Bhutan stands at the threshold of a historic achievement: becoming malaria-free. With the country poised to mark its third consecutive year with zero indigenous cases, the World Health Organization’s (WHO) certification by 2025 now seems within reach. However, the stakes remain high, and there is no room for complacency. Bhutan missed its original elimination target of 2018, and the lessons from that missed milestone should galvanise renewed focus, vigilance, and commitment.
The progress we have made in combating malaria is indeed commendable. From 39,000 cases in the 1990s to fewer than five cases in 2022, the achievements reflect the effectiveness of our health interventions and the resilience of our people. For a country with challenging terrain and a porous border with India, where malaria remains endemic in parts, reducing local transmission has been a monumental task.
The efforts of health authorities, including distributing mosquito nets, conducting biannual indoor residual spraying (IRS), and creating community acceptance groups in gewogs, have been critical in driving down the disease’s incidence. More importantly, we have not reported any malaria deaths since 2019. This is a significant public health triumph, particularly when considering the cases of death in 2017 and 2018. While we achieved pre-elimination status as early as 2013, border cases have posed recurring threats, especially in the southern parts of the country.
Bhutan’s progress towards malaria elimination has been complicated by its geographical and demographic realities. In 2020, 22 indigenous cases of malaria were linked to cross-border movements, particularly among migrant workers. This brings to the fore the inherent difficulty of maintaining malaria-free status in regions where malaria transmission is still active across the border.
The resurgence of malaria in these areas plays up the importance of continued vigilance and robust border control measures. We cannot afford to allow cases from across the border to undermine years of hard-won progress. Cross-border collaboration, regional partnerships, and real-time surveillance are essential to keep the malaria parasite from making its way back into Bhutan.
The Covid-19 pandemic added another layer of complexity to Bhutan’s malaria elimination efforts. The global health crisis strained resources, diverted attention, and delayed interventions, all while health systems across the world struggled to respond. The pandemic disrupted the flow of critical malaria supplies and impacted healthcare access, especially in rural areas. Despite this, we persevered and ensured that our malaria control efforts were not entirely derailed. The post-pandemic recovery phase must focus on redoubling efforts to meet the 2025 target.
So, what does achieving WHO malaria-free certification mean, one might be tempted to ask. Achieving WHO malaria-free certification is not merely a symbolic victory. It means complete eradication of indigenous transmission of the disease in the country, bringing an end to the threat of a deadly disease that has plagued us for decades. The certification would validate Bhutan’s healthcare achievements on the global stage, bringing it into the fold of nations that have conquered malaria.
As we move closer to our goal, the focus must now shift towards ensuring that every case of malaria is detected and treated swiftly, and that transmission is completely halted. The existing preventive measures—net distribution, IRS, and community training—must be maintained and strengthened, particularly in vulnerable southern areas. There is also a pressing need to invest in stronger cross-border collaboration. Our success is tied to the health outcomes of our neighbours, and co-ordinated efforts with India will be vital to preventing resurgence.
We now have come too far to falter. The journey has been long, but the destination is now in sight; the opportunity to become malaria-free is within grasp. Just a few more years of concerted effort is all we need!