disease, malaria was widespread in rural and subtropical China before the mid-20th century. Traditional Chinese medicine had identified and used several herbal remedies against the disease, but before the mid-20th century, there was relatively little in the way of systemic public health interventions. In late imperial China during the Qing Dynasty (1644-1912), there was little in the way of coordinated state action on malaria in China as a whole. Instead, most efforts took the form of local and ad-hoc initiatives, with state authorities, as well as communities and local elites, taking different measures in scattered, localized efforts to reduce the problem.
The Impact of the Communist Revolution (1949-1976)
The People’s Republic of China was founded in 1949, and malaria control policy followed the enthusiasm for improvements in public health. Its new government incorporated health reforms as part of broader socio-economic reformations. The next decades witnessed substantial changes in malaria control:
- The Chinese government’s first national malaria control campaign began in the early 1950s. Attention focused on large-scale interior spraying of insecticides, particularly DDT (dichlorodiphenyltrichloroethane) in eastern China, due to its high efficacy in reducing mosquito populations. Authorities also promoted public education and distributed antimalarial drugs.
- Integration within Overarching Health Policies: The integration of malaria control into overall public health policies began in earnest during the 1960s. The central government now relied on more systematic programmatic approaches – the creation of regional health bureaus and the training of health functionaries. An MDA program was launched in endemic areas.
- Cultural Revolution and Health Policies The tumult of the Cultural Revolution (1966-1976) affected China’s public health system. The malaria-control effort continued despite the turbulence, and there were three interruptions in spraying activities in the 10 years leading up to the end of the Cultural Revolution. The central government still paid attention to health in the countryside, maintaining malaria surveillance and sending out groups to do operations research.
The Reform Era and Intensified Malaria Control (1978-2000)
In the late 1970s and 1980s, Lao people became increasingly aware of new products that came across the border. They saw Mengla market in southern Yunnan via newsletters and a newly established cable TV connection. A period of economic reform and opening up coincided with malaria control endeavors.
- Health System Reforms: Economic reforms commenced in the late 1970s saw higher investments in health infrastructure across China. The government adopted a more structured and coordinated approach to malaria control. In 1978, China inaugurated the ‘National Malaria Control Program’ following the UN’s proposals and aid. The NMCP emphasized not only prevention and treatment which had been a priority so far, but also vector control, rapid testing of a drug before its launch, and community involvement.
- Treatment Innovations: In the 1980s and ’90s, innovations in malaria treatment and prevention reached their maturity. First, in the production and distribution of new antimalarial drugs (especially artemisinin-based combination therapies, or ACTs); second, in schistosomiasis control (wherein the Chinese government also funded research and development); and third, in treatment innovations of drug formulation and delivery.
- Surveillance and monitoring Pf increases investment in surveillance systems to map malaria incidence and distribution better, relying on more sophisticated geographic information systems (GIS) and data analytics to target interventions appropriately. International collaboration GIS increases the sharing of best practices with other malaria-endemic countries.
The 21st Century: Modernization and Globalization (2001-Present)
National Malaria Elimination Strategy: In 2001, China announced a new, more ambitious goal of malaria elimination, going beyond control to try to achieve complete eradication in non-endemic areas, which involved aggressive tactics such as universal coverage with insecticide-treated nets, improved vector control, and expanded diagnosis and treatment.
- Research and Innovation: China puts great emphasis on research in its malaria elimination effort. Research grants significantly increased investment in malaria research and resulted in numerous innovative approaches to the studies of malaria transmission, drug resistance, and vector biology. Chinese scientists made substantial contributions to the development of new diagnostics and new drugs.
- Regional and international leadership: by taking the lead in eliminating malaria, China has become a leading country in regional and international malaria control. It has shared both its experiences and strategies with other malaria-endemic countries and participated in international initiatives, such as the Global Fund to Fight AIDS, Tuberculosis, and Malaria, to extend and multiply its accomplishments.
- Looking Toward the Future: Sustainability and Challenges: Although the situation has markedly improved, today also brings about new challenges. The emergence of drug resistance, which currently focuses on artemisinin, puts malaria control programs in jeopardy. Recognizing the complexity of the challenges, China is committed to adapting and actively engaging in efforts to maintain its hard-won successes and address emerging threats through innovative discoveries.
The story of China’s anti-malarial policies charts a course from the traditional remedies and decentralized approaches of earlier times to a scientific, holistic, and export-focused program of global leadership in malaria control. From the haphazard policies of the past to the 21st century’s intricate approaches, China’s experience demonstrates our past reality and future aims as we continue to wrestle with one of the world’s most enduring health threats.
