The story so far: In 2016, under its National Framework for Malaria Elimination in India (2016-2030), India set an ambitious target to eliminate malaria (zero indigenous cases) by 2030, with an interim milestone of interrupting indigenous transmission across the entire country, including all high-transmission States and Union Territories (UT), by 2027. By the end of 2025, the Ministry of Health and Family Welfare (MOHFW) reported that robust surveillance and sustained interventions had led to 160 districts across 23 States and UTs reporting zero indigenous malaria cases from 2022 to 2024. This was seen as a significant milestone as it meant that the country was getting closer to completely eliminating malaria.

How is prevalence of the disease measured?

According to the World Health Organization (WHO), a country is granted a certification of malaria elimination when “the chain of local transmission of all human malaria parasites has been interrupted nationwide for at least three consecutive years, and that a fully functional surveillance and response system is in place to prevent re-establishment of indigenous transmission”. As of mid-2025, 47 countries or territories have been officially certified malaria-free by the WHO.

Where does India stand?

The World Malaria Report 2025 notes that India made significant progress in reducing malaria incidence and mortality in its high-endemic States, officially exiting the WHO “High Burden to High Impact” Group, in 2024. Malaria cases reduced by around 80% from 2015 to 2023 in the country. In 2024, India accounted for 73.3% of the 2.7 million estimated malaria cases in the WHO South-East Asia Region. While localised transmission driven by population movement and cross-border importation remain as key challenges, India is on track to achieve the WHO Global Technical Strategy (GTS) for malaria 2016-2030 target of at least a 75% reduction in incidence by 2025 (compared with a 2015 baseline), having already achieved reductions exceeding 70% by 2024, the World Malaria Report added.

If Tamil Nadu is taken as an example, data from the State’s Directorate of Public Health and Preventive Medicine show a steady decline in malaria cases, from 5,587 in 2015 to 321 in 2025. Since 2023, 33 of 38 districts have reported zero indigenous cases, placing them in “Category O” (prevention of re-establishment phase). The remaining five districts, including the capital Chennai, are classified as “Category I” (Elimination phase) where the Annual Parasite Incidence (API) is less than one case per 1,000 population at risk (API is the number of confirmed new malaria cases registered in a specific year, expressed per 1,000 individuals under surveillance, for a given country, territory, or geographic area).

How is India working to eliminate malaria?

The country has put in place two national plans to guide and accelerate malaria elimination — the National Framework for Malaria Elimination in India (2016-2030), which outlines the vision, goals, and targets for a phased malaria elimination, and the National Strategic Plan (NSP) for Malaria Elimination (2023-2027) that builds upon earlier frameworks. According to the NSP, transforming malaria surveillance as a core intervention for malaria elimination, ensuring universal access to malaria diagnosis, treatment by enhancing and optimising case management by “testing, treating and tracking” and ensuring universal access to malaria prevention by enhancing and optimising vector control are among the key strategies.

In Tamil Nadu, measures to detect malaria are being carried out intensively in government hospitals and primary health centres. Larval control measures are implemented alongside. One of the key focus areas is to monitor migrant workers. Intensive surveillance is being taken up among workers coming from malaria-prone neighbouring States.

What are the challenges?

One of the challenges is migration from malaria-endemic neighbouring States that poses a risk of reintroduction in low-transmission areas. Urban areas, according to NSP, pose a different set of challenges for malaria elimination. Special focus is given to challenging malaria paradigms such as in urban, forest, tribal, project/and border areas, hard to reach areas and migrant populations, it said.

Acknowledging that the WHO South-East Asia Region has made major progress towards malaria elimination, achieving reductions in both incidence and mortality over the past two decades, the World Malaria Report stated that significant challenges remain. Persistent Plasmodium vivax transmission, which accounts for nearly two-thirds of regional cases, continues to complicate elimination efforts. Localised transmission in India and Nepal, driven by population movement and cross-border importation, points to the need for targeted subnational and regional coordination, it added. Other strategies by India include drug resistance monitoring, insecticide resistance monitoring and ensuring compliance with the 14 days of radical treatment for Plasmodium vivax cases.

The World Malaria Report 2025 has also highlighted the growing threat of antimalarial drug resistance. As the WHO noted: “Partial resistance to artemisinin derivatives — the backbone of malaria treatments after failures of chloroquine and sulfadoxine-pyrimethamine — has now been confirmed or suspected in at least eight countries in Africa, and there are potential signs of declining efficacy of some of the drugs that are combined with artemisinin.”

With the government focusing on achieving zero indigenous cases by 2027 and ensuring prevention of malaria re-establishment, measures to strengthen the surveillance system and diagnostic capacities, and intensifying control measures in high burden districts, are pivotal.

What is the road ahead?

In its annual report of 2024-2025, the MOHFW said that in 2023, 34 States/UTs achieved an annual parasite incidence of less than one except in two States, Tripura (5.69) and Mizoram (14.23).

T. Jacob John, senior virologist, said the most important aspect in this phase is the accuracy of data. Next, to ensure that private practitioners report cases, strict public health surveillance is needed. “All doctors should mandatorily report even suspected cases of malaria,” he added.

T.S. Selvavinayagam, former Director of Public Health and Preventive Medicine, Government of Tamil Nadu, said malaria in urban areas continues to be a challenge. “Urban areas or larger metropolitan cities such as Chennai face challenges due to rapid urbanisation, growing infrastructure and a large number of apartment complexes where water storage conditions need to be looked at. Here, the government alone cannot play a role but needs measures at the individual household level as the source is clean water,” he said.

Published – January 25, 2026 05:32 am IST

The World Malaria Report 2025, launched in December, provided a bag of mixed news, five years ahead of the 2030 global malaria elimination deadline. While the reduction in estimated cases in southeast Asia provided definite hope, of serious concern were rising cases of resistance to artemisinin-based frontline treatment for malaria, and falling funding for malaria programmes.  

Notably, it is the Asia Pacific region that posted much of the good news. The significant reduction was driven by 10 of the region’s 17 malaria-endemic countries, bringing estimated cases down from over 9.6 million in 2023 to approximately 8.9 million in 2024. The major reduction in estimated cases happened in Pakistan, and historic lows were reported in Cambodia, Lao PDR and Vietnam, the second year running. Among the successes being platformed against one of the most crucial emerging threats against malaria treatment also comes from this region, with the Greater Mekong Subregion’s success in tackling antimalarial drug resistance finding mention in the report.  

Uneven progress

The Asia Pacific Leaders Malaria Alliance (APLMA) unites 22 governments  that are committed to the goal of eliminating malaria by 2030. Sarthak Das, CEO, APLMA, says the “Asia Pacific region has made tremendous progress over the past two decades, but it is not entirely on track to meet the 2030 malaria elimination target.” 

He goes on to explain the current position: “Progress continues to stay uneven – while some countries have experienced a resurgence of cases, others reported substantial declines, and several have successfully attained malaria-free status. Sri Lanka, China, and most recently Timor-Leste have demonstrated that malaria elimination is achievable with sustained political commitment and consistent delivery.” 

However, Dr. Das points out that these successes coexist with a concerning plateauing of progress and, in particular, reversal in larger, more complex settings. India illustrates this challenge clearly: after a steep decline post-2015, malaria cases in some regions have rebounded in recent years, signalling that the country overall is off its historical elimination trajectory.

He explains that significant risks still persist, primarily due to two major challenges: securing sustainable long-term financing and ensuring last-mile execution in high-burden countries. “The challenges more often are in ensuring disciplined last mile programme delivery, which is further compounded by the increasing financing shortfalls. The report shows that only about 42% of global malaria financing needs were met in 2024, and funding cuts in 2025 have widened this gap further.” 

The WHO has indeed noted a deep funding shortfall that poses a very serious risk of reversing years of progress in malaria control and elimination, particularly in the Asia-Pacific, where high-burden regions are located. If the elimination goal were to be reached, then sustained investment in malaria control is absolutely essential, experts point out. 

Is elimination goal feasible?

But is the elimination goal within target at all? In fact, India has set itself the target of achieving zero indigenous cases of malaria by 2027, ahead of the 2030 target. Dr. Das says India’s target is ambitious, but attainable. “India has made extraordinary progress since 2015, achieving steep reductions in cases and deaths, with many districts sustaining zero transmission for multiple years. India has also demonstrated proof-of-concept for elimination through indigenous projects such as AMaN – Malaria Control in Inaccessible Areas in Odisha, and the Malaria Elimination Demonstration Project in Mandla.” However, recent data shows that progress has plateaued and cases have even rebounded in parts of the country, indicating that India is currently off the elimination trajectory required to meet the 2027 milestone, he points out. 

Dr. Das explains that to make the leap from control to elimination, three shifts are essential: “First, surveillance must become the central intervention.” India needs real-time, case-based surveillance everywhere – including systematic reporting from the private sector, defence services, railways and urban health systems, so that every infection is detected, classified and responded to rapidly.” 

Secondly, he adds, it is important to make elimination geographically precise. “Today, five States and the Northeast account for nearly 80% of the malaria burden. Success will depend on focused, project-mode execution in these remaining hotspots, while near-elimination States must invest in preventing resurgence.” Thirdly, the continuity of financing and operational discipline must be restored. “This is the most vulnerable phase of elimination, and any dilution of funding, staffing or vector control cycles risks reversal – a pattern India has already experienced,” he adds. India must treat malaria elimination as a time-bound national mission, with accountability, sharp targeting and sustained investment through the last mile. 

Vaccines for malaria 

While factors such as surveillance, vector control and effective case management, have been essential to the achievements of the past years, it was the vaccines that marked a significant breakthrough. Dr. Das says, “Both RTS,S and the newer R21 vaccines represent important milestones. Large-scale pilot implementations in Africa have shown that RTS,S, when delivered through routine immunisation systems, can reduce severe malaria and contribute to measurable declines in child mortality. Evaluations have demonstrated approximately a 13% reduction in all-cause mortality and a 22% reduction in hospitalisations for severe malaria among vaccinated children in high-transmission settings. R21 has shown comparable or higher efficacy in controlled trials.” 

These vaccines have understandably been prioritised for rollout in Africa, where the burden of Plasmodium falciparum malaria and childhood mortality is highest. “In the Asia-Pacific, vaccine introduction is likely to be more targeted rather than pan-regional,” he explains, focusing on specific high-risk settings or populations. The countries in the Asia Pacific and the APLMA are actively evaluating how these vaccines could complement existing tools for targeted implementation. In parallel, there is growing focus on improved radical cure options for P. vivax, significant for the region.  

Artemisinin resistance 

The recent WHO report indicates that artemisinin resistance has emerged as a serious threat to global malaria control. This has been confirmed in many countries in Africa, but has not yet been established in India. Artemisinin-based combination therapies remain the go-to first line of treatment as they are still highly effective, particularly in most endemic settings. Dr. Das points out that in the early 2000s, resistance emerged in the Greater Mekong Subregion (GMS) after partial artemisinin resistance first appeared in western Cambodia before spreading to neighbouring countries. 

“In response, the Global Fund launched the Regional Artemisinin resistance Initiative (RAI) in 2014, investing over US $700 million since to accelerate elimination alongside the WHO’s Mekong Malaria Elimination Program. The impact is evident: Cambodia, Lao PDR and Viet Nam are now nearing elimination, having reduced indigenous cases to just 322, 328 and 239 respectively,” he says. 

India, which otherwise has a huge anti-microbial resistance burden on the other hand, “has taken a precautionary approach by institutionalising regular therapeutic efficacy studies, strengthening pharmacovigilance, and rapidly updating national treatment policies when early warning signals emerge.” India’s emphasis on universal parasitological diagnosis, strict adherence to combination therapy, and avoidance of oral artemisinin monotherapy has been central to preserving drug efficacy at scale, he adds. 

Early detection through routine efficacy monitoring, strict regulation of antimalarial use, strong community-level case management – and critically – regional coordination to prevent cross-border spread are the need of the hour, Dr. Das insists. Resistance cannot be managed country by country; it requires collective action. Protecting artemisinin is not just a technical task – it is a strategic imperative for global malaria elimination, he adds. 

Funding constraints  

The greatest threat today to the success of the malaria elimination programme, however, is not even with artemisinin, it is dwindling financing. Dr. Das says: “At a time when malaria programs are entering the most difficult and expensive phase of elimination, overall international funding has declined. This shortfall is already forcing countries to scale back proven interventions, increasing the risk of resurgence and reversing hard-won gains.” 

In Asia-Pacific, the impact is especially pronounced in high-burden areas that face persistent social and logistical challenges, including those prevalent among mobile and migrant populations and geographically remote communities. Such groups are particularly vulnerable because they often have limited access to health services and are difficult to reach with conventional malaria control measures. 

Dr. Das suggests that a fundamental shift in how malaria elimination is financed and owned is required. Global funding will remain important, but it can no longer carry the full burden. National agencies must step up to fill the existing funding gaps, which APLMA supports by strengthening budget advocacy efforts and building evidence-based investment cases. 

Dr. Das adds: “This is not simply a cost, but an investment. Evidence consistently shows that every dollar invested in malaria elimination delivers multiple dollars in economic return through reduced healthcare costs, increased productivity, and stronger community resilience. Conversely, underinvestment at this stage is far more expensive: resurgence, emergency responses, and avoidable deaths carry a heavy and recurring price.” 

At the end of the day, the fact is that “malaria is unforgiving – it will bounce back unless we reach zero.” There is evidence from 44 countries that it is possible to end malaria. “There is no doubt that elimination of this ancient scourge will lead to greater economic output and less health system burden. Most importantly, malaria elimination is a moral imperative, particularly for our most vulnerable populations,” Dr. Das stresses.