GS Paper I and III

News Excerpt:

According to a new WHO’s World Malaria Report 2023, Malaria cases continue to dip in India.

About World Malaria Report:

The World Malaria Report 2023 presents progress against several important health and development goals in global efforts to reduce the burden of malaria overall and eliminate the disease where possible. 

• These goals are outlined in the Sustainable Development Goals (SDGs) framework:

• The World Health Organization (WHO) Global technical strategy for malaria 2016–2030 (GTS) 
• The RBM Partnership to End Malaria (formerly known as Roll Back Malaria) Action and Investment to Defeat Malaria 2016–2030 
• For most indicators, the report covers the period 2000–2022.

Key highlights of the Report:

• Indian Scenario: Contrasting the global trend, India continued to witness a decline in malaria cases and deaths in 2022 (a decrease of 30% and 34%), according to a new WHO World Malaria Report 2023. There were around 33 lakh malaria cases and 5,000 deaths in India last year.
• Globally, there were 249 million cases in 2022, 5 million more than in 2021.
• According to the National Institute of Malaria Research, the decline in malaria cases and deaths in 2022 was due to good preventive and case management strategies and the availability of effective vector control tools as well as point-of-care diagnostics and prompt treatment at the community level.
• Global Scenario: According to the World Malaria Report 2023, the number of malaria cases globally  down from 243 million in 2000 to 233 million in 2019  and increased during the pandemic. 
• In 2020, the first year of the pandemic, there were 11 million more cases. The figures remained the same in 2021 only to increase in 2022. The number of global malaria deaths was also higher: 608,000 deaths in 2022 compared with 576,000 in 2019.

WHO on Malaria trends in South-East Asia Region:

• The WHO South-East Asia Region had nine malaria-endemic countries in 2022, accounting for 5.2 million cases and contributing to 2% of the burden of malaria cases globally. In 2022, India accounted for about 65.7% of all malaria cases in the region. 
• Between 2000 and 2022, malaria cases decreased by 77%, from 22.8 million in 2000 to 5.2 million in 2022, and incidence decreased by 83%, from 17.6 to 3.0 per 1000 population at risk.
• Sri Lanka was certified malaria-free in 2016. In 2022, Timor-Leste reported zero indigenous cases for the second consecutive year, and Bhutan reported zero indigenous cases for the first time.
• Despite an overall decrease of 11.9% in estimated cases between 2021 and 2022, increases in cases and incidence were seen in Bangladesh, Indonesia, Myanmar, and Thailand. 
• Between 2019 and 2022, there was an increase of more than 500,000 cases in Myanmar due to the political and social instability in the country, with a sevenfold increase in cases, from 78,000 to 584,000 cases. 
• The increase in malaria case burden in Myanmar over the past 3 years has now had an impact on the neighboring country of Thailand, where cases more than doubled between 2021 (2426 cases) and 2022 (6263 cases).

• India and Indonesia accounted for about 94% of all malaria deaths in this region in 2022. Between 2020 and 2022, all countries in the region in which malaria deaths occurred reported an increase in the malaria mortality rate, except for India.
• The mortality rate in Myanmar experienced a nearly six-fold increase, from 0.17 to 0.99 per 100,000 population at risk. 
• Bhutan and Timor-Leste have reported zero malaria deaths since 2013 and 2015, respectively. 
• In 2021, Thailand reported zero indigenous deaths for the first time; also, in 2022, the one reported death from malaria in the country was due to a P. knowlesi infection. In 2022, Nepal reported zero indigenous deaths for the first time.
• The methods used to estimate the burden of malaria cases and deaths depend on the quality of the National Surveillance Systems and the Availability of Data over time.

Challenges presented by the report:

• Direct vulnerabilities: Climate variability, such as changes in temperature and rainfall, can impact the behavior and survival of the malaria-carrying Anopheles mosquito. Extreme weather events such as heat waves and flooding may lead to increases in the transmission and burden of the disease. 
• Indirect vulnerabilities: A changing climate has indirect effects on malaria, too. As an example, population displacement may lead to more malaria as people without immunity migrate to endemic areas. 
• Climate variability has also led to malnutrition in many places, a risk factor for severe malaria among young children and pregnant women.
• Lack of Services: Millions of people continue to miss out on the services they need to prevent, detect and treat the disease. Conflict and humanitarian crises, resource constraints and biological challenges such as drug and insecticide resistance also continue to hamper progress. 
• Taken together, these threats are undermining gains in the global fight against malaria. In 2022, the global tally of malaria cases reached 249 million – well above the estimated number of cases before the COVID-19 pandemic, and an increase of five million over 2021.

Recommendations by World Malaria Report 2023:

• The currently followed operational strategy focuses on WHO/GMP’s role, but also acknowledges the importance of a concerted effort across the ecosystem to accelerate progress towards the GTS 2030 targets. It is therefore fully aligned with both the GTS and WHO’s 14th General Programme of Work. 
• The WHO Global Malaria Programme (WHO/GMP) has developed a departmental operational strategy for the period 2024–2030. 

• Recommendations on Vector Control:

• • WHO published recommendations to cover two new classes of dual-ingredient insecticide-treated mosquito nets (ITNs) with different modes of action: 
    • • Pyrethroid-chlorfenapyr nets, which combine a pyrethroid and a pyrrole insecticide to enhance the killing effect of the net; and
      • Pyrethroid-pyriproxyfen nets, which combine a pyrethroid with an insect growth regulator that disrupts mosquito growth and reproduction.
  • WHO issued a strong recommendation to prevent malaria in adults and children,  in those areas where mosquitoes have become resistant to pyrethroids. 
• Recommendation to Rollout of the RTS, S/AS01 malaria vaccine:
  • This kind of vaccine allocation was determined through the application of the principles outlined in the vaccine allocation framework which prioritizes doses to areas of highest need, where the risk of malaria illness and death among children is highest. 
  • This allocation round makes use of the supply of vaccine doses available to Gavi via the United Nations Children’s Fund (UNICEF).

• Recommendation for a second malaria vaccine, R21/Matrix-M:

• The addition of the R21 malaria vaccine to complement the ongoing rollout of the first malaria vaccine, RTS, which is expected to result in sufficient vaccine supply to benefit children living in areas where malaria is a major public health problem. 
• Tens of thousands of young lives could be saved every year with the broad rollout of these malaria vaccines.
• Good vaccine efficacy when given in an age-based schedule: The vaccine showed good efficacy (66%) during the 12 months following the first three doses, when provided to children from 5 months of age.
• The R21 vaccine was shown to be safe in clinical trials. As with other new vaccines, safety monitoring will continue.

Conclusion:

WHO’s World Malaria Report provides a comprehensive and up-to-date assessment of trends in malaria control and elimination across the globe. This year’s report includes, for the first time, a dedicated chapter focused on the intersection between climate change and malaria.