Pre-Read: Malaria in China

Historical beginnings

  • Malaria has a long history in China. The word malaria was found on the oracle bone and bronze inscriptions of the Shang Yin era from 1562 to 1066 BC, which indicated malaria had prevailed for more than 3,000 years in China.
  • The scourge of malaria—periodic fevers and spleen enlargement, both characteristic of malaria—were attributed to three demons by the Huang Ti Nei Ching (Yellow Emperor’s Classic of Internal Medicine), the classic Chinese medical canon in 270 BC.
    • Malaria remained a widespread challenge in China, with an estimated 90% of the population at risk of infection in the 1940s (i.e., 30 million cases and 300,000 deaths reported annually).
    • In 1955, the National Malaria Control Programme was established to engage communities to confront the burden of malaria. Although the disease remained highly endemic, with large-scale outbreaks in the 1960–1970s, steady progress towards malaria control was made (only 117,000 cases were reported in 1990).

China’s leadership in global malaria eradication efforts

  • In 2010, as part of the United Nations’ 2000 Millennium Development Goals, China’s National Health and Family Planning Commission recruited cooperation from 13 ministries to support the ambitious Action Plan for China Malaria Elimination (2010–2020), which aimed to halt and reverse the incidence of disease by 2015 and eliminate local transmission by 2020.
  • In 2010, the burden of malaria fell by more than 45% and more than 95% of provinces reported malaria incidence rates below 1/10,000. By 2014, only 56 of the country’s 3,078 reported malaria cases were categorized as indigenous.

New challenges in the fight against malaria

  • Despite the recent risk of stagnation in malaria control and incidence worldwide, China has made incredible progress towards malaria elimination and control.
    • Malaria incidence rates decreased by 21% overall and mortality rates fell by an estimated 29% worldwide between 2010 and 2015, with significant reductions in mortality rates in the Western Pacific (58%) and Southeast Asian (46%) regions. The country has effectively beaten back malaria within its borders, with no indigenous cases reported since 2017—the first such report in the country’s history. The country will soon receive global recognition for achieving malaria-free status.

Chinese excellence in science and evidence-based decision making

  • This astounding progress—by the most populous country in the world—has been supported by multiple innovations in malaria treatment and surveillance.
    • Anticipating the need for novel anti-malarial compounds in the 1960s, the national government collaborated with the China Academy of Traditional Chinese Medicine to screen potential natural products based on Traditional Chinese Medicine. These efforts culminated in the identification of the anti-malarial properties of the active product of Artemisia, artemisinin, in 1971 by Professor Tu You You. In 2015, she became the first Chinese winner of the Nobel Prize in Physiology or Medicine. Today, artemisinin remains the world’s primary lifesaving anti-malaria drug used around the world.
    • China’s innovative surveillance methods, particularly the “1-3-7” approach—wherein the National Malaria Elimination Programme disseminates and monitors the tenets of the national elimination strategy by describing a key set of targets, responsibilities, actions, and time frames—has served as a model for malaria control in other countries. The approach has been widely lauded, including by the World Health Organization.

A malaria-free China invests in academic partnerships and establishes an African collaboration network 

  • Over the past decade, China’s multi-billion-dollar investment in health-care reform has enabled the country to make incredible progress toward key public health challenges—with a focus on programs aimed at saving the lives of mothers and children and improving management and development of public health. Today, China continues to innovate in its path to malaria elimination by seeking to incorporate genetic tools to inform its efforts and is currently applying technological advances in genetic epidemiology.
    • With support from the Harvard Global Institute, an academic partnership to advance data-driven decision-making methods was formed among researchers from the China Centers for Disease Control and Prevention and the National Institute for Parasitic Diseases, faculty from Harvard University and the Harvard T. H. Chan School of Public Health, and scientists at The Broad Institute of MIT and Harvard. By employing DNA sequencing and advanced genomic-based tools to understand and predict parasite movement and to differentiate imported from indigenous parasites, this scientific partnership offers a road map for other countries seeking to control the disease across different elimination settings in Africa.
  • China’s efforts to partner with malaria-endemic countries to combat the disease has enabled meaningful connections in terms of providing guidance and support to control and eliminate malaria in Africa and other parts of the world
    • China’s experience in applying innovative genetics-based approaches and tools to characterize malaria parasite populations, including surveillance of markers related to drug resistance, categorization of cases as indigenous or imported, and objective identification of the likely sources of infections to inform efforts towards malaria control and elimination in Africa could offer game-changing results when applied to settings with ongoing transmission.
    • Burkina Faso, Cameroon, Cote d’Ivoire, Sierra Leone, Tanzania, and Zambia have signed agreements with China to establish Institutional-based Networks of Cooperation between Africa and China on Malaria (INCAM). This communication platform will enable the sustainable promotion of Africa-China cooperation to eliminate malaria.

Promising opportunities to align global malaria efforts with new initiatives in China

  • China’s efforts to eliminate malaria is impressive, and the country is dedicated to sharing its lessons learned in malaria elimination—including, but not limited to, the application of novel genetics-based approaches—with other nations through new initiatives, such as the Silk Road Economic Belt and the 21st century Maritime Silk Road. In the coming years, China will promote international relationships and establish collaborative platforms on a wide range of topics in roughly 65 countries, including 20 African nations. China has implemented the Australia-China-Papua New Guinea Pilot Cooperation on Malaria Control Project and the UK-China-Tanzania Pilot Cooperation on Malaria Control Project.

Confronting new global challenges together

  • To support global efforts to combat malaria around the globe, the China CDC/NIPD will partner with Harvard T.H. Chan School of Public Health and the World Health Organization’s Global Malaria Programme to convene a special two-day, online symposium to delve into the aforementioned topics in greater detail. Join us on December 7-8, 2020 to learn about China’s journey—“From 30 Million to Zero Malaria Cases in China: Lessons Learned for Malaria-Eliminating Countries in Africa.”

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