Just a few years ago, malaria was a significant and challenging issue in the Greater Mekong subregion. The spread of malaria in the subregion was recognized as the biggest threat to the global fight against antimalarial drug resistance, and Cambodia was right at the heart of this challenge. In 2018, Cambodia recorded more than 66 000 malaria cases. Alarm bells were ringing.
At that time, evidence was mounting that resistance to antimalarial medication was close to reaching the point of no-return. Some parasites were showing resistance to up to four out of six available artemisinin-based combination therapies, a core component used in antimalarial medication were showing high failures rates. The risk was that the threat could spill over into Africa and reverse all the hard-fought gains of the 21st century.
Instead, 2018 was a turning point. The Cambodian Ministry of Health, the World Health Organization (WHO) and partners came together to find innovative and collaborative solutions to the address the problem of malaria. That year, the National Center for Parasitology, Entomology and Malaria Control (CNM) launched an intensification plan for hard-to-reach populations.
Malaria activities were intensified, based on monthly epidemiological analyses and hotspot mapping. Additional village malaria workers were deployed in hotspot areas, and mobile malaria workers were assigned to high-risk, forested areas to ensure early case detection and treatment.
In early 2020, elimination activities started to be implemented countrywide from to detect, investigate and clear malaria cases and high-risk areas. In November 2020, the CNM, WHO and partners launched the “last mile” of malaria elimination to intensify the focus response and accelerate elimination.
WHO Representative to Cambodia Dr Li Ailan said: “Since 2018, Cambodia has shown the world how a sustained commitment to reaching the unreached can translate into real-world impact. This turnaround in Cambodia is extraordinary. The country has leapfrogged into malaria elimination.”
Malaria has declined, from over 66 000 cases in 2018, to only just over 4,000 malaria cases in 2021, three short years later. As Cambodia looks forward, we need to start talking about what is needed to prepare for applying for malaria-free certification. We know that there are still some gaps to address:
- First, we need to start the process of documenting intervention activities.
- Second, we need to implement subnational verification exercises as well as strategies for preventing re-establishment of transmission in the provinces that have reached zero cases.
- Third, we need to sustain a strong surveillance and response system.
- Finally, we need to work on establishing and expanding integrated drug efficacy surveillance and addressing malaria parasite reservoirs.
Despite these gaps, Cambodia now has the framework in place to reach the elimination goal of Plasmodium falciparum malaria by 2023, and all human species by 2025.
Cambodia should be proud that the spread of malaria in the Greater Mekong subregion is no longer considered a threat to the global progress towards a malaria-free world. Cambodia is now considered a malaria elimination success story and example to others.