Nepal is likely to miss its malaria elimination target yet again, as seven new cases of indigenous infection have been reported from various districts across the country since the start of 2023.

Earlier, the government had committed to eliminating malaria by 2020, which was later extended to 2025.

To earn the ‘malaria-free’ status in 2026, Nepal needs to bring down indigenous cases or local transmission of the disease to zero, achieve zero deaths from 2023, and sustain zero cases for three consecutive years, according to the World Health Organisation.

Indigenous malaria cases are locally transmitted, in which infected persons do not have a history of travel to malaria-affected countries.

Imported cases of malaria have surpassed indigenous cases for several years.

“We are still verifying whether the malaria transmission is local,” said Dr Gokarna Dahal, chief of the Vector Control Section at the Epidemiology and Disease Control Division. “If reported cases prove to be indigenous, we will again miss the target of disease elimination.”

Since January this year, 432 new malaria cases have been reported from 39 districts across the country.

According to the Disease Control Division, Nepal is among the UN health body’s member countries with the potential to eliminate the disease by 2025. In April 2021, the UN health agency launched the E-2025 initiative to halt malaria transmission in 25 identified countries by 2025 and Nepal has committed to meeting the target.

Malaria is caused by Plasmodium parasites. Infected female Anopheles mosquitoes carry these deadly parasites, according to the World Health Organisation. Officials at the health ministry said that until now Plasmodium Vivax, a protozoan parasite, was responsible for most of the malaria cases in the country, which causes relatively less severe disease.

However, cases of Plasmodium falciparum, which most often cause severe and life-threatening malaria, have been rising. The parasite is common in many countries in Africa and the Sahara desert.

Officials say, most of the districts that reported malaria cases are from hilly and mountainous regions.

Studies show vectors transmitting malaria have shifted to the hills and mountains, due to global warming and other factors that pose new challenges. Malaria has been reported even in the mountain districts of Mugu, Bajura and Humla, which were considered non-endemic in the past.

The UN report ‘Climate Change 2022: Impacts, Adaptation and Vulnerability’ states that at least six major vector-borne diseases affected by climate drivers have recently emerged in Nepal and are considered endemic, with climate change implicated as the primary driver.

The report also shows increasing evidence that global warming has extended the elevational distribution of Anopheles, Culex, and Aedes mosquito vectors above 2,000 metres in Nepal.

Malaria-related deaths had stopped since 2016, but five years later, in 2021, the country recorded one death from the disease.

Officials say most of the infections reported so far are cases imported from India. This has become a roadblock to the country’s goal to eliminate the disease.

India is on the list of countries that have committed to eliminating the disease by 2030—five years later than Nepal. In the past, Nepal had sought India’s help to cut the number of malaria cases.

Nepali officials met their Indian counterparts and drew their attention to the growing number of imported cases in Nepal. Officials had agreed to share information on malaria between the two countries in order to have effective control measures.