Why in news? Malaria is all set to become a notifiable disease across India, with Bihar, Andaman and Nicobar Islands and Meghalaya too in the process of putting the vector-borne disease in the category. This will then require by law that cases be reported to government authorities. Currently, malaria is a notifiable disease in 33 States and Union Territories in India.

Highlights:

• This is part of India’s vision to be malaria-free by 2027 and to eliminate the disease by 2030. The Health Ministry has also initiated a joint action plan with the Ministry of Tribal Affairs for malaria elimination in tribal areas.
• In India, malaria is not just a public health issue but also a social, economic, and political challenge that requires the cooperation of all stakeholders.
• India was the only high-burden, high-impact country in the southeast Asia region to report a decline in malaria cases in 2020 as compared to 2019. India witnessed a 85.1% decline in malaria cases and 83.36% decline in deaths during 2015-2022.

What is a notifiable disease?

• A notifiable disease is any disease that is required by law to be reported to government authorities. The collation of information allows the authorities to monitor the disease, and provides early warning of possible outbreaks.
• Notifiable diseases are of public interest by reason of their contagiousness, severity, or frequency.

List of Notifiable diseases in India

1. AIDS
2. Dengue fever
3. Hepatitis B
4. Malaria
5. Whooping cough (Pertussis)
6. Rabies
7. Tetanus
8. Viral encephalitis
9. Anaemia
10. Chickenpox
11. Diphtheria
12. Influenza
13. Measles
14. Plague
15. Smallpox
16. Tuberculosis
17. Malnutrition
18. Iodine deficiency
19. Cholera
20. Hepatitis A
21. Leprosy
22. Cerebro spinal fever
23. Polio
24. Scarlet fever
25. Typhoid fever
26. Vitamin A deficiency

About malaria disease

• Malaria has been one of humanity’s greatest scourges for millennia, primarily killing babies and infants.
• Amongst the human-infecting species of Plasmodium, P. vivax is geographically the most widespread in tropical and subtropical regions, while 95 per cent of all cases of falciparum occur in the African region and are associated with severe disease and disease-associated mortality.
• People who get malaria are typically very sick with high fevers, shaking chills, and flu-like illness.
• Four kinds of malaria parasites infect humans: Plasmodium falciparum, P. vivax, P. ovale, and P. malariae. In addition, P. knowlesi, a type of malaria that naturally infects macaques in Southeast Asia, also infects humans, causing malaria that is transmitted from animal to human (“zoonotic” malaria).
• falciparum is the type of malaria that is most likely to result in severe infections and if not promptly treated, may lead to death.
• People get malaria by being bitten by an infective female Anopheles mosquito. Only Anopheles mosquitoes can transmit malaria and they must have been infected through a previous blood meal taken from an infected person
• Although malaria can be a deadly disease, illness and death from malaria can usually be prevented.

How was malaria kept in check?

• Availability of near-real time data monitoring through an integrated health information platform (HIP-Malaria Portal) and periodic regional review meetings to keep a check on malaria growth across India.
• Many focussed initiatives, like ‘Roll Back Malaria’ launched in 1998 to reduce deaths from malaria by half by 2010, and a major eradication program launched in 2015, have resulted in a significant reduction in cases and deaths.

Breakthrough Malaria vaccines

• The malaria parasite is extremely complex and elusive, its lifecycle involving multiple stages. Scientists across the world have generally found it very difficult to develop efficacious vaccines against malaria. Of more than 100 malaria candidate vaccines to have entered clinical trials in the last three decades, none of them have yet shown the benchmark efficacy of 75 percent set by WHO.
• Given the urgency of malaria control and prevention, last year, the WHO gave a historic go-ahead for the first malaria vaccine called RTS,S to be rolled out in high transmission African countries.
• This vaccine, a result of collaborative efforts of several organisations across the world, including GlaxoSmithKline (GSK), the Walter Reed Army Institute of Research, the PATH Malaria Vaccine Initiative, the Bill and Melinda Gates Foundation, and the Wellcome Trust, has taken more than 30 years and several hundred million dollars for its development.
• Although the RTS,S vaccine has relatively low efficacy, in the range of 30 to 40 per cent, it was granted approval in view of the enormity of the task of malaria control. The vaccine has already been administered to over one million children in pilot trials since 2019, and it has resulted in a significant reduction in severe malaria and hospitalisation in malaria-endemic countries like Ghana, Kenya and Malawi.
• Incidentally, an Indian company, Bharat Biotech, based in Hyderabad, has been granted a licence to manufacture this vaccine. Under the agreement, GSK will provide the adjuvant of the vaccine, a key ingredient of any vaccine, and Bharat Biotech is expected to be the only global manufacturer of the vaccine by 2029.
• Another malaria vaccine called the R21, which like RTS,S works against the liver stage of the parasite, has recently created much excitement in malaria vaccine research circles. The R21 has been developed by scientists at Oxford University and formulated with proprietary adjuvant from Novavax called Matrix M. This adjuvant has also been used in protein-based COVID-19 vaccine, manufactured and marketed in India by the Serum Institute of India (SII) under the brand name COVOVAX.
• Following highly promising results from phase 2 clinical studies, crucial large phase 3 trials of this vaccine have been conducted in several malaria endemic countries in Africa. The results of these trials have also been submitted to WHO for its consideration for prequalification for approval. However, regulatory authorities in Ghana and Nigeria have already given their approval for the vaccine in their respective countries.
• Interestingly, R21 vaccine is manufactured by another India company, the SII, which happens to the world’s largest vaccine manufacturer. Not only is SII the sole manufacturer of the vaccine, it also has sponsored the large Phase 3 licensure clinical trials in Africa. SII has already established capacity to produce 200 million doses annually, underling its commitment to fight against malaria and its eradication.

Malaria vaccine research in India

• Understanding the dynamics of vaccine-induced immunity and pre-existing immunity during disease is absolutely essential. Controlled Human Malaria Infection (CHMI) studies have the potential to fast-track initial assessments of vaccine efficacy, and also facilitate the first clinical evaluation of vaccines involving fewer adult subjects. It is not surprising that across the world many countries have developed the capacity to conduct highly safe CHMI studies.
• Scientists at the International Centre for Genetic Engineering and Biotechnology (ICGEB), New Delhi, have successfully developed and produced two experimental recombinant blood stage malaria vaccines against P. falciparum and P. vivax and carried out Phase I first-in-man clinical trials in India.
• Based on the encouraging results of the Phase I(a) trial with P. vivax vaccine, Phase 2(a) involving efficacy assessment by controlled human malaria infection has been completed in collaboration with scientists at Oxford University.
• If  the CHMI model was available in India, these completely indigenous efforts would have greatly facilitated the progress of these, and other malaria vaccines, developed in India.

World Malaria Day

• World Malaria Day celebrated on 25th April
• The WHO’s guiding theme this year is “Time to deliver zero malaria: invest, innovate, implement” – there are reasons to be hopeful in our quest to control and finally eradicate malaria, in the form of two first generation vaccines that have recently been developed and may soon be rolled out.
• It is an occasion to highlight the need for continued investment and sustained political commitment for malaria prevention and control.
• It was instituted by WHO Member States during the World Health Assembly of 2007.

Long Road Ahead

• The vaccines against infectious diseases, particularly that target young children, is a long drawn and complex endeavour, as exemplified by development of RTS,S and R21 malaria vaccines.
• Development of such vaccines will essentially require collaboration of multiple stake holders, stable high quality infrastructure and long-term financial support from government and other agencies. It seems quite clear that the current and future vaccines that need to be rolled out in lower and middle-income countries will mostly be manufactures by pharma industries in India. The time is right for India to invest, integrate, and be the leader in finding solution in combating deadly infectious diseases in the world.
• Intensified efforts must be made to reach at-risk and vulnerable populations with currently available strategies and tools. Globally, children in the poorest households are five times more likely to be infected with malaria. Malaria is also more prevalent among young children whose mothers have a lower level of education and live in rural areas. Reaching these populations with available malaria prevention, diagnosis and treatment is critical for achieving the global technical strategy for malaria 2016-2030 and Sustainable Development Goal targets and delivering on the promise of zero malaria for everyone, everywhere.