Nepal’s health authorities are mulling postponing the malaria elimination target to 2030, aligning with the World Health Organisation’s target, after efforts to contain the spread of the disease proved ineffective and it became impossible to declare the country ‘malaria-free’ by the 2026 deadline.

What alarmed them most was the isolated indigenous cases that have emerged as a major challenge to eliminating the disease from the country even by 2030.

“Isolated indigenous cases of malaria have become a major challenge in containing the spread of the deadly disease,” said Dr Gokarna Dahal, chief of the Vector Control Section at the Epidemiology and Disease Control Division. “Single indigenous cases of infection have been reported from several places. We have been struggling to trace the source of infection.”

Malaria is caused by Plasmodium parasites. Infected female Anopheles mosquitoes carry these deadly parasites, according to the World Health Organisation.

Nepal had initially committed to achieving ‘malaria-free’ status by 2026. For this, the country needs to bring down indigenous cases or local transmission to zero, achieve zero deaths starting from 2023, and maintain zero indigenous cases for three consecutive years.

However, the country has failed to bring down indigenous cases to zero in both 2023 and 2024.

Instead, cases of infections–both Indigenous and imported have risen alarmingly, which shattered any prospects of eliminating the disease within the deadline.

Health officials say that only 16 cases of local transmission or indigenous cases were confirmed in 2023. But in 2024, more than 20 cases have been reported. Compared to 649 imported cases in 2023, the country witnessed nearly 1,000 such cases in 2024.

Indigenous malaria cases are locally transmitted, meaning the infected person does not have a history of travel to a malaria-affected country. Officials say

that the isolated indigenous cases of malaria infection are such cases that they do not have a history of travelling to the disease-endemic areas.

“Neither the people of the community and family have been infected, nor the infected persons have a history of travelling to disease-hit areas,” said Dahal. “We have stepped up surveillance measures to trace the source of infection.”

Officials attribute that the disease might remain asymptomatic for a long time in the infected person and emerge as single isolated cases or may have been contracted within the country in areas not considered endemic.

Officials further added that open borders, budget cuts in the health sector, and mosquitoes moving to higher altitudes due to climate change have hindered Nepal’s malaria elimination goal.

They say that of the total imported cases, over 80 percent came from India. Some cases were imported from African countries. Nepali security personnel serving in UN peacekeeping missions in conflict-hit African countries also often get tested positive for malaria.

Officials say the disease is unlikely to be eliminated in Nepal unless India eradicates it first. They say that due to proximity, and an open and porous border between Nepal and India and unregulated travel of people of both countries, it is impossible to eliminate malaria in Nepal, until the disease gets eradicated in the southern neighbour.

Several other factors, including cuts in the health budgets by government and aid agencies and shifts in vectors transmitting malaria to the hills and mountains due to global warming, also pose serious challenges to meeting the elimination target. Apart from this, most health facilities across the country lack entomologists necessary for conducting surveillance.

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

Officials at the health ministry said that until recent years, Plasmodium Vivax, a protozoan parasite, had been responsible for most of the malaria cases in the country, which caused relatively less severe diseases.

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.