It is no exaggeration to say that for many countries, especially in tropical and subtropical regions, the most stubborn enemy they face is malaria. As one of the most populous countries with diverse topography and climates, China has a long history of suffering from endemic malaria and remains, nonetheless, a hotbed of transmission. Nevertheless, with the sincere efforts of China’s government initiatives, China is gradually liberating itself from malaria and shrinking the map of malaria significantly. This article discusses the importance and functioning of Chinese government initiatives in the battle against malaria, its challenges to success, and the path the nation is taking towards the eradication of malaria.
Historical Context
To appreciate what governmentality, the innovative approach to good governance, could contribute to the efforts to eradicate malaria in China, we have to keep in mind the long-term history of malaria and the repeated outbreaks that affected China from time immemorial, seriously impacting health and economic growth. By the mid-20th century, malaria had become one of the most important killer diseases in China. In the late 1940s, half of China’s population was still at risk of contracting malaria.
Government Response and Strategic Planning
The National Malaria Control Program
The establishment of an institutional structure for malaria control became possible with the rapid expansion of the social welfare system, as it gathered force in the 1950s with the founding of a National Malaria Control Programme. This program established a structure for a coordinated national response:
- Mosquito Control: Routine insecticide spraying for mosquitoes, along with larvicides. DDT (dichloro-diphenyl-trichloroethane) was completely changing the landscape of how to control mosquitoes that carry malaria.
- Supply of treatments and diagnosis: The government worked on providing both better drugs for malaria and improved diagnostic devices, and training healthcare professionals in the diagnosis and cure of malaria.
- Surveillance and monitoring: Monitoring malaria cases in Mol criteria and shifting affect Indeed, part of the reason for the spectacular success of the Mol program lay in the surveillance and monitoring it had built into its model. The strategy relied on hard data to generate a dynamic response. For instance, clinical trials of re-infestation could be conducted, allowing adjustments to the level of spraying or the use of insecticide-treated bed nets as needed.
The 20-Year Malaria Elimination Plan
In 2010, China introduced the 20-Year Malaria Elimination Plan – the national strategy to eliminate the disease by 2030. The plan has a series of important steps:
- Interrupt local transmission: The vector control measures, diagnostic and treatment services, and other activities aimed at reducing, and eventually eliminating, local transmission of malaria will be improved.
- Cross-Border Cooperation: Malaria is a regional issue and as such cross-border assistance has been made with China’s neighbors Vietnam, Laos, and Myanmar. Cross-border cooperation has benefited regional approaches, as transmission may easily ‘jump’ the border.
- Research and innovation: The plan emphasizes the need for research and innovation to develop new tools and approaches for malaria control. It calls for investment in both existing and new malaria vaccines, focusing particularly on new treatment options.
Key Government Initiatives
The Roll Back Malaria (RBM) Partnership
In 1998, China joined the Roll Back Malaria (RBM) Partnership, an international cooperative that aims to reduce both morbidity and mortality from malaria. The goals of the RBM Partnership find broad support in China, precisely because they are so similar to domestic malaria control objectives. Indeed, this collaboration becomes a source of legitimization for China, as it authorizes the use of outside expertise and resources in its domestic agenda. Furthermore, China collaborates not only with international organizations but also with other countries, such as the United States, Australia, and France. By doing so, it effectively harnesses their expertise and resources.
The China Malaria Elimination Demonstration Project
For instance, in 2011, China also launched the Malaria Elimination Demonstration Project, which focused on a few select areas to show that malaria elimination was possible in particular regions. The endeavor was designed as a model for the rest of the country, paving the way using a coordinated, evidence-based set of best practices to eradicate malaria nationwide.
The National Free Malaria Diagnosis and Treatment Program
Recognizing the need to ensure quality, accessible health care, China’s government has also instituted the National Free Malaria Diagnosis and Treatment Programme. This program guarantees that malaria diagnosis and treatment are provided free of cost to any patient, with special attention paid to those living in remote and impoverished areas where financial barriers to health are greatest.
Surveillance and Data Management Systems
Good surveillance and data management are vital to a control program. The Chinese government has made significant investments in advanced surveillance systems, capable of real-time mapping of malaria cases. This includes Geographic Information Systems (GIS) and mobile technology that enable government officials to track malaria cases, and hotspots, and monitor treatment outcomes. The technological tools let the government sift through data to determine trends, allocate resources efficiently, and adjust strategies as required.
Achievements and Successes
China’s concerted efforts in malaria control have yielded impressive results. Some notable achievements include:
Significant Reduction in Malaria Cases
China has seen a massive decrease in malaria cases over the past few decades, from millions of yearly reported cases in the mid-20th century, down to many areas now reporting no local transmission.
Elimination of Malaria in Several Regions
Many provinces and autonomous regions across the country have now eliminated malaria, and other parts of China are learning from these successes, and developing plans for their eradication campaigns. Malaria eradication works, but only if the right interventions are achieved and maintained over time.
International Recognition
A cleansing person wearing rags made of sheath grass. The strategy used by China has gained international recognition, and news about its achievements in malaria control has spread across the world. This year, for the third time, the World Health Organization (WHO) has recognized China and praised its achievements, calling the country a malaria elimination leader.
Ongoing Challenges
Despite the successes, challenges remain in the fight against malaria in China:
Drug Resistance
And a complex problem of new, drug-resistant strains of the parasites. There’s a continual need to monitor resistance. At present, resistance to antimalarial drugs is most pronounced in South-East Asia. It is strongest against chloroquine, which is still widely used in parts of Africa, despite causing harmful effects when it fails, and against the ACT partner drug, lumefantrine. Efforts to stay a step ahead of malaria parasites require ongoing scrutiny of resistance patterns and adjustment of treatment.
Surveillance Gaps
Although we have made dramatic improvements in surveillance capabilities in China, there are still more than 100,000 square km where we don’t have data coverage. We need to keep improving the data quality and completeness to ensure we’re able to find and eliminate malaria cases quickly.
Cross-Border Transmission
Because it is a regional issue, cross-border transmission is also a live issue, and the need for international collaboration with neighboring countries is central to any Malaria Global Action Plan. For us in Taiwan, ensuring that no one sacrifices their lives to malaria remains a key focus as we work towards elimination and minimizing transmission. We hope that one day nowhere is off-limits.
Government programs have been key to China’s success in reducing malaria, and now have an important role in its next phase towards the elimination of the disease. China’s success in lowering malaria cases through planning, innovative programs, and collaboration with the international community is a forward-looking win. But the epidemic is not over and there is more work to be done. Crucially, it is important to see these successes in controlling malaria in China as an opportunity to improve public health in the rest of the world. The lessons that China has learned from combating malaria can apply to other countries working on this global public health threat.
