London School of Hygiene & Tropical Medicine

Following a 70-year effort, China has been awarded malaria-free certification from the World Health Organization (WHO). This is despite reporting 30 million cases of the disease annually in the 1940s.

Sir Brian Greenwood, Professor of Clinical Tropical Medicine at the London School of Hygiene & Tropical Medicine (LSHTM), is Chair of WHO’s Malaria Elimination Certification Panel (MECP). Sir Brian, with colleagues Professor Fred Binka, Prof. Daouda Ndiaye and Dr Hong Li spent a month in China verifying the country’s malaria-free status as well as its programme to prevent re-establishment of the disease.

The team subsequently presented their findings to a full meeting of the MECP and to WHO’s Malaria Policy Advisory Group (MPAG) which approved its conclusions and forwarded these to WHO’s Director General in June 2020.

Sir Brian Greenwood said: “'Certification by WHO that malaria has been eliminated from China is a major event in global health. Prior to the founding of the People's Republic of China in 1949, there were many millions of cases of malaria and thousands of deaths from malaria in China each year. However, during the past 50 years the infection has been progressively brought under control, and by 2010 national elimination of malaria became a realistic goal.

“This has now been achieved through a carefully planned and monitored set of steps involving many different sectors of the national and provincial governments, and through the commitment of the general population. The success of China in achieving elimination of malaria, and the way that this has been achieved, provide important messages for other countries for whom malaria elimination is now a feasible goal.”

Dr Tedros Adhanom Ghebreyesus, WHO Director-General, said: “Today we congratulate the people of China on ridding the country of malaria. 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.”

China is the first country in the WHO Western Pacific Region to be awarded a malaria-free certification in more than three decades. Other countries in the region that have achieved this status include Australia (1981), Singapore (1982) and Brunei Darussalam (1987).

Beginning in the 1950s, health authorities in China worked to locate and stop the spread of malaria by providing preventive antimalarial medicines for people at risk of the disease as well as treatment for those who had fallen ill. The country also made a major effort to reduce mosquito breeding grounds and stepped up the use of insecticide spraying in homes in some areas.

In 1967, the Chinese government launched the “523 Project” – a nation-wide research programme aimed at finding new treatments for malaria. This effort, involving more than 500 scientists from 60 institutions, led to the discovery in the 1970s of artemisinin – the core compound of artemisinin-based combination therapies (ACTs), the most effective antimalarial drugs available today.

In the 1980s, China was one of the first countries in the world to extensively test the use of insecticide-treated nets (ITNs) for the prevention of malaria, well before nets were recommended by WHO for malaria control. By 1988, more than 2.4 million nets had been distributed nation-wide.

The use of such nets led to substantial reductions in malaria incidence in the areas where they were deployed.    By the end of 1990, the number of malaria cases in China had plummeted to 117 000, and deaths were reduced by 95%.

With support from the Global Fund to Fight AIDS, Tuberculosis and Malaria, beginning in 2003, China stepped up training, staffing, laboratory equipment, medicines and mosquito control, an effort that led to a further reduction in cases; within 10 years, the number of cases had fallen to about 5000 annually.

China provides a basic public health service package for its residents free of charge. As part of this package, all people in China have access to affordable services for the diagnosis and treatment of malaria, regardless of legal or financial status. Effective multi-sector collaboration was also key to success. In 2010, 13 ministries in China – including those representing health, education, finance, research and science, development, public security, the army, police, commerce, industry, information technology, media and tourism – joined forces to end malaria nationwide.

Throughout the COVID-19 pandemic, China has maintained trainings for health providers through an online platform and held virtual meetings for the exchange of information on malaria case investigations, among other topics.

Globally, 40 countries and territories have been granted a malaria-free certification from WHO including, most recently, El Salvador (2021), Algeria (2019), Argentina (2019), Paraguay (2018) and Uzbekistan (2018).