China is officially malaria-free, according to the World Health Organization , following a decades-long battle against the disease. Beijing submitted a certification request to the agency in November, after four years of recording zero local cases. In May, members of the Malaria Elimination Certification Panel – an independent WHO advisory body – travelled to China and verified it was free of the disease and had the appropriate resources to prevent retransmission. Hopes fade for a malaria-free world as UN eradication efforts stall “Today we congratulate the people of China on ridding the country of malaria,” WHO chief Tedros Adhanom Ghebreyesus said on Tuesday. “Their success was hard-earned and came only after decades of targeted and sustained action. With this announcement, China joins the growing number of countries that are showing the world that a malaria-free future is a viable goal.” China joins 39 other countries and territories that have received the certification, including Algeria, Uzbekistan, Argentina, and El Salvador. It is the fourth country in the WHO’s Western Pacific region – and the first in more than 30 years, after Brunei in 1987 – to be declared malaria-free. Before 1949, when the People’s Republic of China was established, the country was reporting more than 30 million cases of malaria and 300,000 associated deaths each year, with an estimated 90 per cent of the population at risk from the mosquito-borne disease. Since then, China has doubled down on its efforts to control the disease, providing antimalarial treatments to those at risk and increasing the use of insecticides to reduce mosquito breeding grounds. The country was also part of an effort in the late 1960s to identify treatments for the disease, with chemist Tu Youyou winning a Nobel Prize in 2015 for her discovery that artemisinin – a compound used in traditional Chinese medicine – was active against malaria. Artemisinin is now the primary component of frontline malaria drugs. Tu Youyou: the Nobel Prize-winning scientist and the malaria controversy By the end of 1990, malaria deaths in China had been reduced by 95 per cent and cases had fallen to 117,000 per year. A heightened effort to strengthen training, mosquito control, and medicine in the following decade further reduced annual cases to 5,000. China introduced another large-scale malaria elimination programme in 2010, this time with a commitment to eradicating the disease within a decade. In 2016, the WHO listed China as one of 21 countries that could realistically eliminate malaria by 2020. That year, the country also recorded its last known cases of local infection, with just three in total. However, China is still at risk from imported cases of malaria, recording more than 2,500 each year from 2017 to 2019, with its southwestern Yunnan province a particular concern because of its shared border with Laos, Myanmar and Vietnam – three countries where the disease is still endemic. China has boosted its malaria surveillance in its at-risk areas and installed 68 field stations in Yunnan’s border towns to help quickly identify imported cases. There is also support for communities living near the border, including education about the disease in schools and information pamphlets at border crossing points. Will mainland China drop its coronavirus travel restrictions any time soon? There is also the risk of Chinese nationals bringing in the disease on their return from Sub-Saharan Africa, home to 94 per cent of global malaria cases and deaths in 2019. According to the World Malaria Report, there were 229 million cases of malaria worldwide in 2019, compared to 228 million the previous year. The number of malaria-related deaths declined slightly, with an estimated 409,000 in 2019 and 411,000 in 2018. Gauden Galea, the WHO representative in China, said future efforts needed to include continued engagement and support for malaria-endemic countries in the region. “Just as in the case of the current pandemic, no country can control malaria without strong cross-border collaboration. Just like viruses, mosquitoes don’t carry passports and don’t care which passports you carry,” he said.