Around a dozen cases of indigenous malaria infection have been reported since January, this year, which is a serious setback in the country’s efforts to achieve its malaria elimination goal.

According to officials at the Epidemiology and Disease Control Division, they have been verifying reported cases and taking measures to prevent further spillover of the infection.

“Around a dozen cases of indigenous malaria cases have been reported so far,” said Dr Gokarna Dahal, chief of the Vector Control Section at the division. “We have been verifying these cases. Alongside them, imported malaria cases have also been reported.”

Malaria is caused by Plasmodium parasites, which are carried by infected female Anopheles mosquitoes, according to the World Health Organisation.

Indigenous malaria cases are locally transmitted, and infected persons do not have a history of travel to malaria-affected countries. Meanwhile, imported cases occur in people who have travelled to disease-hit areas or countries.

Nepal has missed its malaria elimination target multiple times—in 2020, 2023, and effectively in 2026.

The country had committed to achieving ‘malaria-free’ status in 2026, which requires reducing indigenous cases or local transmission of the disease to zero, achieving zero deaths from 2023, and sustaining zero cases for three consecutive years, according to the World Health Organisation.

However, both indigenous and imported malaria infections rose in 2023 and 2024, making it impossible to meet the 2026 target..

According to data provided by the division, 1,043 new malaria cases—including 1,006 imported and 37 indigenous—were reported in 2024, up from 528 cases, including 23 indigenous, in 2023.

Health officials say that the malaria elimination target has been postponed to 2030.

Public health experts and entomologists said that they are sceptical about Nepal’s ability to eliminate the disease even in the next five years, as the country is witnessing all existing and emerging new challenges. Open borders, global travel, and mosquitoes moving to higher altitudes due to climate change all pose challenges to the elimination goal, they said.

“We cannot let our guard down, despite multiple challenges, including existing and emerging ones,” said Sishir Panta, an entomologist. “We must make our surveillance measures robust, strengthen health facilities, impart training to health workers and prevent the spread from imported cases.”

Experts say multiple factors hinder Nepal’s effort to achieve malaria elimination target—open and porous border with India, from which thousands of people enter every day. Malaria remains one of major public health problems in India. It is estimated that India carries 1.4 percent of global malaria burden and 0.9 percent of global malaria deaths.

“Thousands of Nepali people go to India for work and return home during the festive season.

“Imported malaria cases of malaria could rise after Dashain and Tihar festivals [in October],” said Panta. “Testing should be carried out at entry points and in communities.”

Of the total imported cases, over 80 percent have come from India. Experts say elimination in Nepal is unlikely until malaria is controlled in India. Some cases were imported from African countries. Nepali security personnel serving in UN peacekeeping missions in conflict-hit African countries have also tested positive for malaria.

“It is not easy to eliminate the deadly disease without curbing imported cases,” said Panta.

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

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

Several other factors, including cuts in the health budget from 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 in Nepal lack entomologists, who play a crucial role in surveillance.

Unlike in the past, when malaria was concentrated in Tarai districts, a large number of cases are now being reported from hill and mountain districts such as Mugu, Bajura, and Humla, which were considered non-endemic in the past.

Apart from this, isolated indigenous cases of malaria have emerged as a major challenge. Officials admit that single indigenous cases of infection have been reported from several places, and tracing the source of infection is difficult.