Malaria Elimination in Asia-Pacific: Progress and Challenges

Despite significant advancements in reducing malaria cases, funding and execution hurdles challenge the 2030 elimination goal in Asia-Pacific.

Gopi

•January 23, 2026•6 mins read

Asia-Pacific Shows the Way: Malaria Elimination Is Achievable

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1. Global Malaria Situation and the 2030 Elimination Deadline

The World Malaria Report 2025 presents a mixed global picture five years before the 2030 malaria elimination target. While some regions show progress, emerging biological and financial constraints threaten to stall or reverse gains made over the past decade.

A key concern highlighted is the rise of resistance to artemisinin-based combination therapies (ACTs), the backbone of malaria treatment globally. This coincides with a decline in funding for malaria programmes, increasing systemic vulnerability at a critical juncture.

The report underscores that malaria elimination is not linear. Gains achieved through sustained public health interventions can rapidly erode if biological threats and financial support are not simultaneously addressed.

If ignored, the combination of drug resistance and financing shortfalls risks undoing decades of investment, pushing malaria control back into a crisis-management mode rather than elimination.

Statistics:

Global malaria financing met only 42% of estimated needs in 2024 (WHO).
Funding cuts in 2025 further widened the gap.

2. Asia-Pacific Region: Uneven but Significant Progress

The Asia-Pacific region accounts for much of the positive news in the report, demonstrating that elimination remains achievable under conducive policy and institutional conditions. Estimated malaria cases declined from over 9.6 million (2023) to approximately 8.9 million (2024).

This reduction was driven by 10 of the region’s 17 malaria-endemic countries, with Pakistan accounting for the largest absolute decline. Countries such as Cambodia, Lao PDR, and Vietnam reported historic lows for the second consecutive year.

Importantly, the region has also contributed solutions, not just outcomes. The Greater Mekong Subregion (GMS) has demonstrated success in containing and reversing antimalarial drug resistance through coordinated regional action.

The Asia-Pacific experience shows that malaria elimination depends as much on governance capacity and regional cooperation as on medical tools; without these, progress remains fragile.

Statistics:

Cambodia: 322 indigenous cases
Lao PDR: 328 indigenous cases
Vietnam: 239 indigenous cases

3. APLMA and the Challenge of Uneven Progress

The Asia Pacific Leaders Malaria Alliance (APLMA) brings together 22 governments committed to eliminating malaria by 2030. While regional progress over two decades has been substantial, it remains uneven and incomplete.

Several countries have achieved malaria-free status, demonstrating feasibility through sustained political commitment. However, larger and more complex settings have experienced stagnation or resurgence, revealing structural vulnerabilities.

India exemplifies this dual reality: a sharp post-2015 decline followed by recent rebounds in specific regions, indicating deviation from the elimination trajectory.

Elimination outcomes diverge where political commitment, financing continuity, and last-mile execution weaken, highlighting that success is systemic rather than episodic.

Comparative examples:

Malaria-free countries: Sri Lanka, China, Timor-Leste
Resurgence contexts: Large, heterogeneous countries with high internal disparities

4. India’s Elimination Target: Ambition versus Trajectory

India aims to achieve zero indigenous malaria cases by 2027, ahead of the global deadline. The target is ambitious but grounded in demonstrated success across multiple districts and pilot projects.

Initiatives such as AMaN (Odisha) and the Malaria Elimination Demonstration Project (Mandla) provide proof-of-concept that elimination is possible even in difficult terrains.

However, recent plateauing and regional rebounds indicate that India is currently off-track, especially in high-burden and hard-to-reach areas.

Without corrective action, early gains risk being neutralised, reinforcing the lesson that elimination phases are more fragile than control phases.

5. Operational Shifts Required for Elimination in India

To transition from control to elimination, India requires targeted operational shifts rather than broad-based expansion.

First, surveillance must become the central intervention, moving towards real-time, case-based systems that integrate private sector and institutional reporting.

Second, elimination must be geographically precise, focusing on a small number of States and the Northeast that together account for the bulk of cases.

Third, continuity of financing and operational discipline is essential during this most vulnerable phase.

Elimination succeeds when governance systems prioritise precision, accountability, and uninterrupted execution; dilution at this stage leads to rapid reversal.

Challenges:

Five States and the Northeast account for ~80% of India’s malaria burden
Weak integration of private and institutional health data
Financing and staffing discontinuities

6. Role of Vaccines in the Elimination Strategy

The development of malaria vaccines marks a significant scientific breakthrough after decades of stagnation in preventive tools. RTS,S and R21 vaccines have demonstrated measurable reductions in severe malaria and child mortality.

Large-scale pilots in Africa show that vaccines can complement existing interventions when delivered through routine immunisation systems.

In the Asia-Pacific, vaccine deployment is expected to be targeted, reflecting lower transmission intensity and different epidemiological profiles, alongside a focus on Plasmodium vivax radical cure strategies.

Vaccines strengthen elimination efforts but cannot substitute for surveillance and vector control; misplacing emphasis risks strategic imbalance.

Evidence:
RTS,S impact:
1. 13% reduction in all-cause child mortality
2. 22% reduction in hospitalisation for severe malaria

7. Artemisinin Resistance: A Strategic Threat

The emergence of artemisinin resistance poses one of the most serious biological threats to malaria elimination. While widespread resistance is now confirmed in Africa, it has not yet been established in India.

The Greater Mekong Subregion offers a critical lesson. Early resistance emergence in western Cambodia was countered through the Regional Artemisinin Resistance Initiative (RAI) and WHO-led elimination efforts.

India has adopted a precautionary approach through routine therapeutic efficacy studies, pharmacovigilance, and strict regulation against monotherapy.

Drug resistance is transnational by nature; failure to coordinate regionally risks global treatment collapse.

Policy measures:

RAI investment: over US $700 million since 2014
Universal parasitological diagnosis
Prohibition of oral artemisinin monotherapy

8. Financing Constraints and the Risk of Resurgence

The most immediate threat to malaria elimination is declining financial support, both globally and domestically. This is occurring precisely when programmes enter their most expensive phase.

Funding shortfalls are already forcing scale-backs in proven interventions, particularly affecting mobile, migrant, and remote populations.

Experts argue for a shift in ownership, with national governments increasing domestic financing while leveraging global support strategically.

Underinvestment at this stage multiplies future costs through resurgence, emergency responses, and avoidable mortality.

Impacts:

Scaling back of vector control and surveillance
Heightened vulnerability of marginal populations
Risk of cyclical resurgence

"Malaria is unforgiving – it will bounce back unless we reach zero." — Sarthak Das, CEO, APLMA

9. Conclusion

Malaria elimination in the Asia-Pacific, and particularly in India, remains feasible but fragile. The coming years require precision governance, sustained financing, regional cooperation, and disciplined execution. Achieving elimination would yield long-term dividends in health system resilience, productivity, and equitable development, while failure would lock countries into recurrent cycles of preventable disease and expenditure.

Quick Q&A

Everything you need to know

Key findings of the World Malaria Report 2025:

1. Reduction in cases: Southeast Asia reported a decline in estimated malaria cases from 9.6 million in 2023 to 8.9 million in 2024, largely driven by 10 of the 17 malaria-endemic countries, with Pakistan, Cambodia, Lao PDR, and Vietnam showing historic lows.
2. Successes in elimination: Countries like Sri Lanka, China, and Timor-Leste have demonstrated that elimination is achievable with sustained political commitment and consistent program delivery.
3. Emerging threats: Artemisinin resistance is a growing concern, with potential to reverse gains if not managed.
4. Funding gaps: Only 42% of global malaria financing needs were met in 2024, with further shortfalls projected, threatening program continuity.

These findings highlight that while progress exists, the Asia-Pacific region is not uniformly on track to meet the 2030 elimination targets, and targeted interventions, sustained financing, and surveillance are critical to maintain gains.

Reasons for India being off-track:

1. Rebound in cases: After steep declines post-2015, certain regions in India have experienced a resurgence in malaria cases, particularly in high-burden districts, indicating a plateauing of progress.
2. Surveillance gaps: Lack of real-time, case-based reporting across private healthcare, urban centers, defence, and railways has weakened early detection and response capabilities.
3. Funding and operational constraints: Dwindling resources and incomplete last-mile implementation compromise vector control, case management, and community outreach, especially in remote and mobile populations.

While India has demonstrated proof-of-concept through initiatives like AMaN in Odisha and the Mandla Malaria Elimination Project, scaling these successes across remaining hotspots and sustaining prevention in near-elimination states is essential to regain the elimination trajectory.

Strategies for achieving malaria elimination:

1. Surveillance-centered approach: India must implement real-time, case-based surveillance to detect, classify, and respond to every infection. Integrating data from private healthcare, railways, urban areas, and defence ensures complete coverage.
2. Geographic targeting: Focused interventions in the five states and Northeast that account for nearly 80% of the burden are essential. Near-elimination states should invest in preventive measures to avoid resurgence.
3. Sustained financing and operational discipline: Ensuring consistent funding, staffing, and vector control cycles is critical. Project-mode execution with accountability at district and state levels will help maintain intervention quality.

Successful pilot programs like AMaN (Odisha) and Mandla Malaria Elimination Project offer lessons in intensive community engagement, monitoring, and targeted vector control, which can be scaled nationwide to achieve zero indigenous cases by 2027.

Implications of artemisinin resistance:

1. Treatment efficacy: Artemisinin-based combination therapies (ACTs) are frontline treatments. Resistance threatens effective case management, risking increased morbidity, mortality, and resurgence of malaria.
2. Regional spread: Historical patterns from the Greater Mekong Subregion show that partial resistance in one country can quickly affect neighbouring countries, necessitating cross-border coordination.

India's response:

Regular therapeutic efficacy studies and pharmacovigilance to detect early warning signals.
Strict adherence to combination therapy and avoidance of oral artemisinin monotherapy.
Strengthening case management at the community level and ensuring universal parasitological diagnosis.
Regional coordination with neighbouring countries to prevent cross-border spread.

These measures aim to preserve drug efficacy at scale, ensuring artemisinin remains effective as a cornerstone of India’s elimination strategy, while mitigating the risk posed by emerging resistance.

Importance of sustained financing:

1. Program continuity: The most expensive and operationally intensive phase of elimination is the last-mile delivery. Funding gaps can lead to scaling back vector control, case management, and surveillance, allowing resurgence.
2. Targeting high-risk populations: Mobile, migrant, and remote communities require additional resources for outreach and service delivery. Without financing, these populations remain vulnerable and contribute to persistent transmission.
3. Economic rationale: Investment in malaria elimination yields high returns through reduced healthcare costs, increased productivity, and societal resilience. Underinvestment risks not only health but also economic and social losses.

Hence, bridging funding shortfalls, including through national budget advocacy and evidence-based investment cases, is essential to sustain progress, prevent reversals, and achieve malaria elimination targets by 2027 (India) and 2030 (global).

Role of vaccines:

1. Preventing severe disease: Vaccines like RTS,S and R21 have shown measurable reductions in severe malaria and child mortality in high-transmission African settings. RTS,S reduces all-cause mortality by ~13% and hospitalisations by ~22%.
2. Targeted implementation: While Africa bears the highest P. falciparum burden, Asia-Pacific countries may adopt vaccines for high-risk populations and hotspots, complementing vector control, surveillance, and case management.
3. Integrated strategy: Vaccination should be combined with ongoing measures:

Surveillance-centered interventions for rapid detection and treatment
Geographically targeted vector control in high-burden areas
Community engagement and preventive campaigns

By integrating vaccines strategically, India and Asia-Pacific nations can accelerate elimination, prevent resurgence, and enhance the resilience of health systems, particularly in regions where conventional tools alone may be insufficient.

Proof-of-concept projects:

1. AMaN (Malaria Control in Inaccessible Areas, Odisha): This initiative focused on remote, tribal regions with high malaria prevalence. Strategies included rigorous surveillance, community health worker engagement, and rapid case management. The program successfully reduced cases and sustained zero-transmission periods in multiple villages.
2. Mandla Malaria Elimination Project: Implemented in central India, the project demonstrated effective last-mile execution using active case detection, geospatial targeting of vector control, and community involvement. Zero indigenous cases were recorded in several monitored zones, providing a scalable model for other districts.

Lessons for national elimination:
Both projects highlight that intensive, localized, and data-driven interventions, combined with political commitment and community participation, are critical. Scaling these strategies nationwide, alongside continuous surveillance, financing, and vector control, is essential for India to achieve its 2027 malaria elimination goal.

Attribution

Original content sources and authors

Ramya Kannan

The Hindu

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