On June 30, the World Health Organization announced that it has certified China as malaria-free.
The decision follows about seven decades of scientific research and public health measures by China to combat the disease. In the 1940s, malaria killed about 300,000 people in the country per year. In 2017, China recorded zero deaths from malaria. After finding zero indigenous malaria cases for four years in a row, the country applied to the WHO for malaria-free certification, Dennis Normile reports for Science magazine. An independent Malaria Elimination Certification Panel from the WHO conducted an inspection this May and recommended the certification.
“Today we congratulate the people of China on ridding the country of malaria,” says WHO Director-General Tedros Adhanom Ghebreyesus in a statement. “Their success was hard-earned and came only after decades of targeted and sustained action.”
China is the 40th country to eliminate malaria, and the second to receive the certification this year. El Salvador was certified as malaria-free in February. (There are also 61 countries that either never had malaria, or where the malaria disappeared without an active campaign.)
Malaria is caused by a parasite that is carried by Anopheles mosquitoes. When a mosquito carrying the parasite bites a person, the parasite passes into their blood, where it can cause a high fever, shaking chills and flu-like symptoms, per the U.S. Centers for Disease Control and Prevention. Over 90 percent of malaria cases today are recorded in African countries. Approximately 409,000 malaria deaths, most of whom were children, were recorded in 2019.
Reducing wild mosquito populations and protecting people in their homes can greatly reduce the number of malaria cases. In the 1980s, China became one of the first countries to widely use insecticide-treated nets to keep mosquitoes at bay, before the WHO began to recommend the practice.
By then, the country was also decades into the “523 Project,” a military research project established by Mao Zedong to fight malaria, Sui-Lee Wee reports for the New York Times. Pharmaceutical chemist Tu Youyou was working with the 523 project when she isolated the compound artemisinin from sweet wormwood, which is used in traditional Chinese medicine to treat fevers. The chemical kills the malaria parasite and is now a key part of malaria-fighting drugs. The work earned Tu a share of the Nobel Prize in 2015.
“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,” says Pedro Alonso, Director of the WHO Global Malaria Programme, in the statement.
In 1990, China recorded 117,000 cases of malaria, and deaths were reduced 95 percent since 50 years earlier. In 2010, China organized 13 government ministries to end malaria. The country identified the Yunnan Province as the highest risk for local malaria cases because of its rainy season, which creates pools of water where mosquitoes can breed, per the New York Times. The province also borders three countries with malaria: Vietnam, Myanmar and Laos.
China’s “1-3-7” strategy, launched in 2012, requires local health officials to report a malaria diagnosis in one day, investigate the case in three days. Within seven days, residents or officials must take countermeasures to prevent mosquitoes from spreading, like spraying walls with insecticide, per the Economist. Recently, investigations have included genetic analysis of malaria pathogens to determine whether they are local or if they were brought to the region by someone who traveled, reports Science magazine.
“With this announcement, China joins the growing number of countries that are showing the world that a malaria-free future is a viable goal,” Ghebreyesus says in the statement.