Elly Burhaini Faizal, Jakarta – Indonesia's public health response to malaria has continued to improve.
The incidence of the parasitic infection has continued to decline, but the illness remains one of top threats to public health in the nation. Hundreds of thousands of malaria cases and deaths are estimated to occur in the country every year.
According to Health Ministry data, malaria cases dropped by 235,700 – or about 50 per cent – in 2020 from 465,700 in the previous year. And it appears the nation's fight against malaria is on track to meet its target for the disease's elimination by 2030.
A new report titled "Malaria Elimination Amid Covid-19: A Test of Resilience in Asia Pacific" brings some optimism to the malaria battle as it reveals areas of progress in the global fight against the disease.
While health systems have been strained by Covid-19, many countries in the region have demonstrated remarkable collaboration and have swiftly adapted to ensure malaria services continue, the report found. This progress includes Laos and Cambodia reporting zero indigenous malaria deaths in 2020.
Malaysia, which has not had any recorded human cases of malaria for three consecutive years, has issued guidelines on the continuation of malaria intervention to maintain its "zero indigenous human malaria" status.
India, the only country under the World Health Organization's High Burden to High Impact Initiative that registered progress against malaria, has shown its commitment to the continuity of malaria elimination projects. Sri Lanka, which remains certified malaria-free, has instigated efforts to prevent the reintroduction of malaria post-elimination.
Pakistan swiftly adapted its long-lasting insecticidal net distribution and training strategies to prevent outbreaks in high-burden tribal districts, while in Bhutan, community action groups were revitalized to ensure quality service delivery for both Covid-19 and malaria.
The report also praised Indonesia's commitment and steady progress in fighting malaria. The country's health officials in several high-burden provinces have mobilized regional budgets and integrated Covid-19 and malaria screening and testing procedures, said the report, which was released to coincide with the Asia Pacific Leaders Dialogue for Malaria Elimination on Dec 13.
Hosted by Bhutan's Health Ministry, the Asia Pacific Leaders Malaria Alliance (APLMA) and the Asia Pacific Malaria Elimination Network (APMEN), the dialogue gathered senior Asia-Pacific government officials, who reaffirmed their commitments to accelerating the fight against the devastating disease during the ongoing pandemic.
But challenges and disruptions highlighted by the APLMA-APMEN report open our eyes to the fact that war against malaria in the Asia-Pacific region is still far from over. In Indonesia, for instance, four eastern provinces – Papua, West Papua, Maluku and East Nusa Tenggara – maintain the highest number of malaria cases, with Papua accounting for 86 per cent of all national cases, according to the report.
For APLMA CEO Sarthak Das, this situation clearly shows that working toward the elimination of malaria requires not only continued regional and global solutions.
"It also requires tailored subnational solutions," he told The Jakarta Post on Dec 21. Like in other Asia-Pacific countries, the fight against malaria in Indonesia remains tough amid a lack of innovative tools and inadequate financing.
To help people control the spread of malaria, the Health Ministry has introduced some new policies in the national malaria elimination program. By expanding people's access to early malaria detection and proper treatment, the government aims to protect vulnerable groups in high-endemicity areas, especially pregnant women and children under 5 years of age, who are at grave risk of complications from malaria.
To accelerate progress toward malaria elimination, the ministry set up interventions to improve malaria outbreak handling, strengthen malaria surveillance and vector control and, last but not least, ensure the availability of supplies for the prevention and treatment of malaria.
Behavioral change is at the core of the national fight against malaria because it is believed that only a widespread lifestyle change can bring about a large impact. The necessary behavioral changes include the use of insecticide-treated mosquito bed nets and the adoption of clean, clutter-free living environments.
Interventions encouraging these behaviors continue to be conducted in areas with high transmission rates, including Papua, according to the Health Ministry. Health Minister Budi Gunadi Sadikin recently highlighted the government's accelerated efforts to prevent the spread of the disease to people by mosquitoes. He noted that there were various programs to control mosquito-borne disease nationwide and reduce their damage to people's health.
This year, there are 1,000 areas designated as mosquito control points to prevent vector-borne diseases, such as Zika, filariasis, Japanese encephalitis, dengue and malaria, said the minister. Mosquito control remains a priority issue because many areas of Indonesia are not yet free of malaria, Budi said. As of today, only 331 of the nation's 514 regencies and cities have been certified malaria-free.
What may exacerbate the situation is possible cross-border malaria transmission. Three countries close to eliminating the disease – Bhutan, Nepal and Timor Leste – share borders with high burden countries, namely India or Indonesia, and they are a constant source of imported malaria. Border malaria is one critical challenge highlighted by the APLMA-APMEN report.
"It is critical now more than ever to actively focus on strengthening cross-border malaria elimination efforts to address issues of imported cases, outbreaks, drug and insecticide resistance to ensure we finish the fight," Das said.
Since 2017, Indonesia and Timor Leste have been teaming up to prevent cross-border malaria. The two countries held cross-border collaborative meetings involving key provincial and district-level officials. A memorandum of understanding (MoU) was signed for cross-border collaboration on priority diseases for the period of 2019 to 2020.
The MoU included a joint action plan to initiate referral mechanisms, service pathways, malaria screening at border control checkpoints and joint data sharing by using information technology.
Joint cross-border elimination plans for an effective implementation of harmonized activities at ground level is one of three key actions going forward – the others being a whole government approach to address cross-sectoral challenges to malaria elimination and sustained funding for malaria service delivery – the Leaders Dialogue concluded in its call to action.
Regional collaboration is the foundation for building health security, and the journey of Asia-Pacific countries in the elimination of malaria offers a key lesson that "diseases know no borders", Das said. "To end malaria locally, we must collaborate with other countries, particularly those closest to our nations, to devise and execute strategic solutions for our borderless health challenges to achieve regional malaria elimination," he added.
As of Dec 6, 2021, the WHO was seeing rising cases and deaths in the highest burden countries worldwide, evidence of how the pandemic has disrupted malaria services. In the road to malaria elimination, there is no room for complacency. As the pandemic wears on, people will remain at risk of malaria.
Hence, we should not let up on efforts to ensure everybody is safe from this disease, even when remarkable progress has been made.
[The author is a staff writer at The Jakarta Post. The Jakarta Post is a member of The Straits Times media partner Asia News Network, an alliance of 23 news media organisations.]
– The Jakarta Post/Asia News Network