Make malaria a notifiable disease in Delhi: Health minister Harsh Vardhan
Union health minister Dr Harsh Vardhan on Tuesday postponed Delhi’s target of achieving zero indigenous transmission of malaria by two years, to 2022, and asked the Delhi government to make malaria a notifiable disease in the Capital.
During a review meeting with lieutenant governor Anil Baijal, Delhi health minister Satyendar Jain and mayors of the three MCDs, he also pushed the authorities to develop a community-driven approach towards eliminating the disease.
While Delhi reported 228 cases of malaria last year, including the first death due to the disease in at least nine years, the city has seen only 11 cases of malaria till June 26 this year.
“The target for elimination of malaria in Delhi has been postponed to 2022. This target is not impossible to achieve for Delhi because it is among Category 1 states where there is less than one case per 1,000 population. When it comes to malaria, in the last two to three years, the mortality has gone down by over 80% in the country which is a historic success,” said Dr Vardhan.
There are 448 districts in the country where the annual parasite incidence or the number of cases of malaria per year per 1,000 population is less than one. These districts have been listed in category 1 and were given the target to achieve zero indigenous cases by 2020, according to the National Strategic Plan for Malaria Elimination (2017-2022). This is in line with the country’s target to achieve zero transmission by 2027, and maintain it for three years, to achieve malaria elimination by 2030.
Noting down steps to be taken in this regard, Dr Vardhan said, “Capturing actual data from the Hospitals and taking preventive actions in the areas of infection is critical to achieve elimination. So is the regular reporting from the private sector essential for taking timely preventive measures and for accuracy of data pertaining to incidence of malaria. Further,as we move towards elimination, 10% of all fever cases need to be screened for malaria so that no cases of malaria can escape detection.”
A senior official from the Union health ministry said, “This was not a hard target. The WHO (World Health Organisation) only recognises national level elimination and so the states were given sub-national targets to work towards. For Delhi, the challenge also is that many patients come in for treatment from neighbouring states and give Delhi addresses of their relatives, making it difficult to track the origin of the case.”
Dr Vardhan added, “Malaria and dengue have not been made notifiable disease in Delhi despite being discussed every year. This is very important if we have to eliminate the disease. We need to know where every single case is being reported from, what is the environment nearby, and how we can prevent breeding. If the disease is made notifiable, we will be able to track every single case and develop micro-strategies.”
Declaring a disease notifiable makes it legally mandatory for hospitals and private practitioners to report all cases to the administration. During the pandemic, Covid-19 as well as the secondary fungal infection, mucormycosis, were made notifiable disease in the state.
According to a senior official from the North Delhi municipal corporation, which manages data for vector borne diseases like dengue, malaria, and chikungunya for the city, said, “The proposal for making malaria and dengue notifiable diseases was sent to the Delhi government in 2019. The file is still pending with the law department because – one, legal provisions are hard to change and take time, and two, the pandemic meant that the offices weren’t really functioning for almost 15 months.”
‘Not an easy target’
It will be extremely difficult to achieve the target of 2022 for Delhi, according to PL Joshi, former director of National Vector Borne Disease Control Programme. “This is because field level activities were disrupted completely by the pandemic. All field level workers that helped in malaria surveillance were mainly working to control Covid-19,” he said.
He added that the other challenge was that most of the cases were caused by plasmodium vivax in Delhi. There are four plasmodiums that cause malaria in humans – falciparum, vivax, ovale, malariae – the most common being the first two.
“Vivax malaria relapses and hence is difficult to eliminate. The treatment protocol is for 14 days so compliance is an issue; there is a need to follow up every case to ensure that they complete treatment and check for relapse. Currently, there is also no way to detect the plasmodium when it is dormant in the liver,” he said.