China's malaria-free status offers key lessons for global efforts

China's success in achieving malaria-free status in 2021 offers crucial lessons for the global malaria fight, say experts in a special collection of articles published by The BMJ today.

But they also warn that if funding declines, as is expected under US President Trump's drastic policy changes impacting collective efforts on global health, "the hard won gains of the past two decades would be rapidly reversed."

The collection examines China's national strategy, presents case studies from Hainan and Yunnan provinces and the Huai River Basin, and details the evolving interventions that ultimately led to elimination. 

In an editorial to launch the collection, independent experts explain that global and national funding for malaria control has led to major gains in child survival and supported progress towards elimination, with 45 countries and one territory now having achieved this milestone. 

However, they warn that if replenishment of the Global Fund (which supports malaria control) and the Global Alliance for Vaccines and Immunisation (funding for malaria vaccines) declines in 2025, malaria cases and deaths are predicted to increase. 

This collection offers important lessons for countries pursuing malaria control and elimination, especially in Africa, where those goals have broad political support, they say.

For example, in Hainan Province, elimination was achieved through long term use of overlapping interventions-bed nets, indoor spraying, drug administration, and sustained surveillance-that evolved with changing risk levels, showing that persistent but flexible strategies can succeed even in highly endemic areas.

Recognising that success can breed complacency-and resurgence is another important lesson. In the Huai River Basin, early success in the 1980s led to reduced surveillance and funding, resulting in malaria resurgence in the early 2000s. Control was restored only after reintroducing mass drug administration, robust vector control, and community mobilisation, highlighting the danger of prematurely scaling back efforts and the need for long term vigilance.

Other lessons include the importance of cross border collaboration, real time data sharing, and sustained surveillance, while novel approaches to financing are also urgently needed, led by national governments and their ministries of finance and include regional banks and innovative partnerships, they add.

"China's malaria-free status is a public health triumph, but it is also a call to action. Elimination requires long term tenacity; not just funds, but data driven foresight," they write. 

"As global malaria efforts face shifting donor priorities and resulting financing gaps, The BMJ's new collection offers timely insights for policy makers, implementers, and funders alike. China and other countries that have achieved elimination have shown us the destination-now the challenge is translation to action for those left behind," they conclude.