Urban Malaria and India's Elimination Goal

The spread of the invasive vector Anopheles stephensi in metropolitan areas, such as Delhi, has become a significant challenge to India's aim of eradicating malaria by 2030, as per the Health Ministry’s Malaria Elimination Technical Report, 2025.

Challenges in Malaria Elimination

• Persistent transmission due to: 
  1. Asymptomatic infections
  2. Difficult terrain
  3. Population movement
• High-burden pockets in districts of Odisha, Tripura, and Mizoram.
• Cross-border transmission from Myanmar and Bangladesh affects northeastern border districts.

Goals and Strategies

• India aims for zero indigenous cases by 2027, aligning with WHO's global strategy.
• Anopheles stephensi thrives in urban settings, breeding in artificial containers and efficiently transmitting Plasmodium parasites.
• Necessity for city-specific vector control and surveillance strategies due to: 
  1. Container breeding
  2. Construction sites
  3. High population density
  4. Fragmented healthcare delivery

Current Status and Priorities

India is in the pre-elimination phase of malaria, with the disease no longer uniformly distributed, but concentrated in specific pockets.

• Priority strategies include strengthening surveillance, enhancing vector monitoring, and improving supply chain reliability.
• Active surveillance intensified in tribal, forest areas, border regions, and migratory settings.

Progress and Challenges

• Malaria cases in India have reduced from 11.7 lakh in 2015 to approximately 2.27 lakh in 2024, with a 78% reduction in deaths.
• Challenges include: 
  1. Inconsistent private-sector reporting
  2. Limited entomological capacity
  3. Drug and insecticide resistance
  4. Operational gaps in remote tribal areas
  5. Sporadic shortages of diagnostics and treatment commodities

Research and Development

Operational research is crucial for accelerating elimination, focusing on areas such as:

• Asymptomatic infections
• Anopheles stephensi ecology and control
• Drug and insecticide resistance
• Optimization of treatment regimes for P. vivax