Abstract
In the Asia–Pacific region, more than 2 billion people are at risk of malaria. The epidemiology of malaria is highly heterogeneous, with Plasmodium falciparum, Plasmodium vivax and zoonotic Plasmodium knowlesi infections being co-endemic and transmitted by 19 major vector species, and focused in hard-to-reach areas and populations. In response to emerging multidrug-resistant malaria in the Greater Mekong Subregion, the World Health Organization (WHO) has prioritised malaria elimination in the Asia–Pacific region by 2030. The Asia Pacific Leaders Malaria Alliance (APLMA) is a coalition of 22 governments in the Asia–Pacific region, including Australia, committed to eliminating malaria by 2030. Australia has made substantial financial and technical contributions to APLMA and its implementing partner, the Asia Pacific Malaria Elimination Network (APMEN), recognising that investment in malaria research is one of the “best buys” in global health security. Malaria elimination will save millions of lives over a generation and deliver regional economic benefits worth billions of dollars, as well as strengthening Australia's biosecurity. Important global investments have been made over the past two decades (around US$60 billion), resulting in significant reductions in malaria cases (a 76% and 48% reduction in WHO Southeast Asia and Western Pacific regions, respectively, to 3.0 and 2.4 malaria cases per 1000 population at risk). Despite these investments, only Sri Lanka and China in the Asia–Pacific region have achieved this goal, with Timor-Leste in the pre-certification phase. Other countries are progressing towards malaria elimination goals. Malaysia has eliminated human malaria parasite species, and Vietnam, Lao People's Democratic Republic and Cambodia had only 316, 785 and 1382 respective locally transmitted (indigenous) cases (mainly P. vivax) in 2023. Since 2015, progress in reducing the malaria burden in the Asia–Pacific region has been highly variable within and across countries and Plasmodium spp, and recently it has stalled, and even reversed, in many countries, including Papua New Guinea, Myanmar and Pakistan. The reasons behind the slowing progress are multifactorial, but, in recent times, the coronavirus disease 2019 (COVID-19) pandemic, climate change and armed conflict have interrupted health services, affected people migration and movements, and increased malaria transmission risk. Moreover, there are emerging threats in our ability to track, prevent and treat malaria, which impedes progress towards APLMA's 2021 roadmap to malaria elimination.