India Malaria Transition
Malaria elimination has re-entered the policy spotlight as India advances steadily towards its national target of ending indigenous malaria transmission. Under the National Framework for Malaria Elimination (NFME) 2016–2030, India has set an ambitious goal of eliminating malaria nationwide by 2030, with an interim milestone of achieving zero indigenous transmission across the country by 2027. By the end of 2025, official data indicate that 160 districts across 23 States and Union Territories have reported zero indigenous malaria cases for three consecutive years (2022–2024). This milestone places India among a shrinking group of countries nearing the final phase of malaria elimination.
At the same time, global benchmarks and regional realities highlight that elimination is not merely about reducing cases, but about sustaining zero transmission through strong surveillance, health systems, and regional cooperation. India’s progress must therefore be understood within both national and global contexts.
How Malaria Elimination Is Assessed Globally
Malaria elimination is not declared solely on the basis of declining case numbers. The World Health Organization (WHO) defines elimination as the interruption of local transmission of all human malaria parasites for at least three consecutive years, supported by a robust surveillance and response system capable of detecting and responding to every case.
Based on this strict criterion, 47 countries and territories had been officially certified malaria-free by mid-2025. Certification requires not only epidemiological evidence but also proof of sustained public health capacity to prevent re-establishment. This underscores that elimination is as much an institutional and governance challenge as it is a biomedical one.
India’s Current Status in the Fight Against Malaria
India has recorded remarkable gains over the past decade. According to the World Malaria Report 2025, malaria cases in India declined by approximately 80% between 2015 and 2023. In 2024, India exited the WHO’s High Burden to High Impact (HBHI) group, signalling sustained improvements in historically high-endemic States.
By 2023–24, India had already achieved more than a 70% reduction in malaria incidence, placing it firmly on track to meet the WHO Global Technical Strategy (2016–2030) interim target of a 75% reduction by 2025. Furthermore, 34 States and Union Territories reported an Annual Parasite Incidence (API) of less than one, indicating very low transmission levels.
However, progress remains uneven. Despite national-level gains, India still accounted for over 70% of malaria cases in the WHO South-East Asia Region in 2024. This reflects the country’s size, diversity, and the persistence of localised transmission pockets.
India’s Strategy for Malaria Elimination
India’s malaria elimination drive is guided by two interlinked policy instruments:
- National Framework for Malaria Elimination (2016–2030) – which provides the long-term vision and phased national and sub-national targets.
- National Strategic Plan (NSP) for Malaria Elimination (2023–2027) – which operationalises the framework with time-bound, district-level interventions.
A defining feature of India’s strategy is the recognition of surveillance as a core intervention, rather than a passive reporting mechanism. The NSP emphasises the “test, treat, and track” approach, ensuring universal access to early diagnosis, complete treatment, and follow-up of every case.
Vector control remains central, through the use of long-lasting insecticidal nets, indoor residual spraying, and environmental management. At the same time, India has increasingly focused on tailoring interventions to local contexts rather than adopting uniform national solutions.
Key Challenges in the Elimination Phase
As malaria transmission declines, the nature of challenges changes. One of the most significant risks is reintroduction due to migration. Population movement from malaria-endemic districts and neighbouring countries can re-seed transmission in areas that have achieved zero cases.
Urban malaria presents a distinct challenge. High population density, informal housing, construction activity, and water storage practices create ideal breeding conditions for mosquitoes, particularly in rapidly expanding cities. Unlike rural malaria, urban transmission requires coordination across municipal governance, urban planning, and public health systems.
The NSP identifies forested, tribal, border, and hard-to-reach areas, as well as zones around large infrastructure projects, as priority regions requiring intensified interventions. These areas often face health workforce shortages, logistical constraints, and limited access to diagnostics.
Regional and Cross-Border Transmission Risks
Malaria elimination cannot be achieved in isolation. Cross-border transmission, particularly in border regions shared with Nepal and other neighbouring countries, remains a persistent concern. Localised transmission driven by population mobility highlights the need for sub-national and regional coordination rather than solely national-level strategies.
Another complicating factor is Plasmodium vivax, which accounts for a large share of malaria cases in the South-East Asia Region. Unlike P. falciparum, P. vivax can relapse due to dormant liver stages, making elimination more complex and demanding sustained follow-up and treatment adherence.
Drug and Insecticide Resistance: An Emerging Threat
The WHO has warned of partial resistance to artemisinin derivatives, which form the backbone of modern malaria treatment. There are also signs of declining efficacy of partner drugs and growing insecticide resistance among mosquito vectors.
India has responded by strengthening drug-resistance surveillance, rotating insecticides, and emphasising strict adherence to the full 14-day radical treatment for P. vivax infections. However, resistance management requires continuous investment in research, monitoring, and health worker training.
The Road Ahead: From Control to Elimination and Beyond
India has reached an advanced but fragile stage in its malaria elimination journey. With only a few States still above the API threshold of one, the challenge is now geographically concentrated but operationally complex. Experts emphasise that data accuracy and real-time surveillance will determine success in the final stretch.
Mandatory reporting of even suspected malaria cases, including by private healthcare providers, is increasingly seen as essential. Without full case visibility, elimination gains may be overstated and vulnerable to reversal.
Urban malaria control, community participation, and sustained political commitment will be decisive. As India moves from reducing malaria to preventing its re-establishment, elimination must be treated not as an endpoint, but as a continuous public health function embedded in strong primary healthcare systems.
Conclusion
India’s progress towards malaria elimination represents one of the most significant public health achievements of the past decade. Sharp declines in cases, expansion of zero-transmission districts, and exit from the HBHI category demonstrate that elimination is within reach. Yet, the final phase is the most demanding, requiring vigilant surveillance, regional cooperation, resistance management, and sustained community engagement. If India succeeds in achieving zero indigenous malaria cases by 2027 and preventing resurgence thereafter, it will not only meet its national targets but also provide a global model for malaria elimination in large, diverse, and resource-constrained settings.
UPSC-Style Questions
Prelims Question
With reference to malaria elimination, consider the following statements:
- The World Health Organization certifies a country as malaria-free only after local transmission of all human malaria parasites has been interrupted for at least three consecutive years.
- India’s National Framework for Malaria Elimination aims to eliminate malaria nationwide by 2027.
- Plasmodium vivax poses a challenge to malaria elimination due to its potential for relapse.
Which of the statements given above are correct?
(a) 1 and 3 only
(b) 1 and 2 only
(c) 2 and 3 only
(d) 1, 2 and 3
Mains Question (GS Paper II / III)
India has made substantial progress in reducing malaria burden over the past decade.
Discuss the key strategies adopted for malaria elimination in India and critically examine the challenges that may hinder the achievement of zero indigenous malaria cases by 2027.
