China has stamped out malaria – a mosquito-borne infectious disease – which affected more than 30 million people in the 1940s, snuffing out hundreds of lives annually.

After reporting zero cases of the disease for the last four consecutive years, the World Health Organization (WHO) certified the country "malaria-free" on Wednesday. It took the Chinese government nearly 70 years of sustained efforts to wipe out the malaria parasite with the involvement of 13 ministries.

"Today, we congratulate the people of China on ridding the country of malaria," said Dr. Tedros Adhanom Ghebreyesus, director-general of the WHO.

"Their success was hard-earned and came only after decades of targeted and sustained action. With this announcement, China joins the growing number of countries that are showing the world that a malaria-free future is a viable goal," he added.  

Globally, only 40 countries and territories in the world are certified malaria-free. China has become the first country in the WHO Western Pacific Region to get the certification in the last 30 years. Other countries in the region that have also eradicated the disease include Australia (1981), Singapore (1982) and Brunei Darussalam (1987).

Most developed nations – such as the U.S. and the UK, which became malaria-free in 1970 and 1963, respectively – have stamped out the disease, reducing the burden on their health systems.

Tackling mosquito bites

Once a prominent malaria-endemic country, China launched the National Malaria Control Program in 1955, engaging communities to prevent the breeding of mosquitoes and transmission of the parasite.

A major breakthrough in treating the disease happened when Professor Tu Youyou extracted a compound called artemisinin from a substance used in traditional Chinese medicine. The discovery helped save hundreds of lives globally, and propelled Madame Tu to win a Nobel Prize in 2015.

Artemisinin is "the most effective antimalarial drug available today," said a statement released by the WHO.

Apart from finding a cure, China was one of the first countries in the world to extensively test the use of insecticide-treated nets (ITNs) to prevent malaria. By 1988, more than 2.4 million such nets were distributed nationwide to protect people from mosquito bites, drastically reducing the caseload of malaria.

The WHO later recommended the ITNs for malaria control in other countries. The use of these affordable and easy-to-use nets substantially reduced the cases of malaria.

"Over many decades, China's ability to think outside the box served the country well in its own response to malaria, and also had a significant ripple effect globally," said Dr. Pedro Alonso, director of the WHO's Global Malaria Program.

"The government and its people were always searching for new and innovative ways to accelerate the pace of progress towards elimination."

Despite scientific breakthroughs and global efforts, malaria has remained one of the world's leading killers. In 2017, more than 219 million cases of the disease and nearly 400,000 malaria-related deaths were reported globally.

Tragically, most fatalities are among children under 5 years old, accounting for 60 percent of malaria-related deaths.

Risk from neighboring countries and imported cases

However, a malaria-free status doesn't mean a country is completely shielded by the parasite, warned the WHO.

"The risk of imported cases of malaria remains a key concern, particularly in southern Yunnan Province, which borders three malaria-endemic countries: Lao People's Democratic Republic, Myanmar and Vietnam," said the WHO.

Returning Chinese nationals from sub-Saharan Africa and countries endemic to malaria also pose a severe risk of re-establishing the disease. Therefore, surveillance, monitoring and control initiatives must remain active to ensure zero cases.

Strikingly, Sri Lanka was declared malaria-free in 2016. However, around two years later, a case of malaria infection was reported in the country, prompting authorities to beef up the disease surveillance system.  

(Cover: Xu Shiyan (center), works with colleagues Li Chunxin (left) and Wu Linbo to test blood samples for malaria parasites at the Yunnan Institute of Parasitic Diseases, April 2019. /WHO)