Foreword to Special Issue: Malaria elimination in the Asia-Pacific

The path to malaria elimination in the Asia-Pacific region, encompassing 21 countries spanning from Afghanistan to Vanuatu, is at an unprecedented crossroad. To be certain, there has been remarkable progress over the past decade. Countries such as Sri Lanka and China have been certified as having eliminated malaria; Malaysia, Bhutan and Timor-Leste are on the cusp of elimination with zero to very few indigenous cases reported in the past 2 to 3 years. The Greater Mekong Subregion has achieved dramatic success: Cambodia has reported zero deaths since 2018 while there has been a reduction of 60%–90% of P. falciparum malaria cases across the subregion from 2020 to 2021, despite COVID-19 disruptions (World Health Organization, 2021).At the same time, with the 2030 goal of elimination committed to by 21 Heads of State firmly before us, there remains much work to be done in the decade ahead. Together, India, Indonesia, Pakistan and Papua New Guinea account for over 80% of the total region's malaria burden (World Health Organization, 2020). Indeed, there are several key challenges ahead.

Many of the highest pockets of endemicity are in the hardest-to-reach communities. Surveillance remains a high order of priority in need of strengthening particularly in rural and remote areas. While remarkable progress has been made with regards to P. falciparum, P. vivax continues to present considerable challenges in terms of case management and treatment. Policy reform in areas such as making malaria a notifiable disease still needs robust advocacy efforts. In an era of diminishing resources, malaria elimination efforts increasingly need ways to maximise the long-term benefit of donor funding while increasing domestic resources for malaria and health systems strengthening in the long term.

This special issue entitled Malaria elimination in the Asia-Pacific provides critical evidence in many of the areas outlined above, such as reaching hard-to-reach populations, the adequate treatment of P. vivax, examining donor support and policy reform. Wangdi et al. (2021) emphasise the importance of ensuring access to effective interventions for patients at risk in border or forested areas through, for example, mobile clinics, screening posts and village volunteers. Burkot and Gilbert (2021) offer a country perspective from the Solomon Islands on the impact of foreign aid on malaria elimination efforts with recommendations for future priorities on the integration of malaria services within the general health system. Ruwanpura et al. (2021) summarise the missing gaps in data that can help inform a safer and more effective radical cure for P. vivax malaria, including for example on the cost-effectiveness of novel treatment options. Finally, Lamy et al. (2021) explain why making malaria a notifiable disease is an essential policy milestone for countries nearing elimination to detect any new emerging or re-emerging outbreaks and to react quickly. This is also a prerequisite to a robust surveillance system for any other emerging health threat.

I am grateful to the researchers, scientists and practitioners who have shared these important insights grounded in rich context. I also wish to extend sincere thanks to the Guest Editors of this special issue in the Asia & the Pacific Policy Studies journal, Vivian Lin and Tikki Pangestu, for recognising the importance of evidence generation on our collective endeavour to battle malaria in the Asia-Pacific. Despite these unprecedented times, may our collective efforts in research, practice, and policy enable us to reach the goal of malaria elimination by 2030 in the Asia-Pacific.