China has officially eliminated malaria. On June 30, an official certification of malaria elimination from the World Health Organization (WHO) was awarded to China, the first country in the WHO Western Pacific Region to obtain this certificate in three decades.
This has been no small feat. In the 1940s, China reported some 30 million cases of the disease each year. However, off the back of decades of work, the number of cases reached zero in 2017.
To get this certificate, a country has to show with rigorous evidence that the chain of indigenous malaria transmission by Anopheles mosquitoes, the primary vector of the malaria parasite, has been interrupted nationwide for at least the past three consecutive years. China applied for an official WHO certification of malaria elimination in 2020 after reporting four consecutive years of zero indigenous cases.
The push to kick malaria out of China started in the 1950s when health authorities started providing preventive antimalarial medicines for people at risk of the disease, as well as controlling mosquito breeding grounds. Things stepped up a gear in 1967 under “Project 523”, a secret military project of the People's Republic of China to find antimalarial medications that took place during the country’s bloody “Cultural Revolution”.
One of the biggest successes of this project was the work led by pharmaceutical chemist Tu YouYou who screened traditional Chinese medicines looking for antimalarial properties. Eventually, while studying sweet wormwood (Artemisia annua), she managed to extract a substance called artemisinin which inhibits the malaria parasite. This led to the creation of a class of new antimalarial drugs called artemisinins. Decades later, this feat won YouYou the 2015 Nobel Prize in Physiology or Medicine jointly with William C Campbell and Satoshi Ōmura.
Throughout the 1980s, China was one of the few countries pioneering the use of malaria nets. By the end of 1990, the number of malaria cases in China had plummeted to 117,000 and deaths were reduced by 95 percent. Another push came in 2003 when China received support from the Global Fund to Fight AIDS, Tuberculosis, and Malaria, which resulted in better training, staffing, laboratory equipment, medicines, and mosquito control.
China is the 40th country in the world to be granted a malaria-free certification from the WHO. Other countries that have recently earned the certificate include El Salvador (2021), Algeria (2019), Argentina (2019), Paraguay (2018), and Uzbekistan (2018).
China should not get complacent, however. It borders three countries where malaria is still endemic: Lao People’s Democratic Republic, Myanmar, and Viet Nam. It also runs the risk of imported cases among Chinese nationals returning from sub-Saharan Africa, where China has an increasing presence and influence.