India has made enormous gains against malaria by reducing it by over 80 per cent since 2015. However, there are still some States which need to achieve the feat of becoming malaria-free. In an interview with BusinessLine, Kaushik Sarkar, Director, Institute for Malaria & Climate Solutions (IMACS), and Director-in-Charge, Malaria No More India, talks about the status of malaria elimination efforts in India and why India must continue to step up efforts to combat vector-borne diseases even as it battles variants of Covid-19.

What is the current status of Malaria elimination in India?

India has demonstrated tremendous resilience in the uphill battle of containing the spread of malaria even amidst the Covid-19 pandemic. The recent gains that the country has made against malaria are historic as it has reported a reduction in the malaria burden by over 80 per cent since Prime Minister pledged to eliminate malaria in 2015. In addition, 116 districts have already registered zero cases, while another 215 are on the verge of interrupting malaria transmission. However, while the highest-burden states reported a rapid transition to becoming low-endemic, the less affected states targeted to stop malaria transmission by 2020 are yet to achieve the feat. With high population density, migration, and changing climate augmenting the risk of malaria, India now has a narrow window to take the conclusive leap to end the scourge of malaria altogether.

How has Covid impacted Malaria in India, in terms of prioritisation of elimination, patient care, availability of medicines etc?

The pandemic has etched a wound on the entire health system worldwide that is deeper than one can see by looking at it from a single disease perspective. It had disrupted the supply chain of life-saving tools, siphoned resources required to fight the other illnesses, and left policymakers baffled with an unwieldy apprehension of uncertain catastrophe.

Yet, despite the incarceration of the last wave right before the monsoon, when the health systems make the most preparations to fight the peak of mosquito-borne diseases, India managed to sustain the reduction of malaria. But, malaria testing in India dropped below 100 million for the first time in the decade in 2020. It also managed to fulfil only about 50 per cent of its distribution target of long-lasting insecticidal nets to protect the high-risk communities from malaria, as per the recently published World Malaria Report. In fact, the imminent upsurge of the new variant has put India at a critical junction where the country must sustain its fight against the pandemic but, at the same time, step up its fight against malaria to avoid losing the gains it has made in the last five years.

What are some of the current on-ground programs that have showcased high success rates towards Malaria elimination?

India has really taken the battle to the last mile by intensifying point-of-care testing by the frontline health workers, ASHAs. In addition to this, the Swachh Bharat Mission has transformed the environment, reducing breeding places for vector mosquitoes. At the same time, the large-scale distribution of long-lasting insecticidal nets in high burden states like Odisha, Chhattisgarh, Jharkhand, Madhya Pradesh, Meghalaya, Tripura, and many others helped the country in rapidly bringing down the malaria burden.

What changes have been witnessed in high-endemic states post implementation of malaria elimination strategies?

In high-endemic states, the bulk of malaria cases have reduced. For example, once India’s highest Malaria-burdened state, Odisha has been a trendsetter in India’s fight against Malaria. From over 450,000 cases in 2016, the Malaria burden has gone down to below 50,000. Two of the most critical interventions that made this unthinkable happen are the large-scale distribution of long-lasting insecticidal nets and the state’s innovative approach of addressing the asymptomatic malaria burden through the DAMAN program. With these changes, there is now an urgent need to design transformative strategies to make the final leap. In this regard, two approaches will be critical in the coming months — tapping the burden of Malaria in the private health sector and strengthening the system for more accurate case tracking and management through digital health innovations under the wonderful opportunity of Ayushman Bharat Digital Mission in the health and wellness centers.

What role does Malaria No More play in accelerating India’s path towards elimination of Malaria?

Malaria No More has been working globally with the noble mission of ending Malaria within our generation.

We conducted an initial landscape to prioritise strategic focus and partnered with the state of Odisha to accelerate its progress towards Malaria elimination. Besides providing techno-managerial assistance to the State program through our Strategic Support Unit, we also demonstrated innovative models of precision programming to move the needle at the last mile in two of its most challenging districts — Malkangiri and Koraput. One of our most critical innovations has been the use of weather information and disease data to forecast the risk of malaria and drive targeted interventions based on the risk in collaboration with the India Meteorological Department.

Nationally, we have contributed to the larger mandate through our flagship “Bite Ko Mat Lo Lite” campaign that reached over 500 million digitally in the last two years to make positive shifts in care-seeking and use of bed-nets. Currently, we are committed to advancing strategic and digital health support to the Indian Government in its efforts for a Malaria Mukt Bharat.

What are some of the best practices that people should follow?

There is no better way of stopping the spread of Malaria than people taking simple preventive measures , like sleeping under bed-nets, wearing full sleeve clothing, removing stagnant water, getting tested for malaria within 24 hours of the onset of fever, and completing the treatment recommended by a health worker or a doctor. The best way to promote these practices is to find innovative ways of reinforcing these behaviours and practices. At the same time, every case must get reported so that public health interventions can be targeted to the most granular level. Finally, the silver lining of the pandemic is that it has brought the power of applying big data technologies, data visualization, and Artificial Intelligence into mainstream decision making and health communication. We must translate these applications for combatting a host of other illnesses like malaria that have fever as a cardinal symptom.