Malaria Elimination in India: Progress, Challenges and the Road to 2030

Context

1. Under the National Framework for Malaria Elimination (2016-2030), India has committed to eliminating malaria nationwide by 2030, with an interim target of interrupting indigenous transmission by 2027.
2. By the end of 2025, sustained surveillance and targeted interventions resulted in 160 districts across 23 States and Union Territories reporting zero indigenous malaria cases for three consecutive years.
3. While these gains mark a decisive shift from control to elimination, challenges persist in urban centres, border regions, and among mobile populations.
4. India’s progress must be viewed within global benchmarks set by the World Health Organization, which certifies malaria elimination only after sustained interruption of transmission backed by robust surveillance.

Q1. What does India’s target of eliminating malaria under the National Framework for Malaria Elimination (2016–2030) signify, and how does the interim goal of zero indigenous cases by 2027 shape policy priorities?

1. India’s elimination target signifies a shift from managing malaria as a public health burden to permanently interrupting local transmission.
2. The interim goal of zero indigenous cases by 2027 creates urgency and measurable milestones for programme implementation.
3. It prioritises surveillance, early diagnosis, and rapid response over broad population-level control.
4. States are incentivised to sustain gains once transmission drops to very low levels.
5. This phased approach reduces the risk of complacency and resurgence before full elimination.

Q2. How does the World Health Organization define malaria elimination, and where does India currently stand in relation to global malaria-free certification standards?

1. The WHO defines malaria elimination as the interruption of local transmission of all human malaria parasites for at least three consecutive years.
2. Certification also requires a strong surveillance and response system capable of preventing re-establishment.
3. As of mid-2025, 47 countries or territories had achieved WHO malaria-free certification.
4. India has not yet reached nationwide elimination but has achieved elimination-level status in many districts.
5. The current challenge lies in scaling district-level success to national certification standards.

Q3. What evidence highlights India’s progress in malaria reduction over the past decade, and why is India’s exit from the WHO High Burden to High Impact group significant?

1. Malaria cases in India declined by nearly 80% between 2015 and 2023.
2. Deaths due to malaria have also fallen sharply due to improved diagnosis and treatment.
3. Exiting the WHO High Burden to High Impact group in 2024 reflects sustained improvements in high-endemic States.
4. This exit signals that malaria is no longer a nationwide crisis but a localised challenge.
5. It strengthens India’s credibility as a potential malaria elimination success story.

Q4. What institutional strategies guide India’s malaria elimination effort, and how do the National Framework and National Strategic Plan complement each other?

1. The National Framework for Malaria Elimination provides long-term vision and phased targets till 2030.
2. The National Strategic Plan for Malaria Elimination (2023–2027) operationalises this vision through concrete actions.
3. Surveillance is treated as a core intervention rather than a supporting activity.
4. Universal access to diagnosis and treatment is ensured through the “test, treat, and track” strategy.
5. Vector control, community engagement, and health system strengthening work in coordination.

Q5. Why do migration, urbanisation, and border regions continue to pose major challenges to malaria elimination in India?

1. Migrant workers often move between endemic and non-endemic areas, increasing reintroduction risk.
2. Urbanisation creates breeding sites through water storage, construction, and poor drainage.
3. Border districts experience cross-border population movement, complicating surveillance.
4. Mobile populations may not complete treatment, enabling transmission.
5. These factors demand targeted, location–specific strategies rather than uniform interventions.

Q6. How do regional and cross-border transmission dynamics, particularly involving Plasmodium vivax, complicate malaria elimination efforts?

1. Plasmodium vivax accounts for nearly two-thirds of malaria cases in the South-East Asia region.
2. Its ability to relapse after months complicates elimination.
3. Cross-border movement between India and neighbouring countries sustains localised transmission.
4. Elimination therefore requires regional cooperation and data sharing.
5. Sub-national coordination is essential to prevent re-establishment of transmission.

Q7. Why are drug and insecticide resistance emerging as serious threats to malaria elimination, and how is India responding to these risks?

1. Partial resistance to artemisinin derivatives threatens treatment effectiveness.
2. Declining efficacy of partner drugs increases relapse and transmission risk.
3. Insecticide resistance reduces the impact of vector control measures.
4. India is strengthening resistance monitoring systems
5. Strict adherence to full treatment regimens is being enforced to prevent resistance spread.

Q8. What does India’s current malaria epidemiological profile reveal about the geographical concentration of risk, and why does this matter for policy focus?

1. In 2023, 34 States and Union Territories recorded an Annual Parasite Incidence below one.
2. Only Tripura and Mizoram remain above this threshold.
3. This shows malaria risk is now geographically concentrated.
4. Focused resource allocation can yield faster elimination.
5. Blanket national strategies are being replaced by targeted district–level action.

Q9. What key actions will determine whether India can achieve zero indigenous malaria by 2027 and sustain elimination through 2030?

1. Surveillance systems must detect every suspected case, including in the private sector.
2. Urban malaria control requires community participation and behavioural change.
3. Cross-border and inter-state coordination must be strengthened.
4. Continuous funding and political commitment are essential to avoid resurgence.
5. Sustaining elimination will depend on vigilance even after cases reach zero.

Conclusion

India’s malaria elimination journey has reached a decisive phase, marked by dramatic reductions in disease burden and widespread district-level elimination. However, the final stretch toward zero indigenous cases by 2027 will test surveillance capacity, governance coordination, and community engagement. If India successfully consolidates gains in urban, border, and high-risk regions, it can not only achieve malaria elimination by 2030 but also set a global example of disease elimination in a large, diverse, and mobile population.