Part 2. Malaria ‘imported’ from African and Asian countries will be a “challenge” in the process of malaria elimination in Vietnam (Continued and End)

Lessons from China: After LTSR recognition, malaria is now at risk of reappearing

After nearly 100 years of implementing malaria prevention and elimination (PC & LTSR) and achieving the goal of LTSR nearly 5 years ago along with more than 40 countries and territories worldwide, China is at risk of facing malaria returning due to the invasion of mosquitoes and malaria parasites from abroad, mostly from Africa. However, experts warn that the disease, which is caused by parasites transmitted by mosquitoes, could re‐emerge if malaria prevention or re‐emergence (POR) activities are stopped or neglected, with malaria cases rising sharply again as soon as control projects are stopped, as has happened in African countries as well as developed countries.

According to WHO, the Greater Mekong Subregion includes Campuchia, Laos, Myanmar, Thailand, Vietnam and the two provinces of Yunnan and Guangxi in China are where the strains have appeared. malaria parasites are multidrug resistant and the elimination of these multi‐resistant parasite strains globally, especially in border areas between countries, is extremely complicated. This also shows that, malaria can be eliminated, does not mean there are no more malaria mosquitoes and does not mean that we have eliminated the risk of recurrence of these strains. P. vivax and P. ovale after radical treatment. A concrete example is the tightly controlled border areas during the pandemic. COVID‐19, but how can it be prevented mosquito Anopheles spp. cross‐border invasion , which has become a big challenge for China in particular and countries with malaria endemic and bordering other countries in general, and the possibility of malaria returning is inevitable.

What is important now to ensure that malaria outbreaks are prevented in China is to work with international organizations and countries to strengthen best practice disease control, not only in the Greater Mekong Subregion but also in the African region.

Some limitations in controlling “imported malaria”

1‐Limitations in medical history taking:Exploiting the medical history and especially exploiting the epidemiological factors of travel to malaria‐endemic areas, including inland SRLH areas in Vietnam. Therefore, when in doubt, it is necessary to ask about the patient’s medical history and travel history in the past 2‐4 weeks, with this period of time, not only helping to screen for malaria but also investigating a number of other infectious diseases (according to travel medicine documents).

2‐Limitations of multispecies diagnosis and RDTs: Currently in Vietnam, medical facilities are using rapid malaria diagnostic tests that detect only two species that are circulating most in Vietnam:P. falciparum and P. vivax, while other species cannot be detected by this rapid test, unless private medical facilities are equipped with a test that can detect both at the same time. P. falciparum and non‐falciparum (Pf/PAN Ag RDTs).

Meanwhile, malaria imported from Africa, Asia and South America into Vietnam has all kinds of species. P. falciaprum, P. vivax, P. ovale, P. malariae and even P. knowlesi, If primary health care facilities rely solely on rapid diagnostic tests for the above two species, it is easy to miss diagnoses and cause serious consequences. Therefore, it is necessary to train and maintain the quantity and quality of microscopy sites and/or supplement the Pf/PAN Ag RDTs test types as well.

3‐Limitations on drugs and chemicals: Currently, the effectiveness and efficiency of mosquito treatment drugs and chemicals still need to be monitored and evaluated to select and make recommendations for the best use.

4‐Limitations in risk communication and warning points for malaria testing on entry

It is thought that in the current period, the issue of tourism and trade exchange, legal or illegal labor cooperation is more common, so the risk of foreign malaria entering Vietnam is possible. Therefore, providing risk communication information, communication to change behavior to reduce malaria is very necessary and extremely important through channels.

Furthermore, at border entry points there should be a warning system or checkpoints for testing for malaria and other circulating diseases and maintained regularly, as well as updates on the cross‐border disease situation.

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REFERENCES

1.WHO, World Malaria Report 2023 (note that 2022 is the most recent year for which data is publicly available).

2.AU, Catalytic Framework to End AIDS, TB and Eliminate Malaria. Ethiopia, The Gambia, Ghana, Rwanda, Togo, South Africa, and Zimbabwe. Additionally, Algeria, Cabo Verde, Egypt, Morocco have all eliminated malaria or reported no malaria cases or deaths (Cabo Verde is in the final stages of being certified as having eliminated malaria). 20 Member States reduced incidence by> 10% and 23 reduced incidence by >23%. WHO, World Malaria Report 2023.

3.WHO, Guidance for Malaria: Pyrethroid‐chlorfenapyr ITNs for prevention of malaria vs Pyrethroid‐only ITNs for prevention of malaria, MAGICapp (2023).

4.Three‐year study of net effectiveness conducted in Tanzania. Results showed that PBO nets were 13% more effective versus 39% for Pyrethroid‐chlorfenapyr nets. Jacklin F. Mosha et al., Effectiveness of long‐lasting insecticidal nets with pyriproxyfen‐pyrethroid, chlorfenapyr‐pyrethroid, or piperonyl butoxide‐pyrethroid versus pyrethroid o­nly against malaria in Tanzania: Final‐year results of a four‐arm, single‐blind, cluster‐randomised trial (2023).

5.WHO, News release: WHO recommends R21/Matrix‐M vaccine for malaria prevention in updated advice o­n immunization (2023).

6.The two vaccines have not been tested in direct comparison studies, and R21/Matrix‐M has not been tested in areas of high, perennial transmission. Given the similarity of the vaccines and that RTS,S is efficacious in high, moderate and low transmission settings, however, it is likely that R21 will also be efficacious in all malaria endemic settings.

7.This analysis was based o­n the submissions by Member States during the first two windows of the GF7 grant applications in 2023.

8.See sections o­n insecticide resistance and drug resistance.

9.During the early stages of the COVID‐19 Pandemic, WHO estimated that malaria deaths could double if essential malaria services were disrupted. This scenario was avoided due to the prioritisation of malaria interventions by Member States despite lockdowns and other disruptions.

10.WHO, Global Technical Strategy for Malaria 2016‐2030 (2021), https://www.who.int/.

11.World Bank, Africa Pulse: Delivering Growth to People Through Better Jobs, No. 28(Oct. 2023).

12.WHO, World Malaria Report 2023.

13.See, e.g., WMO, Africa Suffers Disproportionately from Climate Change (Sept. 2023); IMF, Africa’s Fragile States Are Greatest Climate Change Casualties (Aug. 2023); African Development Bank, Climate Change in Africa: Africa, Despite Its Low Contribution to Greenhouse Gas Emissions, Remains the Most Vulnerable Continent (Dec. 2019).

14.IPCC, Sixth Assessment Report, Ch. 9 (2022).

15.WMO, Africa Suffers Disproportionately from Climate Change (Sept. 2023).

16.EM‐DAT (2023)&EM‐DAT (2023).

17.Dr. Marina Romanello et al., The 2022 Report of the Lancet Countdown o­n Health and Climate Change: Health at the Mercy of Fossil Fuels (Oct. 2022).

18.Sadie J. Ryan et al., Shifting Transmission Risk for Malaria in Africa with Climate Change: A Framework for Planning and Intervention, Malaria J. (May 2020).

19.Available athttps://www.who.int/publications/i/item/9789240060265.

20.A. Mnzava et al, Anopheles stephensi in Africa requires a more integrated response, Malaria J. 21(1)(May 2022); W. Takken & S. Lindsay, Increased Threat of Urban Malaria from Anopheles stephensi Mosquitoes, Africa, Emerg. Infect. Dis. 25(7) (Jul. 2019).

21.WHO, Initiative to Stop the Spread of Anopheles stephensi in Africa (Updated 2023).

22.WHO, World Malaria Report 2023.

23.During 2023, the African Union Commission developed a framework to integrate health security, emergency preparedness & response, resilient and sustainable health systems, and UHC into the humanitarian, development and peace nexus. This framework will be announced o­n the sides of the 2024 AU Summit.

24.Case studies and best practices are documented o­n the ALMA Scorecard Hub.

25.Several Member States are exploring opportunities to launch councils and funds to support both malaria and Neglected Tropical Diseases. Existing councils are also considering expanding their mandate to include NTDs.

26.CS4ME is a coalition of more than 600 civil society organisations advocating for and supporting efforts to control and eliminate malaria. See Regional Malaria Scorecards under Digitalisation.

27.Expanded Malaria Toolkit.E.g., WHO, Uniting to Combat NTDs, Bill & Melinda Gates Foundation, AMREF, GLIDE, The END Fund, CIFF.